Diabetes Forecast

A Sneaky Complication: Peripheral Arterial Disease

Watching out for peripheral arterial disease

By Erika Gebel, PhD ,

It may not be at the top of your "complications I hope to avoid" list, but peripheral arterial disease (PAD) is serious—and worth getting familiar with. Not only can PAD severely reduce your quality of life by making moving around difficult; it is a sign that you are at even greater risk than others with diabetes for a heart attack or stroke. People with diabetes are at increased risk for PAD—1 in 3 people over the age of 50 with diabetes may have it—but there are effective ways to prevent and treat it.

Why PAD Is Bad

PAD is a circulation problem caused by atherosclerosis, a buildup of fats, cholesterol, and other debris along the interior walls of arteries. You are probably familiar with atherosclerosis as a risk factor for heart attacks; that's when it occurs in the arteries leading to the heart. Yet when atherosclerosis clogs the arteries of the legs or, less commonly, the arms, it can constrict blood flow to the legs, feet, or hands.

Sometimes PAD has no symptoms; people with diabetes who are over 50 should get screened for PAD once every five years. Those under 50 should be tested if they have PAD symptoms or additional risk factors including smoking, overweight, lack of exercise, high blood pressure, blood lipid imbalances (such as high LDL cholesterol and triglycerides), cardiovascular disease, and family history of heart attacks or strokes.

PAD is commonly diagnosed through a test called the ankle-brachial index, or ABI. The test measures the ratio of blood pressure in the ankle to that in the arm. A low ratio means blood flow to the legs is sluggish. A weak pulse in the legs can also signal PAD. For a look into the arteries, doctors can inject a special dye (a procedure called angiography) to monitor blood flow and identify narrowed arteries.

Circulation problems can cause poor healing of sores, which may lead to severe complications like gangrene and even amputation. These problems can be exacerbated by neuropathy,
the nerve degeneration associated with poorly controlled diabetes. Furthermore, if atherosclerosis is found in the legs, there's a good chance the arteries near the heart and brain are feeling the squeeze, too, increasing the risk of heart attack and stroke.

Best Defenses and Good Offenses

Here are some ways to ameliorate PAD:

Move. A painful leg cramp is disheartening when you're trying to get some exercise. That is the catch-22 of PAD; it causes pain that may keep people from one of the best ways to alleviate the disease: exercise. Treating PAD will often focus on keeping its symptoms under control so people can engage in physical activity. A recent study found that people with PAD who participated in a supervised walking program increased their endurance and quality of life more than both a group that did strength training and a control group that didn't exercise.

Medicate. A doctor may also treat PAD by prescribing medications that lower cholesterol, reduce blood pressure, and prevent blood clots. Such meds can combat the atherosclerosis that's causing PAD, while also reducing heart attack and stroke risk. Some PAD medications, like cilostazol (Pletal), can increase blood flow to the limbs by preventing blood clots and increasing the width of blood vessels, reducing pain felt during exercise. Quitting smoking is also important, of course, as is eating a heart-healthy diet and keeping blood glucose under control.

Monitor. Keeping a close eye on your feet is important for most people with diabetes, but it is critical for those with PAD. The poor blood circulation in PAD may keep wounds from healing and increase the risk of infection. You should treat your feet kindly to prevent sores and check them regularly to keep wounds from deteriorating. At the first sign of trouble, contact your doctor.

More. In some cases, a doctor may recommend angioplasty or bypass surgery. In angioplasty, a tiny balloon is passed into an affected artery and inflated to hold the artery open, improving blood flow. Bypass surgery for PAD involves using either a synthetic tube or a blood vessel from elsewhere in the body to create an alternate path for blood to flow around the
atherosclerotic blockage.

Learning about yet another diabetes complication may seem discouraging, but knowing about PAD can help you take steps to detect and treat it, preserving your mobility—and your health.



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