For pain management, Belleville, the largest city in the Metro East and the seat of St. Clair County, is the longest drive we ask of any Illinois patient. It is around forty minutes to our offices in Missouri. Illinois licensure is no obstacle. Dr. Gurpreet Singh Padda, MD, MBA, MHP practices under it, and holds full staff privileges at Anderson Hospital in Maryville.
We are blunt about the distance because it should change what you expect from the visit. Say forty minutes each way buys you a slightly different pill and a follow-up in six weeks. Then the trip was not worth it, and we wasted your afternoon.
So the first visit from St. Clair County is packed. We do the exam and review the scans you already have. If the picture points at a nerve, we test it the same day, not at a third visit. The goal is that you leave with a cause, not a guess.
Burning feet at night. Numbness that started in the toes and crept up like a stocking. Skin that cannot bear a bedsheet. This is usually called diabetic neuropathy, and the label is where the thinking normally stops.
It should not. This kind of nerve injury starts years before a diabetes diagnosis. It starts in the long stretch when insulin is high and glucose still looks fine on a lab panel. Insulin is not just a key for sugar. It is a growth and inflammation signal. Kept high, it damages the vasa nervorum — the tiny vessels that feed the nerve itself. The nerve is not so much poisoned by sugar as slowly starved of blood. That is why symptoms so often come before the diagnosis. It is also why a normal fasting glucose is no comfort at all.
Under 12.2% of the general adult population was metabolically healthy by NHANES 2009–2016 criteria. On the tighter criteria used 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 do not just happen to show up together. They grow from the same soil.
Insulin resistance comes years before diabetes and hyperinsulinemia and chronic pain lay out how it works.
For years we treated the nerve and left the metabolism to somebody else. It was a tidy split. We handled symptoms, primary care handled the A1c, and everyone stayed in their lane. Patients got a stimulator or a membrane-stabilizing (nerve-calming) drug. A year later they came back with the same feet and a bigger waistline.
The lane was the problem. Treating the pain of a metabolic nerve injury while the cause runs free is managing an outcome and calling it care. We changed how we work because the results forced it, not because it was in fashion.
Electrodiagnostic testing sorts out which problem you have. It tells a metabolic neuropathy that starts in the longest nerves apart from a pinched lumbar root or a trapped nerve. It also catches small-fiber cases that a standard study can miss. Each needs a different treatment. They get mixed up all the time because they all cause burning in a foot.
Once the diagnosis is confirmed and conservative care has not held, peripheral nerve stimulation and spinal cord stimulation are options with real evidence in painful diabetic neuropathy. They turn down the pain signal. They do not repair the nerve, and we tell you that before you consider one, not after.
Lowering the insulin load is the only step that goes after the cause. It is not a lifestyle footnote tacked onto the real treatment — it is the treatment with the best claim on the outcome. Cutting acellular carbohydrate restores blood flow to the nerve. Patients report the burning easing before any weight comes off. That is the blood supply responding, not the scale.
We do this in-house through lifestyle medicine and medical weight management, alongside treatment for diabetic neuropathy itself. A Belleville patient is not sent to a fourth building for the part that matters most. Type 2 diabetes remission and what it does to chronic pain covers what you can achieve.
Our offices are 4477 Woodson Rd, St. Louis and 12174 Natural Bridge Rd, St. Louis. From Belleville there are two good routes. Take IL 15 west, then I-255 north to I-64. Or take IL 159 straight to I-64 west. Both then run north on I-170 toward the airport. Allow around forty minutes outside rush hour. The afternoon westbound rush is the one to plan around, so we book St. Clair County patients in the morning when we can.
On coverage: most major commercial plans and Medicare cross the state line without trouble. Illinois managed Medicaid and Illinois-only narrow networks are the ones to check. We verify benefits before you drive, not after you arrive.
Because glucose control and insulin load are not the same thing. Insulin can run high for years while glucose stays in range. It is the insulin signal that damages the small vessels feeding the nerve. Insulin resistance comes years before diabetes explains which tests to ask for.
Small fibers grow back slowly once the metabolic damage stops. That is why the cause matters more than the symptom drug. Long-standing large-fiber loss is a different story, 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 (the deep fat around the organs) acts like an immune organ. It releases inflammatory signals that make nerves more sensitive. That is why pain often improves before the scale moves much. Fat is an immune organ — that is why it hurts lays out the biology.
No, and you should not. Your primary care doctor or endocrinologist keeps managing your diabetes. What changes is that the metabolic cause stops being somebody else’s job while we treat the nerve. We share findings back instead of running a second plan. Why we treat insulin before we treat the joint explains the thinking.
Call us or request an appointment. See also our Illinois pain management page.
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