Dr. Gurpreet Singh Padda says hidden diabetic nerve damage drives falls

For Falls Prevention Awareness Week, Dr. Gurpreet Singh Padda of Regenerve says neuropathy that causes no symptoms can still undermine balance and independence. The St. Louis clinic is pushing earlier testing and fall-risk evaluation for people with diabetes, especially those whose nerve damage has gone unnoticed.

Why it matters: - Roughly 40% of people with diabetes develop peripheral neuropathy, and as many as half of those cases produce no symptoms. - Silent nerve damage can still weaken balance, increase fall risk and reduce independence before a patient notices a problem. - Dr. Gurpreet Singh Padda argues that falls risk should be treated as a metabolic issue, not only a geriatric one.

What happened: - Dr. Gurpreet Singh Padda, MD, MBA, MHP, who leads Regenerve in St. Louis, used Falls Prevention Awareness Week to highlight the link between diabetic neuropathy and falls. - He said lost sensation in the feet can create a mechanical emergency long before pain appears. - Dr. Padda said many patients can stand still in a clinic but remain unsafe on stairs or at night at home.

The details: - Balance depends on sensory feedback from the feet, including pressure, position, texture and the timing of heel strike. - When protective sensation declines, the body compensates with a wider, more cautious gait and greater dependence on vision. - That compensation can fail in low light, on stairs, on uneven ground or during an unexpected stumble. - Insulin resistance impairs skeletal muscle protein synthesis, and type 2 diabetes accelerates age-related loss of muscle mass and muscle power. - Dr. Padda said recovering from a stumble is a power task measured in fractions of a second, not a strength task. - Vitamin D insufficiency can compound the muscular side of the problem. - Regenerve begins evaluation with on-site electrodiagnostic testing, including nerve conduction studies and needle electromyography. - Those tests help determine whether a nerve is compressed, metabolically injured or both, and how much protective sensation remains. - Care can include balance and gait training, durable medical equipment, wound care, peripheral or vagal nerve stimulation, endoscopic decompression when entrapment is present, photobiomodulation and infusion therapy. - Regenerve also treats the home environment as part of the clinical picture, including lighting, thresholds, stair rails and bathroom transfers. - Dr. Padda said grab bars and lighting are not lifestyle advice for a patient who cannot feel the floor. - Regenerve describes itself as a physician-led peripheral neuropathy clinic in St. Louis led by Dr. Padda, a board-certified pain physician. - The clinic says its care targets metabolic, autoimmune, nutritional, structural and toxic causes of nerve damage.

Between the lines: - The message is that fall prevention starts before a patient reports pain, numbness or tingling. - A symptom check can miss patients whose nerve damage is already changing gait and stability. - The clinic is trying to shift the conversation from reaction after a fall to detection before the first major injury.

What's next: - Regenerve appears focused on earlier identification of neuropathy, more specific fall-risk assessment and home-safety changes for patients with diabetes. - The clinic is likely to keep linking nerve testing with rehabilitation and environmental adjustments rather than treating falls as an isolated event.

The bottom line: - In people with diabetes, hidden nerve damage can quietly raise fall risk long before a patient feels pain.