Diabetes Self-Management Articles

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When Your Legs Ache
Peripheral Arterial Disease and Diabetes

by Joyce Malaskovitz, PhD, RN, CDE, and Susan Rush Michael, DNSc, RN, CDE

Cramping, pain, or tiredness in the legs when walking or climbing stairs — these may not sound like symptoms of a serious condition. In fact, many people believe that they are normal signs of aging. But they can be signs of peripheral arterial disease, a severe condition that can lead to gangrene and amputation if left untreated. So if you have these symptoms, be sure to tell your doctor.

Peripheral arterial disease (PAD) is a condition in which arteries leading to the legs and feet (or in some cases the arms) become clogged with fatty deposits called plaque, resulting in reduced or blocked blood flow to these areas. It affects between 8 million and 12 million Americans, and people with diabetes are more likely to develop PAD than the general population. PAD is also known as peripheral vascular disease (PVD), leg atherosclerosis, or simply poor circulation.

PAD and diabetes
Anyone can develop PAD, but people with diabetes, especially those with Type 2 diabetes, have a higher risk of developing it because of a series of bodily changes associated with diabetes, including insulin resistance, a higher level of blood fats, and an increase in blood pressure. All of these contribute to arteries becoming clogged with fatty deposits, leading to the hardening and narrowing of these blood vessels.

Having diabetes also increases the risk of developing neuropathy, or nerve damage, as a result of high blood glucose. Neuropathy can cause decreased sensation in the feet and legs, which can cause a person not to notice small injuries to the foot, such as blisters or cuts. If a person continues to walk on an injury, it is likely to enlarge and get infected.

The combination of PAD and neuropathy is particularly dangerous because when blood flow to the feet is reduced, the body has a harder time healing injuries to the feet and fighting infection. A wound that goes unnoticed and that the body cannot heal on its own may become severely infected and develop into an ulcer.

And that’s not all that can go wrong. If you have PAD, you may also have clogged blood vessels in your heart or brain, putting you at higher risk for heart attack and stroke. In fact, having PAD means there is a one-in-four chance that you will experience a heart attack, stroke, amputation, or even death in the next five years.

Warning signs and symptoms
One symptom of PAD that is hard to ignore is pain, which can occur in the legs, feet, or toes, and often interrupts sleep. Pain may also increase with walking and let up with sitting; this type of pain is called claudication. Sometimes it may not be actual pain, but rather a feeling of heaviness, tiredness, or cramping that occurs in the buttocks, thighs, or calves. The pain or discomfort can limit your ability to do everyday activities like shopping or going out with friends. Since PAD often interferes with activities that bring enjoyment, it can also take a mental toll by leading to feelings of isolation and confinement.

Another sign of PAD is that sores on the legs or feet heal slowly (longer than 8 to 12 weeks) or don’t heal at all. Feet may feel cold because of decreased blood flow. When this happens, you may notice that one foot or leg seems colder than the other, although sometimes both are cold. Cold feet can be a subtle sign; if you have a spouse, he or she may notice them more than you do, particularly when you sleep at night.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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