Peripheral Vascular Disease in Diabetic Patients

People suffering from diabetes are prone to various foot conditions. The two main conditions that are responsible for foot problems are Peripheral Vascular Disease (PVD) and Peripheral Neuropathy (PN). We will look at PVD in this article

People who have diabetes are prone to various foot conditions. The two main conditions that are responsible for foot problems are Peripheral Vascular Disease (PVD) and Peripheral Neuropathy (PN). We will look at PVD in this article

What is PVD?

It is a disorder of blood circulation that leads to the narrowing of blood vessels outside of your heart and brain. As the blood vessels become narrow, the blood flow to the body parts decreases. According to research, PVD is 20 times more prevalent in people with diabetes than in non-diabetic people. In diabetic people, prolonged high blood sugar level raises the risk of developing PVD. Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Other risk factors that may cause PVD are smoking, obesity, inactivity, and high cholesterol levels.

What are the symptoms of foot problems in diabetes?

One of the first symptoms of PVD is cramping leg pain during walking. Most commonly, this affects your calf muscles. However, it can occur in the thigh or hip muscles too. Some also experience pain in the toes, while sleeping.

As the disease progresses, leg or feet pain occurs even when you are not walking. Changes in the skin, including decreased skin temperature, thin, brittle, shiny skin on the legs and feet, and hair loss on the legs are noticed. Weakness or heaviness in the limbs or thickened and discolored nails are observed more often.

Another symptom of PVD is the small cuts or abrasions on the feet, especially on the pressure points that do not heal quickly.

PVD can eventually become a severe problem if not treated timely. It can lead to the development of foot ulcers and gangrene and may require amputation of the leg.

How is PVD diagnosed?

Diagnostic tests can include:

  • Ankle Brachial Pressure Index (ABPI): This method evaluates the blood supply to your feet by comparing it with the blood pressure in your both arms.
  • Treadmill Exercise Test: This test combines the ABPI with a treadmill test. The ABPI is done before and after you walk on a treadmill.
  • Duplex Ultrasound: It is a non-invasive investigation that uses a probe and jelly on the skin to look inside your leg and give a picture of your blood vessels.
  • Angiography: In this test, a dye is injected into the blood vessels, and then x-rays are taken to see the blood flow through the blood vessels. Other imaging techniques can also be used like Magnetic resonance angiography or CT Scan.

What is the treatment for PVD?

Treatment and management of PVD may include:

  • Lifestyle changes to control risk factors, including regular exercise, proper nutrition, and quitting smoking
  • Postural corrections while standing, sitting, and sleeping
  • Managing risk factors, including smoking, high blood pressure, and diabetes
  • Diabetic medications to lower the blood sugar level
  • Anti-platelet drug (prevents forming blood clots inside the blood vessels)
  • Peripheral vasodilators (relaxes/expand the blood vessels and increase the blood flow)

Invasive therapy:

For some people with severe vascular disease, invasive treatment such as balloon angioplasty or stent insertion may be considered. Bypass graft would also be an option.

Complications of PVD

Complications most often occur because of decreased or absent blood flow. Such complications may include:

  • Amputation (loss of a limb)
  • Poor wound healing
  • Restricted mobility due to pain or discomfort
  • Severe pain in the affected extremity
  • Stroke (3 times more likely in people with PVD)

Prevention of PVD

To prevent PVD, take steps to manage the risk factors. A prevention program for PVD may include:

  • Quit smoking, including avoidance of second-hand smoke and use of any tobacco products
  • Dietary changes include reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
  • Weight loss
  • Limiting or quitting alcohol intake
  • Medicine to reduce your risk for blood clots, as determined by your healthcare provider
  • Exercise 30 minutes or more daily
  • Control of diabetes and high blood pressure

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