Diabetes very often gives complications to the legs. Lifetime problems with the legs occur in 25-35% of all diabetics. And the older the patient, the more likely they are to appear. Diseases of the feet in diabetes cause a lot of trouble to the sick and doctors. Diabetes hurts the legs - unfortunately, a simple solution to this problem does not yet exist. We'll have to go all over. And you need to be treated only by a professional doctor, and in any case not by "folk remedies." In this article you will learn what to do. The goals of treatment:
- Relieve pain in the legs, and even better - get rid of them completely;
- Save the ability to move "on your own two."
If you do not pay attention to the prevention and treatment of complications of diabetes on the legs, the patient may lose their toes or feet entirely.
Now the patient's legs do not hurt, because the operation to expand the lumen in the arteries improved the blood flow in them, and the foot tissue stopped sending pain signals
In diabetes mellitus, my legs hurt because atherosclerosis leaves a very narrow lumen in the blood vessels. Foot tissues receive insufficient blood, “choke” and therefore send signals of pain. Surgery to restore blood flow in the arteries of the lower extremities can relieve pain and improve the quality of life of a diabetic.
There are two main scenarios for diabetes foot problems:
- Chronically elevated blood sugar affects the nerve fibers, and they cease to conduct impulses. This is called diabetic neuropathy, and because of her legs lose their sensitivity.
- The blood vessels that feed the legs become blocked due to atherosclerosis or the formation of a blood clot (thrombus). Ischemia develops - oxygen starvation of tissues. In this case, the legs usually hurt.
Diabetic foot syndrome
Nerve damage due to elevated blood glucose is called diabetic neuropathy. This complication of diabetes leads to the fact that the patient loses the ability to feel touch on his feet, pain, pressure, heat and cold. Now if he hurts his leg, he won't feel it. Most diabetics in this situation have ulcers on the feet and soles of the feet, which heal long and hard.
If the sensitivity of the legs is weakened, then wounds and ulcers do not cause pain. Even if a dislocation or fracture of the foot bones happens, it will be virtually painless. This is called diabetic foot syndrome. Since patients do not feel pain, many of them are too lazy to follow the recommendations of the doctor. As a result, bacteria multiply in wounds, and because of gangrene, the leg often has to be amputated.
Peripheral arterial disease in diabetes
If the patency of the blood vessels falls, then the tissues of the legs begin to “starve” and send pain signals. Pain may occur at rest or only when walking. In a sense, if you have sore legs with diabetes, it is even good. Because the pain in the legs stimulates the diabetic to consult a doctor and go all out to heal. In today's article we will look at exactly this situation.
Problems with the blood vessels that feed the legs are called “peripheral arterial diseases”. Peripheral - means far from the center. If the lumen in the vessels is narrowed, then most often diabetes causes intermittent claudication. This means that because of the severe pain in the legs, the patient has to walk slowly or stop.
If peripheral artery disease is accompanied by diabetic neuropathy, the pain may be mild or even completely absent. The combination of vascular occlusion and loss of pain sensitivity dramatically increases the likelihood that a diabetic will have to amputate one or both legs. Because the leg tissue continues to collapse due to “starvation,” even if the patient does not feel pain.
What tests do if diabetes hurts
You must carefully examine your legs and feet daily, especially in old age. If the blood flow through the vessels is disturbed, then you will be able to notice early external signs of this. Symptoms of early-stage peripheral arterial disease:
- leg skin becomes dry;
- perhaps it will begin to peel off, combined with itching;
- on the skin may appear the fate of pigmentation or depigmentation;
- in men, the hair on the legs turns gray and falls out;
- skin can become constantly pale and cold to the touch;
- or vice versa, it can become warm and take on a bluish color.
An experienced doctor can touch by touch what a patient has a pulse in the arteries feeding the leg tissue. This is considered the easiest and most affordable method for detecting disorders of the peripheral circulation. At the same time, the pulsation on the artery stops or significantly decreases only when its lumen is narrowed by 90% or more. It is too late to prevent tissue starvation.
Therefore, they use more sensitive research methods using modern medical equipment. Calculate the ratio of systolic (“upper”) pressure in the arteries of the lower leg and brachial artery. This is called the ankle-brachial index (ABI). If it is in the range of 0.9-1.2, then the blood flow in the legs is considered normal. The pressure in the finger artery is also measured.
The ankle-brachial index gives unreliable information if the vessels are affected by Menkeberg's atherosclerosis, i.e., are covered with lime "scale" from the inside. In elderly patients, this is very common. Therefore, we need methods that give more accurate and stable results. This is especially important when the issue of surgery is solved to restore the vascular permeability so that the legs stop hurting.
