Diabetes mellitus is a polysymptomatic disease that can manifest itself in different ways in patients. However, there is a certain algorithm for the development of events. It all starts with an increase in blood sugar. In the absence of adequate treatment, many patients begin to develop signs of specific complications over time. One of the most common questions from people suffering from the “sweet disease” is: “Why do leg pain occur with diabetes?” To answer it, you need to understand the mechanism of development of the pathological process that leads to the formation of this symptom.
A constantly high level of glycemia has an extremely adverse effect on all organs and systems of the human body. Blood sugar is not as bad as its consequences. Glucose molecules have a damaging effect on blood vessels and nerve endings, which actually causes discomfort.
Important points that potentially influence the occurrence of pain:
There are 2 basic mechanisms for the occurrence of such unpleasant sensations in the lower extremities:
Both types of tissue damage are a consequence of hyperglycemia. Therefore, the main emphasis of therapy should be on its elimination.
Depending on the mechanism of development of discomfort, subjective symptoms will also differ.
In the case of an ischemic version of the problem, the patient will present the following complaints:
The severity of symptoms depends on the percentage of vascular blockage.
If the damage is neuropathic, the patient notes:
Treatment of both options in most cases requires surgical intervention if wound surfaces have already formed.
The main direction in the treatment of leg pain in diabetes mellitus remains normalization of glycemic levels. If you keep glucose in check, the blood vessels will not be exposed to its pathological effects. Depending on the type of disease, the complex of medicinal procedures may differ.
In type 1 diabetes, insulin must be used for life. Only such treatment can accurately prevent the development of unwanted complications.
With the 2nd type of “sweet disease”, it is necessary to take antihyperglycemic drugs, since the problem is not the amount of pancreatic hormone, but the resistance of peripheral tissues to its action.
In addition, there are special recommendations that are effective in treating both variants of the disease and are useful even for healthy people:
You can also use the knowledge of alternative medicine to relieve pain in the legs.
The following procedures and recipes have proven themselves to be effective:
Conduct a contrast shower for the feet once a day. 10 minutes of hot water and 3 minutes of cold. This treatment stimulates local blood circulation, which relieves pain.
Comfrey infusion. 1 tbsp. A spoonful of well-crushed root of this plant is poured into 1 liter of vodka. Leave in a dark place for 3 weeks. After the expiration date, filter and dilute with water to obtain 3 liters of liquid. Take 1 tbsp. spoon three times a day after meals.
Water vibration massage. A variety of aqua massagers work well. Like a contrast shower, they normalize local blood circulation and promote the restoration of sensitivity.
For topical use, a mixture of aloe juice and essential oils is perfect. To prepare it you need:
All these liquids are mixed and rubbed on the painful areas of the legs 3 times a day. The result appears after the 1st day of use.
The use of such methods of treating leg injuries is recommended if a consultation with the attending physician has been previously held.
Director of the Diabetes Institute: “Throw away your blood glucose meter and test strips. No more Metformin, Diabeton, Siofor, Glucophage and Januvia! Treat him with this. »
Persistent increases in blood sugar (glucose) levels can be associated with serious complications in people with diabetes.
Feet are particularly at risk. In people with diabetes, two complications called diabetic neuropathy and peripheral vascular disease can cause damage to the foot (and other parts of the body).
Chronically elevated sugar levels associated with uncontrolled diabetes can cause nerve damage, which interferes with the ability to sense pain and temperature. This so-called “sensory diabetic neuropathy” increases the risk that a person with diabetes may not notice problems developing in his or her foot.
About 10% of patients with diabetes develop leg ulcers, which are a consequence of peripheral vascular disease and nerve damage. People with diabetes may not notice sores or cuts on the leg, which in turn can lead to infection. Nerve damage can also affect the function of the foot muscles, leading to foot misalignment and injury.
Diabetes is associated with poor circulation (blood flow). Inadequate blood circulation increases the time it takes for wounds and cuts to heal. Peripheral vascular disease refers to impaired circulation in the arms and legs.
Poor blood flow increases the risk that the infection will not be cured. This, in turn, increases the risk of developing ulcers and gangrene, which is tissue necrosis and occurs in limited areas with poor circulation.
