Circulation in the Diabetic Patient

August 26, 2010
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Patient’s recently diagnosed with diabetes are often encouraged to visit a Podiatrist for a complete lower extremity exam, but the reason for this evaluation is unknown to the patient! Podiatrists have expert knowledge in understanding the lower extremity in addition to the affects that diabetes can take on the body, and we will evaluate you and identify risk factors for increased complications in the short and long-term. As we discussed last week, diabetes is an autoimmune disease that stimulates an increase in blood sugar levels if not managed correctly. The first complication we see in the diabetic population, relative to the lower extremity, is a loss of sensation in the feet, or diabetic neuropathy. In last weeks blog, we mentioned that prevention is most important in managing this complication, and this same ideal goes with this weeks discussion on circulation to the lower extremities in the diabetic patient.

When it comes to circulation, the complications that present themselves to anyone, but especially the diabetic patient with diabetic induced neuropathy becomes the decreased flow, and subsequently decreased healing potential in the lower extremities. The circulatory system in our bodies, beginning with the heart, carries blood, oxygen and thousands of growth factors out to the organs of our body supplying nutrition to those areas. When blood flow out to the extremities decreases, as it often does in the diabetic population, healing potential deceases because those nutrients can longer reach the affected areas. Thus, with neuropathy, if an injury to the soles of the feet goes unnoticed and blood flow to that area is compromised, healing to the site of injury becomes very difficult!

Decreased circulation in the diabetic patient comes from the root of all evils: uncontrolled blood sugar levels. Long-term, uncontrolled blood glucose levels induce damage on the arteries of the body, particular the peripheral arteries (those farthest from the heart) through weakening of the vessel walls. Weakening creates strain on the vessels and often leads to their thickening or collapsing in efforts to overcome that strain. In addition, co-morbidities often seen in the diabetic patient, including high blood pressure and high cholesterol, increase damaging risks to the vessels. These other medical issues induce atherosclerosis, which is a fancy way of saying “narrowing and hardening” of the vessel walls, making it more difficult for blood to flow easily down to the feet.

At your Podiatric appointment, in addition to checking the sensation in your lower extremities, your circulation will be evaluated. If pulses are easily palpable and there are no open wounds, at that point in time you’re good to go! However, if the pulses are difficult to feel, if your feet are a little cooler than your legs and if blood flow into the toes is slowed, it will be explained to you that circulatory issues are presenting themselves. It may be that your Podiatrist will order lower extremity arterial (blood flow) studies to evaluate your flow in addition to evaluating your healing potential so that a baseline of your circulatory status can be noted. It certainly isn’t the end-all, be-all to have circulatory issues, but it simply means that you need to be more careful and as we discussed in relation to diabetic neuropathy, prevention of further circulatory issues is the best possible scenario!

The ways in which you can prevent circulatory complications are many, but first and foremost include controlling your blood glucose levels to prevent weakening of the peripheral arteries. Next, you can decrease your risks by following up with your primary care physician regularly for management of your co-morbidities such as your high blood pressure and high cholesterol. Take medications prescribed to you as directed to lower the risk of complications by these associated medical issues. In addition, maintaining a good exercise routine, even if its 30 minutes of walking three times per week, helps increase blood flow and efficiency of the heart. (Of course, speak with your doctor before starting any exercise routine.) Finally, protect your feet! Wear shoes at all times and check the soles of your feet and in between your toes daily. Catching an opening in the skin early on significantly increases your chance of healing that wound, as the longer it goes unnoticed, the longer it will take to heal.

Next week, we will discuss the biomechanics of the feet, relative to diabetes and what you can do to decrease pressure areas that lend themselves to ulceration!

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