Venous disease and diabetes

Lynette Lacock discusses how venous disease is linked to diabetes and how to prevent future complications.

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What is venous disease?

Venous disease is any condition that affects the veins in your body. Veins are flexible, hollow tubes that are part of the circulatory system that moves blood through your body. The different types include: blood clots, deep vein thrombosis (DVT), superficial thrombophlebitis, chronic venous insufficiency, varicose and spider veins, venous ulcers, and arteriovenous fistulas.

Unfortunately, these conditions are familiar complications to millions of people who have unmanaged diabetes. The vascular system is negatively impacted by diabetes when it’s uncontrolled. This can result in poor circulation, deep vein thrombosis or clots, venous stasis, and varicose veins particularly in legs.

Why are people with diabetes susceptible to varicose veins?

You may have seen someone with varicose veins. They appear as lumps near the surface of the skin with a darker or bluish colour. This is actually enlarged vein walls that have become weakened over time due to the inability to push the blood back up toward the heart. This is caused by poor circulation and malfunctioning valves in the veins. Besides its distinctive appearance, it can be very uncomfortable, resulting in heavy aching legs and possible ulceration.

In diabetes, the risk of developing varicose veins is heightened for several reasons:

• Altered circulation: Over time, uncontrolled high blood glucose can damage the blood vessels. As the vessels become worse, the valves start to malfunction due to the increase venous pressure leading to stretching of the veins causing them to become varicose.
• Overweight and inactive lifestyle: Did you know that when you walk, your leg muscles help the blood defy gravity and pump it back up toward your heart?

 Unfortunately, the reverse is also true, inactivity helps gravity keep the blood in your lower extremities. Excessive weight puts pressure on the venous system making it harder to circulate the blood which compounds the problem.

• Altered sensation due to neuropathy: Due to the decrease in sensation when you have peripheral neuropathy, you may be unaware that your legs are tight and sore. Therefore, you may not realise you have a problem until you start seeing the varicose veins or other problems appear.

Venous insufficiency in those with diabetes

When the venous system continues to malfunction, it’s called venous insufficiency. When the valves in the veins are damaged the condition becomes chronic. Chronic venous insufficiency can cause complications, such as swelling of the lower extremities and venous ulcers. Once ulcers appear, there is an increased risk of infection.

• Delayed wound healing: Due to compromised circulation in people with diabetes, injuries and wounds will take longer to heal and are more prone to infection because of the delay in healing.
• Chronic increased venous pressure: Obesity and a sedentary lifestyle can make circulation worse. Venous stasis can lead to complications because it starts to damage tissue in the area.
• Complications of diabetic neuropathy: Having peripheral neuropathies makes it difficult to feel when something isn’t right. This delay in addressing a problem early can lead to complications that require a longer treatment.
• Immune system weaker: Spikes in blood glucose or uncontrolled blood glucose can have negative effects on your immune system making it harder for the body to fight off infections. Having varicose veins only makes it harder to fight off infections due to venous stagnation.

What is a deep vein thrombosis?

A deep vein thrombosis (DVT) is a clot deep in the vein that can become a life-threatening condition if the clot travels to the lungs causing a pulmonary embolism (PE). Therefore, it’s essential to be aware of the symptoms to seek early treatment.

The symptoms include a warm, red, swollen and painful extremity.  Should you develop any of these symptoms, you should see your healthcare provider immediately.

People living with diabetes have an increased risk of DVT due to the following reasons.

1. Increase in thickness of blood: Higher blood glucose levels can make blood more viscous and increase clotting factors, leading to an increased risk of clot formation.
2. Obesity and inactive lifestyle: Obesity and diabetes slow down the circulation in the lower extremities. This greatly increases the risk of developing a DVT.
3. Chronic systemic inflammation: Chronic inflammation is often present in people with diabetes due to prolonged high blood glucose levels and insulin resistance. This inflammation can damage blood vessel walls and increase the risk of clot formation.
4. Vascular cellular damage: When the blood glucose spikes or remains elevated the endothelial lining of the vessels gets damaged. This damage produces inflammation in the vessels making the chance of a clot formation higher.

How to prevent venous disease if you have diabetes?

There are measures you can take to prevent early onset or the severity of venous disease.

1. Stable blood glucose: Unstable and fluctuating blood glucose can cause inflammation and damage to your vessels and decrease circulation. Therefore, you must maintain a stable blood glucose level by taking your medications, eating correctly, and checking your blood glucose regularly.
2. Maintain a healthy weight: Exercise and follow a healthy diet to maintain an optimal weight and prevent inflammation and added pressure on leg veins.
3. Compression stockings: Compression stockings can help prevent blood from pooling in the lower extremities which can prevent a DVT. Discuss using stockings with your healthcare provider. You may need to be fitted for these stockings or you may not be a candidate for stockings if you have peripheral neuropathy.
4. Keep fit and active: Maintaining physical fitness can go a long way in preventing the development and progression of venous disease. Speak to your healthcare provider about which exercises are best for you. Keeping your leg muscles fit and strong will help push the blood back to your heart preventing venous stasis.
5. Avoid inactivity: Don’t stand or sit for long periods at a time as this will cause swelling and pressure in the legs. Changing positions often, elevating your legs, and lower leg exercises can prevent venous stasis.
6. Foot-, wound- and skin- care routine: Examine your skin for cracks or ulcers and signs of varicose veins regularly. See a podiatrist every six months to have your nails trimmed and feet examined. See your healthcare provider with any signs of infection or DVT as soon as possible to prevent complications.

References

1. usaveinclinics.com
2. veinspecialists.com
3. pmc.ncbi.nlm.nih.gov
4. https://veincenter.doctor/chronic-venous-insufficiency-diabetes-mellitus/