Diabetes Self-Management Articles

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Diabetic Leg Pain and Peripheral Arterial Disease

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

You may already take medicines that can help reduce your risk of PAD, such as diabetes drugs, cholesterol-lowering drugs, and blood-pressure-lowering drugs. In addition, your doctor may prescribe an antiplatelet drug to decrease the risk of developing clots in your blood vessels.

There are several surgical options for the treatment of PAD. One, with which many people are familiar, is an angioplasty. This procedure is often used when there is a blockage leading to the heart, but it can also be done for PAD. To perform it, a doctor inserts a small tube with a balloon at its end into the affected artery. The balloon is inflated, opening the narrowed area. Sometimes a stent, a tiny wire mesh tube, is inserted to keep the artery open. Another procedure that can be done is an artery bypass. This surgery, too, is commonly performed in the heart, and is often used when the blockage is more complete and cannot be opened by an angioplasty. In this procedure, a blood vessel is taken from another part of the body and reattached around the blocked section of artery.

A more recently developed treatment is plaque removal. In this procedure, a small tube is inserted into the affected artery, and a tiny rotating blade is used to shave plaque from the artery wall as the doctor advances the tube through the artery. This is generally not a possibility if an artery is nearly or fully blocked.

Risk factors
What can you do to reduce your risk of developing PAD? The first step is to know the risk factors. Some that you cannot change include the following:

  • Your age. Simply being over the age of 50 increases your risk of PAD.
  • Having diabetes. One in four people over the age of 50 with diabetes has PAD.
  • Your ethnicity. African-Americans are twice as likely to have PAD as Caucasians. Hispanics are also at increased risk for PAD.
  • Your personal history. If you have had vascular disease, a stroke, or a heart attack, you have a one-in-three chance of developing PAD.

You are also at risk if you have a family history of heart disease or diabetes.

There are also some risk factors that you can modify through lifestyle changes, including these:

  • Diabetes control. Keep your HbA1c level (a measure of diabetes control over the past two to three months) within the target range that you and your doctor have established. The American Diabetes Association recommends an HbA1c level of below 7%, or as close to normal as possible.
  • Smoking. If you smoke or have a history of smoking, your risk of developing PAD is multiplied by four. Smoking is one of the biggest, and most avoidable, risks for developing PAD. Even if you already have PAD, you can halt or even reverse the progression of the disease by stopping smoking. So if you smoke, find a way to quit!
  • High blood pressure. The established blood pressure goal for individuals with diabetes is below 140/80 mm Hg. Numerous lifestyle measures can help you lower your blood pressure, including making dietary changes such as reducing your sodium intake; engaging in regular physical activity; losing weight if you’re overweight; learning and practicing relaxation techniques such as meditation or guided imagery; and keeping your alcohol intake moderate. If these steps are not enough, your doctor may prescribe one or more blood-pressure-lowering drugs
  • High blood cholesterol. If your LDL (low-density lipoprotein, or
    “bad”) cholesterol is higher than 100 mg/dl, you have a greater risk of developing PAD. Know your cholesterol numbers, and ask your doctor for a copy of your lab test results so that you can track your progress. Many of the lifestyle changes that help lower blood pressure are also good for cholesterol levels. It may also help to meet with a dietitian for specific advice on food choices. If necessary, your doctor may recommend that you take a medicine to increase your HDL (high-density lipoprotein, or “good”) cholesterol and decrease your LDL cholesterol level.
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