Diabetes and Peripheral Arterial Disease (PAD)

Diabetes and Peripheral Arterial Disease (PAD) - People with diabetes have a high risk of developing PAD. Learn what PAD is and how you can manage it. What You Need To Know About Diabetes And Peripheral Arterial Disease (PAD). You probably know that diabetes affects the blood vessels supplying the brain and heart. This raises your risk for stroke and heart attack. But this insidious disease can also block the arteries in the legs. This leads to a painful condition called peripheral arterial disease, or PAD. About one in three people with diabetes over the age of 50 also have PAD.

PAD can be disabling. Leg pain can keep you from getting activity that can help manage diabetes and reduce your heart disease risks. Fortunately, PAD symptoms can be treated. Symptoms also signal your doctor to check for problems in the blood vessels of the heart and brain.

What is PAD?

Someone has PAD when the plaque builds up along the artery walls in the legs. Plaque is made up of fat, cholesterol and other substances in your blood. The buildup of plaque causes arteries to harden and narrow. Hardened and narrowed arteries make it hard for blood to travel to organs and other parts of the body. If arteries in the legs become narrowed with plaque, this is a sign that other arteries in the body may be clogged as well. When arteries near the heart and brain become clogged, a heart attack or stroke can occur. People who have PAD also have a high risk of having a heart attack or stroke.

What Are the Symptoms of PAD?

It's important to recognize the symptoms of PAD and report them to your doctor. Pain and discomfort are not a normal part of aging. Symptoms may include:

• Pain in the leg, hip or buttocks when walking or exercising. The pain may disappear after resting for a few minutes. This is called intermittent claudication.
• Tired or weakness in the legs.
• Numbness, coldness or tingling in the legs and feet.
• Sores or infections on your feet that do not heal easily.
• Tissue death (gangrene) in the legs and feet.

Sometimes PAD does not have any symptoms. If you have diabetes and any of the above symptoms, let your doctor know right away.

How is PAD diagnosed?

Only your doctor can diagnose PAD. Tests to diagnose it include:

• Ankle-brachial index (ABI) test. This is the best test to see if you have PAD. It compares the blood pressure in your legs to the blood pressure in your arms to see if blood is flowing well. If the blood pressure in your legs is lower than it is in your arms, you may have PAD. The American Diabetes Association advises that people with diabetes over the age of 50 have an ABI test to see if they have PAD.
• Angiogram. Dye is injected into your blood vessels and then an x-ray is taken to see if arteries are blocked.
• Ultrasound. Images of your blood vessels are shown on a screen using sound wave technology. A doctor can tell if blood vessels are blocked by looking at the images.
• Magnetic resonance imaging (MRI). A body scan shows if blood vessels are blocked.

Tips to Help Manage PAD

PAD can be managed through lifestyle changes and with medication. You can do the following to help lower your risk factors for PAD:

1. Stop smoking. Check with your doctor to learn about programs that can help you quit. Smoking is a major risk factor for PAD.
2. Exercise. Talk to your doctor before you start an exercise program. Walking and doing leg lifts may be good exercises for people with mild PAD.
3. Eat a healthy diet. Many people with PAD and diabetes also have high cholesterol. Limit saturated fat, trans fat and cholesterol in your diet to help lower your cholesterol levels.
4. Keep your hemoglobin A1c levels below 7 percent. An A1c test measures what your average blood sugar level has been over the past 2 to 3 months.
5. Keep your blood pressure under 130/80 mm Hg. Your doctor may prescribe you a medication to help lower blood pressure.
6. Keep your LDL cholesterol below 100 mg/dL or the goal that your doctor has set for you. Your doctor may prescribe you a medication to help lower cholesterol levels.
7. Ask your doctor about taking daily aspirin therapy. Daily aspirin therapy may help cut the risk of heart attack and stroke in people with PAD. But, it's not right for everyone.
8. Medications to increase the blood flow to the legs and ease pain may also be prescribed.
9. Surgery to open up the blood vessels in the legs (such as bypass or angioplasty) may be an option if other treatments don't help.

Read also: How Diabetes Affects Your Feet

References

• Aronow WS, Ahn C, Weiss MB, Babu S. Relation of increased hemoglobin A1c levels to severity of peripheral arterial disease in patients with diabetes mellitus. American Journal of Cardiology. 2007;99(10):1468-1469.
• Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. British Medical Journal. 2006;332(7540):521-525.
• Beckman JA, Libby P, Creager MA. Peripheral arterial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Saunders; 2007.
• American Heart Association. Peripheral artery disease (PAD).