Belleville is the largest city in the Metro East and the seat of St. Clair County, and it is the longest drive we ask any Illinois patient to make — around forty minutes to our offices in Missouri. Illinois licensure is not an obstacle here: Dr. Gurpreet Singh Padda, MD, MBA, MHP practices under it, and holds full staff privileges at Anderson Hospital in Maryville.
We are candid about the distance because it should change what you expect from the visit. If the outcome of forty minutes each way is a slightly different tablet and a follow-up in six weeks, the trip was not worth making and we have wasted your afternoon.
So the first visit from St. Clair County is built to be dense: examination, a review of imaging you already have, and where the picture points at nerve, objective testing on the same day rather than at a third appointment. The aim is that you leave with a mechanism, not an impression.
Burning feet at night. Numbness that started in the toes and crept upward in a stocking distribution. Skin that cannot bear a bedsheet. This is usually described as diabetic neuropathy, and the description is where the thinking normally stops.
It should not. Nerve injury of this kind begins years before a diabetes diagnosis, during the long stretch when insulin is high and glucose still looks respectable on a panel. Insulin is not merely a glucose key; it is a growth and inflammatory signal, and sustained elevation damages the vasa nervorum — the microscopic vessels feeding the nerve itself. The nerve is not being poisoned by sugar so much as slowly starved of its blood supply. That is why symptoms so often predate the diagnosis, and why a normal fasting glucose is no reassurance at all.
Under 12.2% of the general adult population was metabolically healthy by NHANES 2009–2016 criteria, and on the tighter criteria applied after 2021 the figure is under 7%. In our own chronic pain population the figure is under 1% — practice-reported figures from our own population, not trial outcomes, and individual results vary. Pain and metabolic disease are not two conditions that happen to co-occur. They share a substrate.
Insulin resistance comes years before diabetes and hyperinsulinemia and chronic pain set out the mechanism properly.
For years we treated the nerve and left the metabolism to somebody else. It was the tidy division of labor: we controlled symptoms, primary care controlled the A1c, everyone stayed in their lane. Patients got a stimulator or a membrane-stabilizing drug and came back a year later with the same feet and a worse waistline.
The lane was the problem. Treating the pain of a metabolic nerve injury while the driver runs unopposed is managing an outcome and calling it care. We changed how we work because the results demanded it, not because it was fashionable.
Electrodiagnostic testing distinguishes a length-dependent metabolic neuropathy from a compressed lumbar root, from an entrapment, and from the small-fiber presentations that a standard study can miss. Those are different problems with different treatments, and they are routinely confused because they all produce burning in a foot.
Where the diagnosis is confirmed and conservative measures have not held, peripheral nerve stimulation and spinal cord stimulation are options with real evidence in painful diabetic neuropathy. They modulate the pain signal. They do not repair the nerve, and we will tell you that before you consider one rather than after.
Lowering the insulin load is the only intervention that addresses the driver, and it is not a lifestyle footnote appended to the real treatment — it is the treatment with the best claim on the outcome. Reducing acellular carbohydrate restores nerve blood flow, and patients report the burning easing before any weight is lost, which is the circulation responding rather than the scale.
We do this in-house through lifestyle medicine and medical weight management, alongside treatment for diabetic neuropathy itself, so a Belleville patient is not being sent to a fourth building for the part that matters most. Type 2 diabetes remission and what it does to chronic pain covers what is achievable.
Our offices are 4477 Woodson Rd, St. Louis and 12174 Natural Bridge Rd, St. Louis. From Belleville the two sensible routes are IL 15 west then I-255 north to I-64, or IL 159 to I-64 west directly; both then run north on I-170 toward the airport. Allow around forty minutes outside peak. The afternoon westbound peak is the one to plan around, so we schedule St. Clair County patients in the morning wherever the diary allows.
On coverage: most major commercial plans and Medicare cross the state line without trouble. Illinois managed Medicaid and Illinois-specific narrow networks are the ones worth checking, and we verify benefits before you drive rather than after you arrive.
Because glucose control and insulin load are not the same measurement. Insulin can run high for years while glucose is held in range, and it is the insulin signal that damages the small vessels supplying the nerve. Insulin resistance comes years before diabetes explains what to ask to be tested for.
Small fibers regenerate slowly when the metabolic insult is removed, which is why the driver matters more than the symptom drug. Long-standing large-fiber loss is a different proposition and we are straight about which one you have. Type 2 diabetes remission and what it does to chronic pain covers what changes and what does not.
The weight is a marker; the fat tissue itself is the actor. Visceral fat behaves as an immune organ, releasing inflammatory signals that sensitize nerves directly, which is why pain often improves ahead of any meaningful change on the scale. Fat is an immune organ — that is why it hurts sets out the biology.
No, and you should not. Your primary care physician or endocrinologist keeps managing your diabetes; what changes is that the metabolic driver stops being treated as somebody else’s department while we treat the nerve. We share findings back rather than running a parallel plan. Why we treat insulin before we treat the joint explains the reasoning.
Call (314) 481-5000 or request an appointment. See also our Illinois pain management page.
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