Diabetes and Vascular Health: Understanding the Connection
Prasad Katta, MD
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
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:
- Wearing shoes and socks when walking, even indoors
- Following proper foot hygiene, carefully washing and drying the feet daily
- Having a podiatrist treat foot problems such as corns or calluses, rather
than treating them with over-the-counter remedies
- Be very careful of going to salons for pedicures; be certain to ask if
they use disposable instruments or if instruments are sterilized after each use
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