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Out on a limb: diabetes and PAD
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Out on a limb: diabetes and PAD

People with chronic diabetes are at higher risk of peripheral artery disease and its complications

Diabetics are more likely to develop peripheral artery disease and its complications.

When it comes to chronic diabetics, recurring foot cramps cannot be taken lightly. Though leg pain after strenuous muscular activities is common among many people, it could have a different vascular manifestation in people with diabetes.

The condition restricting blood flow to the legs due to arterial blockages in the lower limbs is called peripheral artery disease (PAD). Though common in the elderly, this condition could have an early onset among those with uncontrolled diabetes.

Dr Sanjay Chugh, director of cardiology and interventional cardiology, Aarvy Health Care Superspeciality Hospital, Gurugram explains that people with diabetes are more prone to this condition mainly because high blood sugar hastens cholesterol deposition. Comorbidities of diabetes like obesity and hypertension are also risk factors.

Four types of peripheral artery disease

Experts list four types of PAD

  • Asymptomatic peripheral artery disease. Here, the affected person won’t feel pain or cramps
  • Intermittent claudication. Occasional pain in calf muscles after mild exertion
  • Critical limb ischemia. The most common diabetic manifestation that could lead to gangrene and amputation
  • Acute limb ischemia. Caused by a sudden drastic interruption in blood flow. Lack of care could lead to amputation

The risk factors

People with diabetes could suffer from both peripheral artery disease and diabetic neuropathy (nerve damage due to diabetes) at the same time.

Diabetic neuropathy mostly affects nerves in the limbs; PAD could eventually lead to nerve damage. Because people with diabetic neuropathy cannot feel normal pain due to nerve damage, it makes timely diagnosis difficult.

Dr Nihal Thomas, a professor in endocrinology and head of Unit-1 at the department of endocrinology at the Christian Medical College, Vellore, Tamil Nadu, explains that restricted blood flow to the leg muscles and tissues can slow down the wound healing process in the legs of people with diabetes.

Dr Thomas says that in chronic diabetics, nerve damage could result in the deformation of toes; they could bend into a claw-like shape affecting normal body weight distribution on the feet, making people prone to corns and callosities (thickened skin).

“If the corn and callosities get bruised, you can get blood clot formation under the callosities that can pose the risk of infection. High blood sugar also reduces immunity further increasing the risk of infection,” cautions Dr Thomas. He also points out higher chances of infections like septicemia in such cases.


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Critical limb ischemia (CLI) and diabetes

Bengaluru-based diabetologist Dr Ashwitha Shruti Dass says that CLI is commonly diagnosed in those with severe and prolonged diabetic neuropathy caused by PAD. It leads to open ulcer wounds and gangrene in the affected limbs. She also adds that CLI could affect cardiac health because of a lack of proper blood supply.

Dr Dass adds that the lack of blood flow to the tissues could also increase the risk of amputations.

According to a research paper by Steven P Marso and William R Hiatt published in the March 2006 edition of the journal, American College of Cardiology, it was pointed out that diabetics had a higher risk of PAD; ischemic events were higher in diabetics with PAD than non-diabetic ones. It also recommended early diagnosis and treatment of PAD in diabetics to reduce the risk of cardiovascular complications.

Other symptoms

Dr Dass says when visible leg wounds don’t heal, doctors examine arterial pressure to rule out PAD.

Apart from leg pain, those with PAD may find one foot colder than the other. There could also be a discolouration of the skin. Some people with diabetic retinopathy might even feel no sensation in the limbs.

diabetes and PAD

PAD could also affect the hands

Dr Chugh explains that apart from leading to cardiac complications and restricted blood flow to the brain, peripheral vascular disease can also affect the hands.

According to the Centers for Disease Control and Prevention, though PAD could affect the upper limbs, it is more common in the legs than in the arms.

Medical intervention

Experts recommend invasive or non-invasive treatment for PAD depending on its severity. Arterial and venal doppler tests (soundwaves to scan arteries) can detect abnormal blood flow in the artery.

Dr Thomas suggests an ankle-brachial index test that compares the blood pressure in the ankle and arm to determine if there is any blood flow obstruction in the legs.

“Vasodilators (blood vessel dilators), antiplatelets (blood thinners) and painkillers are also used to treat PAD,” says Dr Chugh.

Dr Chugh explains that in some cases, revascularisation (restoring blood flow in blocked arteries) through stent or balloon angioplasty can bypass blockages.

Managing PAD naturally

Dr Thomas recommends offloading the diabetic foot to manage the condition. Offloading means keeping the affected foot off the ground so that pressure doesn’t affect the foot further.

Walking is an exercise experts suggest as it is a low-intensity activity. Dr Thomas points out that in cases where there are active symptoms like wounds on the legs, people can focus on working out the torso and upper limbs.

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