1) Diabetes and Glycemic Control: Diabetes is defined as either a) two separate-time >126 fasting blood glucoses; b) two separate-time random blood glucoses >200 or two 2-hour post-meal glucoses >200 (or one of each); c) a single measurement of HbA1c >6.5% (see below for explanation of HbA1c). While type 1 diabetes is treated with insulin, type 2 diabetes is treated with either insulin, pills, or a combination of both. Glycemic control is a term used to describe the level of blood sugar present. Glycemic control is measured as HbA1c, which is a percentage reflecting average glucose over a 3-month time period. In general, excellent glycemic control <115 fasting glucose, or <140 2-hour post-meal glucose, or HbA1c <6.5%.
2) Diabetic Complications: Poor glycemic control can lead to diabetic complications. Diabetes causes damage to small vessels (microvascular complications); this includes diabetic neuropathy (nerve damage), diabetic retinopathy (eye damage), and diabetic nephropathy (kidney damage). Diabetes can also lead to damage to large vessels (macrovascular complications); this includes damage to the coronary arteries (resulting in coronary artery disease), the brain (resulting in stroke), and the larger upper and lower extremities vessels (resulting in peripheral vascular disease). Based on several studies, it is felt that poor glycemic control or HbA1c > 6.5%, over time, will result in increased incidents of both microvascular and macrovascular complications.
3) Diabetic Neuropathy: Diabetic neuropathy can result from poor glycemic control. Initially, neuropathy symptoms consist of a loss of sensation in the upper and/or lower extremities caused by diabetic injury to nerves. On physical exam, there may be a loss of sensation to touch, pinprick, or vibration. As diabetic neuropathy progresses, this loss of sensation can predispose patients to chronic skin breakdown (ulceration) due to the loss of ability to perceive and react to injury.
Diabetes medical expert witness specialties include endocrinology, internal medicine, pediatrics, family medicine, retina vitreous ophthalmology, neurology, vascular surgery, podiatry, nephrology, critical care medicine, hospitalist medicine, pediatric hospitalist medicine, pediatric endocrinology, obstetrics, and maternal-fetal medicine.