The following pictures depict the most common foot problems that can occur in any person. However, patients with diabetes have an increased risk of developing severe complications, including infection and even amputation.
A fungal infection of the foot is called athlete's foot. This disease causes cracked skin, itching and redness.
The fungus gets into cracks in the skin, causing an infection that must be treated with antifungal medications. Oral medications or topical creams can also be used to treat athlete's foot.
Thick, brittle, yellow-brown or opaque nails are a common symptom of fungal infection. The infected part may break off from the rest of the nail. The fungus loves the warm, moist, dark environment created by wearing closed shoes.
Damage to your nails also increases your risk of developing a fungal infection. Such infections are difficult to treat, but not impossible. Oral medications work well to treat fungal nail infections. Topical treatment is effective only for certain types of fungal infections. Sometimes surgery is necessary to remove infected areas of the nail.
Corns are areas of thickened skin that grow on the sole of the foot. The formation of corns can be caused by uneven weight distribution, skin pathologies or unsuitable shoes.
Having a few corns is not that bad. It is important to never try to cut them off as this can cause serious injury.
A callus is a thickened area of skin that forms between the toes or near the bony prominences of the toes. Calluses can cause pressure and friction.
Use the following tips to care for calluses:
Blisters are raised, fluid-filled areas of skin that form due to friction. Crushing or punching a blister is not the best way to treat it, since the skin covering the blister protects against infection.
To care for a blister, keep your skin clean, apply an antibacterial cream or ointment, and cover it with a bandage to reduce the risk of infection.
Hallux valgus is a painful, red, calloused area that forms on the outside of the big toe joint. This pathology can be observed on both feet and has a hereditary tendency to develop. Wearing uncomfortable high-heeled shoes increases the risk of developing hallux valgus by squeezing the big toes in an unnatural position.
Covering the deformation with a special pad helps protect it. Toe separators and other devices may be used to keep the thumb in the correct position. If hallux valgus is very painful or disfiguring, surgery may be used to relieve symptoms.
Dry, cracked skin allows bacteria and other pathogens to enter your body, potentially causing an infection. Moisturizing soaps, lotions, and other products can help keep the skin barrier soft, intact, and healthy.
Leg ulcers are dangerous sores that can occur in patients with diabetes. When a small scratch, skin break or wound on the foot becomes infected, an ulcer can form.
In people with diabetes, wounds heal very slowly or not at all. Early diagnosis and treatment are necessary to reduce the risk of complications. Your doctor is the best source of information about how to properly care for foot wounds.
Weakening the muscles of the toes contributes to the development of hammertoe deformities. This weakening shortens the tendons in the fingers, causing them to bend.
Hammer toes can be hereditary. In addition, this pathology can be caused by wearing unsuitable shoes. Toe deformities can cause problems such as corns, sores, blisters and difficulty walking. Corrective shoes and splints can help treat and correct hammertoes. Sometimes surgery is necessary to straighten the affected fingers.
Ingrown toenails get their name from when they grow into the skin along the edges of the nail plate. An ingrown toenail can cause pain and damage to the skin, which can lead to infection.
Wearing ill-fitting shoes increases the risk of developing an ingrown toenail. Intense exercise such as running and aerobics may contribute to this problem. Walking, squeezing your toes, and improperly trimming your nails can also cause this condition.
The best way to prevent ingrown toenails is to keep them trimmed. If an ingrown toenail becomes infected, professional medical treatment is necessary. Sometimes surgery is needed to remove the affected part of the nail and the growth zone from which it grows.
Thickened areas on the sole of the foot that have small black spots or pores are most likely plantar warts.
They are caused by a virus. The affected areas of the skin are painful and may appear alone or in groups. Treating plantar warts on your own is a bad idea. When in doubt, your doctor can determine whether the lesion is a corn or a wart.
Taking good care of your feet can prevent problems from developing before they start! Follow these tips to reduce your risk of developing frequent foot problems and serious complications associated with them.
Living with diabetes requires you to pay special attention to your health and illness. Follow your doctor's instructions about diet, exercise, and medications.
Keeping your blood glucose levels within the recommended range is the best thing you can do to control your condition and protect your legs.
