Avoid Treatment Delays: How to Discuss Your DPN Symptoms with Your Doctor

By Rebecca McKinsey

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, affecting as many as half of those living with the disease.

But in far too many cases, individuals with diabetes do not know about or recognize DPN, or medical professionals don’t ask about it or identify it early.

U.S. Pain Foundation’s “A Chronic Pain Crisis” survey, which surveyed 2,275 people living with pain in 2022, found that 64.2% of surveyed individuals with diabetes experienced related neuropathic pain, but fewer than 60% of those living with that pain had been diagnosed with DPN.

The consequences of not identifying DPN can be severe, and even deadly: loss of sensation caused by DPN can lead to unchecked wounds or injuries such as diabetic foot ulcers. Wounds that are not treated in time may lead to the need for amputations, and the physical and mental complications of these issues can increase the risk of death for those living with diabetes.

“What you can’t feel can hurt you,” says David G. Armstrong, DPM, MD, PhD, professor of surgery at University of Southern California’s Keck School of Medicine and founder and co-director of the Southwestern Academic Limb Salvage Alliance (SALSA). “People can wear a hole in their feet with diabetic peripheral neuropathy just like they can wear a hole in their shoe or sock. Bringing this up may save your leg and keep you alive.”

There’s a lot to cover in a brief diabetes checkup, says Gary Graf, ARNP, an endocrinology specialist with the Cotton O’Neil Diabetes and Endocrinology Center in Topeka, Kansas.

“Is your blood sugar under control, are you wearing your monitor, are you taking your insulin or oral meds? We always have to address other comorbidities—hypertension, dyslipidemia, weight reduction,” Graf shares. “We’re squeezing all of that into a 15-minute visit, and our patients may feel pressured to not make any more waves and not ask about pain.”

Still, much of the impetus is on patients to keep an eye on changing symptoms, bring up concerns, and make sure medical providers hear and address them.

“If you’re not your own advocate, nobody is,” says Dave Griffin, DPM, assistant clinical professor at Oregon Health and Science University in the Division of General Internal Medicine and Geriatrics.

Here’s how individuals with diabetes can ensure they’re identifying and bringing up their concerns—and how to get doctors to listen.

Knock your socks off

Questions about DPN, foot pain, or loss of sensation in the feet may go by the wayside during the chaos of a multifaceted medical appointment.

“DPN can sometimes come on so slowly that patients don’t even realize it and don’t talk about it,” Armstrong says. “Clinicians are good at responding to really urgent problems. What we’re not good at, or what we really have to work at, is responding to quiet things. This is slow, silent, and sinister—it creeps up on you.”

There’s a simple way to make sure concerns with your feet are addressed, Armstrong says: “Knock your socks off.”

At every appointment.

“You may think it’s weird to have the doctor walk in and you have your shoes and socks off,” Armstrong says. “But what that does is, it immediately brings their attention to your feet. Otherwise, they have so much to do that the foot is going to be 51st out of the 50 most important things on which to focus.”

Be specific: rather than just saying your feet hurt, share if you are experiencing loss of sensation, tingling, burning, sensitivity to touch, or electric shock-like feelings.

“Foot pain is not normal,” Griffin shares. “Tingling and numbness are not normal. Both of those should raise the red flag to say, ‘Something’s wrong.’”

Even if you are not experiencing painful symptoms, getting your feet examined at each annual appointment is still important if you have diabetes, says Robert Gabbay, MD, PhD, chief scientific and medical officer with the American Diabetes Association.

“Many people have no symptoms, but it is important that their health care professional checks their sensation at least yearly because of the potential risk for foot problems due to loss of sensation,” he shares.

Be sure to specifically ask your doctor if any existing foot problems could be related to your diabetes, Gabbay stresses.

He recommends writing down your questions and concerns ahead of the appointment to ensure you don’t forget anything and that all issues are addressed.

Ask about referrals

Most medical doctors only get about one hour of training related to the foot during their primary care training, Griffin says.

If you are concerned about DPN, you can ask your primary care physician about a referral to a specialist who can help further, such as a podiatrist or a diabetologist (an endocrinologist with a specialized focus in diabetes). Those specialists can help you address symptoms related to DPN within the larger context of treating your diabetes.

Additionally, seeing more than one provider when you are dealing with diabetes complications increases the likelihood that those complications will be identified and addressed.

“If you see a foot doctor along with one other member of your diabetes team—it could be a diabetologist or endocrinologist, a primary care physician, or a nurse practitioner—if you see those two each year, you reduce your risk for an amputation by anywhere from 20% to 80%,” Armstrong explains.