Transcutaneous oximetry is a painless method that allows you to evaluate how well oxygenated tissues are. Transcutaneous means “through the skin.” A special sensor is applied to the surface of the skin that makes the measurement.
The accuracy of the test depends on many factors:
- condition of the patient’s pulmonary system;
- blood hemoglobin level and cardiac output;
- oxygen concentration in the air;
- the thickness of the skin to which the sensor is applied;
- inflammation or swelling at the measurement site.
If the value obtained is below 30 mm Hg. Art., then critical ischemia (oxygen starvation) of the leg is diagnosed. The accuracy of the transcutaneous oximetry method is not high. But it is still used because it is considered informative enough and does not create problems for patients.
Ultrasound of the blood supplying arteries
Duplex scanning (ultrasound) of the arteries of the lower extremities - is used to assess the state of blood flow before and after the surgical operations on the vessels. This method increases the chances that it will be possible to detect arterial occlusion by a blood clot or re-narrowing of the lumen in the vessels after surgery (restenosis) in time.
Ultrasound of the vessels allows to study problem areas, i.e., segments that are “turned off” from the bloodstream as a result of the development of the disease. With the help of this method, one can well examine the state of the vessels and plan in advance the course of the operation to restore their patency.
A recall of a patient with type 2 diabetes who had problems with his legs after the sugar in the blood supply improved ...
Posted by Sergey Kuschenko on December 9, 2015
X-ray contrast angiography
X-ray contrast angiography is a method of examination in which a contrast agent is injected into the bloodstream, and then the vessels are x-rayed. Angiography means “vascular examination.” This is the most informative method. But it is unpleasant for the patient, and most importantly - a contrast agent can damage the kidneys. Therefore, it is recommended to use it only when the issue of surgery to restore vascular patency is being decided.
Stages of development of diabetes complications in the legs
There are 3 degrees of impaired peripheral blood flow in patients with diabetes mellitus.
Grade 1 - no symptoms or signs of leg blood vessel disease:
- arterial pulsation is palpable;
- ankle-brachial index 0.9-1.2;
- finger-shoulder index> 0.6;
- the rate of transcutaneous oximetry> 60 mm Hg. Art.
Grade 2 - there are symptoms or signs, but there is still no critical oxygen starvation of tissues:
- intermittent claudication (sore legs);
- ankle-brachial index <0.9, with systolic pressure in the arteries of the lower leg above 50 mm Hg. v .;
- finger-hinged index 30 mm Hg. v .;
- transcutaneous oximetry 30-60 mmHg. Art.
3rd degree - critical oxygen starvation of tissues (ischemia):
- systolic pressure in the arteries of the lower leg <50 mmHg. Art. or
- pressure in the finger artery <30 mmHg. v .;
- transcutaneous oximetry <30 mmHg. Art.
What is the treatment if the feet are sick with diabetes
If your legs hurt with diabetes, then treatment goes in 3 directions:
- effects on factors that stimulate the development of atherosclerosis, including in the arteries of the legs;
- careful implementation of recommendations for the prevention and treatment of foot problems, which are discussed in detail in the article “Diabetic Foot Syndrome”;
- the decision of the question of conducting surgical operations to restore blood flow in the vessels
Until recently, at the stage of intermittent claudication, patients were prescribed pentoxifylline. But studies have shown that there is no real benefit for diabetics with peripheral arterial disease.
With complications of diabetes on the legs, surgery to restore blood flow in the vessels can be of great benefit. Doctors decide on its conduct with each patient, taking into account his individual indicators of the risk of surgical intervention.
Patients with sore legs with diabetes, as a rule, have pronounced disorders of carbohydrate metabolism (high blood sugar), diabetic foot syndrome, as well as manifestations of other complications of diabetes. In order to really help them, you need to involve a whole team of specialists in treatment.
The treatment of diabetic foot syndrome is a special podiatrist (not to be confused with a pediatrician pediatrician). First, you may need surgical treatment of wounds on the foot to prevent gangrene, and only then - to restore the patency of blood vessels.
Diabetes and leg complications: conclusions
We hope this article has explained to you in detail what to do if your feet with diabetes hurt. It is necessary to switch to a healthy lifestyle in order to normalize blood sugar and stop the development of atherosclerosis. With a doctor, you will be able to decide on a surgical procedure that will restore the patency of the leg vessels. You also need to be examined for other complications of diabetes and to treat them.
Please do not try to “muffle” pains from peripheral lameness with the help of some kind of pills. Their side effects can significantly impair your condition and life expectancy. Consult a qualified physician. In diabetes, it is important to carefully observe the hygiene of the legs, in order to maintain the ability to move “on foot”.
Read also articles:
- How to lower blood sugar and keep it normal;
- Treatment for type 2 diabetes is the most effective;
- How to make insulin shots painlessly.