Carefully inspect your feet for redness, blisters, sores, calluses, and other signs of irritation. Daily checks are especially important if you have poor circulation.
Diabetes mellitus and leg problems. Prevention tip No. 3
Follow these tips for proper foot care:
After bathing, use a pumice stone or a special device to smooth out thickened areas of skin on your feet (corns and calluses).
It is best to rub them in one direction. Talk to your doctor about the proper way to use pumice stones or foot rubs.
Follow these care tips to prevent the development of ingrown toenails:
Diabetes and foot problems. Prevention tip No. 6
Proper shoes, socks and stockings can help protect your feet. Follow these tips:
Diabetes mellitus and leg problems. Prevention tip No. 7
To keep blood flowing in your legs, follow these tips:
Quit smoking if you have this bad habit. Smoking worsens circulatory problems.
People with diabetes should visit a doctor (preferably a podiatrist) every 2-3 months, even if they do not have any problems with their legs. At each appointment, ask your doctor to carefully examine your feet. An annual foot examination should include:
To avoid such complications from diabetes, the patient should learn to independently check their feet every day for any signs of infection, wash their feet daily and apply an emollient cream to dry areas. To have good blood circulation, the patient must lead an active lifestyle, stop smoking, and remind the doctor to examine his legs at every visit. You can learn about proper and competent care from the article School of Diabetes Mellitus.
The disease is very insidious and you never know what will suffer first. Another big problem is that many doctors blame everything on diabetes and do not understand that a person fights for every centimeter of his body. It is not uncommon for a situation where a surgeon tells a diabetic that in your case it is better to amputate. I heard so many phrases like this, and after the first one, I walked on my own feet for about five years.
Doctors recommend that a patient who suffers from type 2 diabetes go for a check-up every three months. From time to time a full examination is necessary. This means taking blood pressure, examining your legs, neurological examination, ophthalmological examination. Blood glucose levels should also be measured regularly.
Long-term complications are: diabetic retinopathy (damage to the blood vessels of the eyeball), diabetic polyneuropathy (damage to the peripheral areas of the nervous system), diabetic nephropathy (kidney damage), atherosclerosis, and coronary heart disease.
People with diabetes should call their doctor if they experience headache, confusion, trembling, double vision, or dizziness. Calling a doctor is necessary, as these manifestations can transform into convulsions, loss of consciousness or hypoglycemic coma.
It is strongly recommended that people over 45 years old have their blood glucose levels checked every 3 years, and even more often if there is a family history of diabetes.
With diabetes mellitus, especially if the second type, atherosclerosis develops. Moreover, the older the age, the more severe the narrowing of blood vessels. With stenosis, a sufficient amount of oxygen and nutrients is not delivered to the lower extremities, so pain occurs, which proportionally depends on the size of the lumen of the vessels. It is important to perform stenting in case of stenosis of 50%. This will not only help get rid of pain, but will also allow the vessel to maintain the necessary lumen for many years.
There are two courses of development of complications.
The first course is dangerous because even the slightest microtrauma will go unnoticed, and weak immunity will lead to the development of an ulcer, the treatment of which will take a very long time.
Edema is a symptom of nephrotic syndrome and atherosclerosis. The syndrome disrupts metabolic processes in the body, and sclerosis impedes blood flow. Therefore, if your legs hurt and swell, you should immediately consult a doctor, since diabetes mellitus in its decompensated form progresses very quickly. Especially if you have type 2 diabetes, in which patients monitor their sugar levels once a week.
For edema, it is important to carefully follow a diet, do special exercises that will help alleviate the condition, and follow the prescribed treatment that will combat both the symptoms and the cause.
Causes of ulcer formation in patients with diabetes:
Prerequisites include:
The second most serious complication after a trophic ulcer. This disease is dangerous because it is detected in more than 80% of patients with diabetes mellitus who ignored the initial symptoms of the disease - swelling and pain. The result of severe and moderate cases is amputation. The level of amputation depends on the severity of the process and the depth of the lesion.
Treatment of feet for diabetes mellitus has no standards. The approach to each patient is individual, which means that the treatment and recommendations will differ, since the severity of the disease and concomitant diseases are different for everyone.
