I am 23 years old and have had type 1 diabetes for 20 years. I believe I am starting to experience symptoms of neuropathy with numbness and tingling of the feet. The nurse practitioner I see for diabetes care always asks if I experience any numbness or tingling and when I answer that I do experience these, nothing really comes of it. I really think that I should get it checked out before it becomes any worse, but I’m not sure what kind of physician/specialist to see about it. What do you suggest?

With 20 years of diabetes, it is hard to prevent the development of some neuropathy. The kinds of things that need to be screened for are the lack of sensation on the feet. If you can’t feel the monofilament fiber the doctor uses to screen your sensation in your feet, you might be a risk for a foot ulcer and amputation. Some neuropathy involves the autonomic nervous system. It is also called the “automatic nervous system” because it is responsible for carrying out functions that are automatic to our daily function. They include things such as sweating, blood pressure control, bowel motility, bladder emptying, and sexual function. The fact that you feel some numbness is not necessarily a sign that these things will happen to you. However, if you lose your sensation in your feet so that you cannot feel when a blister comes up or you have an ulcer and don’t know it is there, it puts you at risk for amputation. This is preventable by compensating for the loss of sensation by frequent visual inspection of your feet. Make sure you get a mirror or make sure you can look on the bottoms of the feet, especially over those areas that are responsible for distributing the weight from your foot bones. Some of this foot care is provided by a podiatrist. However, just talking with your physician will give you additional information about how to address your particular situation. Finally, keep working on those blood sugars.

JTL