See a Diabetic Neuropathy Doctor in Los Angeles

Patients walking on the beach after seeing a Painful Diabetic Neuropathy Specialist
Painful Diabetic Neuropathy Specialist Dr. Michael Lalezarian
At ProVascularMD, we provide cutting edge care for painful diabetic neuropathy. Browse our educational resources to learn more about conditions, symptoms, diagnosis, and treatment.

When you’re ready to see a diabetic neuropathy doctor, we’re here to help. Dr. Michael Lalezarian is double-board certified Vascular and Interventional Radiologist at ProVascularMD that specializes in neuromodulation procedures for painful diabetic neuropathy. Dr. L is a committed partner in the battle against diabetes and its many complications. He values spending quality physician time with his patients to address their needs and concerns, and assisting them on their journey to better health.

ProVascularMD Review Score for Diabetic Neuropathy care

“Dr. L changed my life. He’s knowledgeable, caring and my experience with his office staff was as good as it gets. I wish all of my doctor visits felt this way. After a few pregnancies I was having incredibly painful varicose veins that was really wearing on me. The treatment was practically painless and I’m so happy with my results. He’ll be my vascular doctor moving forward.”

Michelle H, February 2022

ProVascularMD credentials with UCLA David Geffen School of Medicine
ProVascularMD credentials with American Medical Association
ProVascularMD credentials with American Board of Radiology
ProVascularMD credentials with Society of Interventional Radiology
ProVascularMD credentials with Alpha Omega Alpha Honor Medical Society

About Painful Diabetic Neuropathy

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Overview

Diabetic neuropathy is a condition in which nerves in the arms, hands, legs, feet, and other regions of the body are damaged by chronic, uncontrolled diabetes. The word “neuropathy” is used in medicine to describe disease or dysfunction of peripheral nerves (nerves in the arms and legs), and “diabetic neuropathy” describes when nerve dysfunction is caused by diabetes.

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Pain

Damage to peripheral nerves can cause numbness, loss of sensation, and pain signaling even when there is no identifiable source of pain. Pain signals originate in the peripheral extremities and are communicated to the spine. From the spine, the signals are integrated and sent to the brain where they are processed and perceived.

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Progression

Neuropathy develops slowly, worsening over the course of several years. Nerve damage is often felt first in the feet and later in the hands. From the extremities, symptoms typically spread evenly up the legs and the arms. Diabetic neuropathy is also the most frequent complication of diabetes, impacting 60% to 70% of individuals with the disease at some point during their lifetime.

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Causes

The root cause of diabetic neuropathy is chronically high blood sugar levels. If left uncontrolled, high blood sugar damages many major systems in the body, and the nerves are no exception. Neuropathic pain patterns in the feet, hands, legs, and arms are predominantly caused by nerve damage in the affected regions, impairing nerve signaling to and from the brain. Three groups of nerves are affected by diabetic neuropathy: sensory nerves, motor nerves, and autonomic nerves.

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Complications

One of the biggest challenges of living with diabetic neuropathy is loss of sensation, especially in the feet. Pain signals help us avoid injuries and detect when something is wrong, but individuals with diabetic neuropathy are often unable to feel when they’ve stepped on something sharp, when they have a blister, or when they’ve developed an ulcer. Diabetes also impairs healing, so minor injuries can become major problems if left untreated.

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Comorbidities

Between 20-30% of people with diabetes also have peripheral artery disease (PAD). In addition to nerve damage, diabetes also causes inflammation, atherosclerosis, and hardening of the arteries, causing poor blood circulation in the legs. PAD presents many challenges on its own, but insufficient blood flow and constricted arteries can also impair the body’s ability to heal injuries and fight infections, making the complications of diabetic neuropathy even worse.

Symptoms of Painful Diabetic Neuropathy

Sensory nerves, motor nerves, and autonomic nerves may be affected by diabetic neuropathy, leading to several distinct diabetic neuropathy symptoms.

