Curing Diabetes

Peripheral vascular disease is more common and occurs at a younger age in people with diabetes than in the general population. Among nondiabetic patients, far more men than women develop peripheral vascular disease. However, among those with diabetes, almost as many women as men develop it.Nondiabetic patients with peripheral vascular disease usually develop a single arterial occlusion in one leg and have normal collateral blood vessels. However, patients with diabetes usually develop several occlusions in both legs and have poor collateral circulation.

In patients who have diabetes and peripheral vascular disease, hyperglycemia, uncontrolled hypertension, or other factors can lead to atherosclerotic changes in the peripheral arteries. These changes may include capillary basement membrane thickening and increased platelet adhesion. They may lead to arterial occlusion, which diminishes the oxygen supply to the tissues, and subsequent muscle tissue ischemia and pain. Unfortunately, the diabetic patient’s poor tissue perfusion and impaired small vessels may reduce her ability to develop good collateral circulation to bypass the occlusion.

If your diabetic patient has hyperlipidemia, she’s at even greater risk for developing peripheral vascular disease. If she smokes, she’ll experience further compromised circulation. Smoking increases the progression of atherosclerosis by increasing LDL and triglyceride levels and decreasing HDL levels. It also raises the blood pressure, which can damage the arterial endothelium. The nicotine in cigarettes induces vasospasm and increases blood viscosity and clotting factor concentrations, which helps diminish arterial circulation.

If peripheral vascular disease is untreated, your patient may develop infections or even gangrene in her legs, which may lead to amputation. More than half of all nontraumatic amputations of the lower leg are caused by peripheral vascular disease in patients with diabetes.

Filed under: Chronic Complications