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Diabetes Complications: Peripheral arterial disease

Peripheral arterial disease is far more common in persons with diabetes, than in nondiabetics. In the beginning, the blood flow to the muscles is adequate at rest. But when the person walks, the blood supply becomes inadequate, giving rise to pain in calves, which is relieved by slowing the speed of walking or by halting. When the blood supply is poor, the person gets pain in legs or feet, even at rest, and the foot may become cold, blue, red or pale. A part of the foot or the leg may suffer a local death or gangrene when the blood supply is markedly reduced.

It is now possible to assess, the blood flow in the lower limbs by means of noninvasive technique like Doppler test. After injecting a special dye, x-ray picture of the arteries of the lower limbs can be taken.

With the help of such pictures, the site or sites of obstruction to the blood flow can be established and an overall blood flow below the level of the obstruction can be assessed.

It is absolutely essential to stop consuming tobacco when there is a disease of the blood vessels of the limbs. Care of the feet is of vital importance.

It is now possible to improve the blood supply of the lower limbs by bypass surgery or by angioplasty, provided the large vessels are occluded. Many a limb, which would have been amputated, has been salvaged by the advances in surgery of blood vessels of the lower limbs.

An amputation, that is removal of a part of a limb, becomes imperative when the part cannot be salvaged. The amputation is carried out at a level compatible with good healing of the stump and the functional capacity of the remaining part of the limb. Soon after an amputation, the person understandably, gets some degree of depression, hopelessness and anxiety. An amputation need not mean an end of active life. The patient should try to develop the potential of the remaining parts of the body to the maximum. The remaining joints of the limb should be kept flexible and shoulder muscles should be strengthened. The patient should participate in a rehabilitation programme. The stump is shaped to fit the artificial limb. In the first few weeks after the operation, some patients are aware of the amputated limb-phantom limb - and may even get pain in it. Replacement of the leg is now possible; the actual design, the material of the replacement, depend on the patient's needs. Standing up, shifting the weight in all directions, balancing on the false leg and walking have to be learnt in stages. The person should learn the care of the stump. Smoking should of course, be stopped. Care of the other foot is essential.

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Diabetes Complications: Peripheral arterial disease