Sensory neuropathy pain caused by diabetic neuropathy

Sensory Neuropathy

The most common diabetic neuropathy symptoms include numbness or tingling in the toes or feet, prickly or sharp pain, burning, pinching, pins and needles, or an exaggerated sensitivity to touch. Over time, the hands may be affected, as well as the legs and the arms. Some individuals with sensory nerve damage are also unable to feel pain, temperature changes, or changes in pressure, or these sensations are dulled due to nerve damage.

Motor Neuropathy

Motor nerves are responsible for coordinating movements between your muscles and your brain. Diabetic neuropathy can damage motor nerves as well, causing muscle weakness, loss of muscle tone in the feet or legs, or loss of balance. Motor neuropathy can also lead to changes in the shape or structure of the feet, leading to areas of increased pressure.

Autonomic Neuropathy

Autonomic nerves are responsible for the body’s automated functions (respiration, digestion, heart rate, blood pressure, sweating). Diabetic damage to autonomic nerves can affect many of the body’s systems, but the most apparent symptom of autonomic neuropathy for diabetics is dry, cracked feet caused by damage to the nerves controlling the sweat glands.

Diagnosis for Painful Diabetic Neuropathy

A physical exam with basic sensory testing is often sufficient to diagnose diabetic neuropathy, but more extensive testing can help determine the nature and extent of the disease, including nerve conduction testing, electromyography, autonomic testing, biopsy, and imaging modalities like X-ray and CT.

Telltale signs of diabetic neuropathy include the loss of the ability to sense pain, light touch, temperature, vibration, or movement in the toes or feet. A loss or reduction of the Achilles tendon reflex is another telling sign of diabetic neuropathy.

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Physical Exam

Your physician will assess your overall muscle strength and tone, tendon reflexes, sensitivity to touch, pain, temperature and vibration.

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Filament Testing

A soft nylon fiber (monofilament) is brushed over areas of your skin to test your sensitivity to touch.

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Sensory Testing

This noninvasive test is used to tell how your nerves respond to vibration and changes in temperature.

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Nerve Conduction Testing

Nerve conduction testing measures how quickly the nerves in your arms and legs conduct electrical signals.

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Electromyography

Also called ‘needle testing,’ this test measures electrical discharges produced in your muscles.

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Autonomic Testing

Additional tests may be done to determine how your blood pressure changes while you are in different positions, and whether your sweating is within the standard range.

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Nerve Biopsy

This diagnostic procedure involves removing a small portion of a nerve to look for abnormalities.

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Skin Biopsy

A small portion of skin is removed to look for changes in nerve endings.

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Imaging

CT or MRI scan can look for anatomical abnormalities affecting nerves or blood vessels.

Treatment for Painful Diabetic Neuropathy

Treatment for painful diabetic neuropathy is often multi-faceted, consisting of blood sugar control, lifestyle interventions (diet and exercise), feet care to avoid injuries, and interventions to manage pain. At ProVascularMD, we provide spinal cord stimulator surgery to help you overcome debilitating pain caused by diabetes.

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Controlling Blood Sugar Levels

Diligently monitor your blood glucose levels and take diabetes medications as prescribed. Follow medical advice from your general practitioner or endocrinologist.

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Diet and Exercise

Healthier lifestyle habits are critical to getting diabetes under control and preventing complications. Diet and exercise can improve symptoms and slow the progression of diabetic neuropathy.

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Feet Care


Routine foot inspection is extremely important to prevent serious foot complications. Seek care immediately if you have an injury or sore.

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Pain Control

Medications may be prescribed to manage pain caused by diabetic neuropathy. Alternative therapies like acupuncture are often considered as well if conventional medicine is ineffective.

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Spinal Cord Stimulation

A spinal cord stimulator works by creating an electric field near the nerves along the spine. This electric field interferes with the electrical activity of the nerves that are involved with pain signaling to the brain. When the spinal cord stimulator is active, painful sensations are replaced with a mild tingling sensation. An important advantage of a spinal cord stimulator is that it can be personalized to your pain patterns and sensory preferences.

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