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Diabetes and Vascular Health: Understanding the Connection
Author: Prasad Katta, MD
Specialty: Endocrinology
Most people would be surprised to learn that dry, cracked feet could possibly lead to loss of use of a limb—maybe even amputation. For a diabetic, the slightest wound can become dangerous. In fact, the vast majority of toe and foot amputations performed in the U.S. each year are related to complications from foot wounds in people with diabetes.
At some point, most diabetics will develop some diabetic peripheral neuropathy – a loss of sensation in the feet. This means diabetic patients may develop sores and other foot problems without realizing it.
With diabetes, the body cannot properly convert sugar from food into energy, causing sugar levels in the blood to rise. Normally the body changes sugars, starches, and other foods into glucose. Then insulin (a hormone produced in the pancreas) changes glucose into energy. With diabetes, there is a lack of insulin or resistance to insulin, resulting in higher than normal levels of sugar in the blood.
Most diabetics die of stroke or heart attack—both of which are vascular in nature. The major blood vessels (macrovascular) serve the heart, brain and limbs. The minor blood vessels (microvascular) serve the eyes, kidneys and arteries to nerve endings. Damage to blood vessels may take the form of partial or complete blockage in the vessel. This obviously impairs blood circulation, which can lead to many problems.
The wound-healing process, for example, depends on good circulation of blood throughout the body. This is why a foot wound can become a chronic wound that refuses to heal. In addition to painless wounds (due to lack of sensation), diabetics are more prone to infection.
Infections for diabetics may start with a small thing. Walking barefoot when you have callouses or cracks in your feet is an opportunity for infection. This can be an infection on the skin, which is a soft tissue infection, or it can develop into a bone infection, which is more serious. Infections can also follow any surgical procedure. A diabetic must be carefully monitored after surgery.
A diabetic patient particularly benefits from a multidisciplinary team of physicians. Prevention is the first step. A primary care physician will keep track of a patient’s “numbers”—blood pressure, cholesterol, and blood sugar levels. This physician will monitor and help the patient control these important health indicators.
But when a problem arises, a team of specialists, such as an endocrinologist, a diabetes educator, a physical therapist, a podiatrist, a wound care specialist and, when needed a vascular surgeon, will provide the best care. With each specialist bringing their knowledge and experience to the case, the best treatment plan can then be created for a patient.
Some may be surprised to see a physical therapist in this group, but physical therapy plays an important role in healing. If, for example, a patient has lost mobility for a period of time, the leg muscles can weaken or atrophy. Without physical therapy, the chances of regaining the ability to walk are greatly hindered.
Prevention of diabetes is best, but if unsuccessful, managing diabetes is critical. This includes monitoring blood sugar levels and understanding which foods impact those levels. Regular exercise is also important and to enable that, vigilant foot care is critical.
A diabetic should perform foot exams regularly and any cuts or bruises—especially those not healing in a timely manner—should be seen by a doctor. Foot care should also include:
Improving blood circulation and minimizing the risk of infection are goals of a diabetic’s treatment plan. Controlling diabetes now can help maintain long-term health and independence.
Posted January, 2020