There are three areas that are considered basic:
If conservative treatment does not produce positive results or is no longer advisable, then the surgical method is used.
Unfortunately, patients seek help in the later stages, and therefore about 80% of ulcers develop into an inflammatory process that cannot be treated for a long time. Just like the treatment of diabetic foot, the treatment of ulcers can be conservative or surgical.
Conservative is the most strict, therefore it is often carried out in a hospital under the supervision of medical personnel, because diabetes mellitus is not a disease that can be stabilized on its own.
Complications of diabetes mellitus that result from the absence or improper treatment of the legs:
It is important to know that no treatment can replace a correct lifestyle. Even amputation of a limb is not the final stage if the patient does not comply with the doctor’s instructions. Another problem is that patients ignore the initial symptoms and come to the doctor with already advanced complications that require a radical solution.
In the initial stages, you can get by with self-massage and physical therapy, which will improve blood circulation and relieve pain. However, if you have existing symptoms (such as swelling or numbness), it is important to discuss any exercise and massage with your doctor, as this can only complicate the course of diabetes. In the absence of any prerequisites, it is still worth taking preventive measures; this will help not only improve the current condition, but also avoid serious problems in the future.
One of the most unpleasant consequences of this disease are complications of diabetes mellitus associated with the effect of high blood sugar on small vessels. For the patient, this means the risk of serious illnesses that greatly reduce the standard of living. That is why doctors insist that all patients maintain good compensation for diabetes, because this is the guarantee that complications will not develop.
Vascular complications of diabetes mellitus arise due to the fact that in patients, glucose from the blood quickly goes into the walls of small vessels, they lose elasticity, become clogged, and as a result, the tissues around them stop receiving oxygen and nutrients from the blood and slowly die. Of course, the smaller the diameter of the vessels, the faster they will bleed. The smallest vessels are found in the eyes, kidneys, feet and pancreas. What complications of diabetes arise from poor diet? In this case, there is a decrease in vision up to blindness, impaired blood circulation in the legs up to gangrene and impaired kidney function up to renal failure and self-poisoning of the body.
What other complications can occur with diabetes? Secondarily, the brain, liver and pancreas are affected. As a result, it stops producing insulin, and diabetes requires, in the case of type II diabetes, a switch from tablets to insulin, or in the case of type I diabetes, a significant increase in insulin doses.
A drug has been developed that prevents changes in the structure of dendritic spines, as a result of which neurological pain decreases.
Having identified symptoms of diabetes complications, the doctor prescribes treatment.
Neuropathy and microangiopathy are microscopic changes that are one of the main complications of diabetes, and they can cause great trouble for the patient. How to avoid this?
Here you can see photos of complications of diabetes mellitus on the legs - neuropathy and microangiopathy:
Microangiopathy in diabetes mellitus leads to the fact that the smallest wound or abrasion on the foot cannot heal on its own and threatens to turn into an ulcer. If larger vessels are affected, gangrene may develop, that is, necrosis of an area of the foot, most often one of the toes.
Nervous tissue is also capable of absorbing glucose from the blood; in addition, the nerve trunks are penetrated by tiny vessels, which become empty with constant decompensation of diabetes mellitus. Therefore, the nervous tissue no longer works as it should, and the diabetic's sensitivity decreases. In this case, neuropathy occurs in diabetes mellitus, in which at first night pain like a burning sensation and “goosebumps crawl” are disturbing. Then numbness of the legs develops from the toes to the knee. Also signs of neuropathy in diabetes mellitus are a decrease in temperature and pain sensitivity, the so-called “socks” or “stockings”. Thus, even if an ulcer appears, a diabetic may not feel pain and, if he does not regularly examine his legs, may not be aware of the presence of an ulcer. Also, if a patient has neuropathy of the legs due to diabetes, he can get a serious burn unnoticed, for example, by placing a hot heating pad in bed.
The same changes occur on the hands. Therefore, a diabetic needs to be careful in the kitchen or when ironing clothes. He may not feel the burn and be seriously injured.
Look at the photo of what leg ulcers look like with diabetes and find out how to treat them:
If there are ulcers on the legs in diabetes mellitus, the affected limb must be unloaded. For this purpose, special orthopedic shoes, a cast or a wheelchair are used. The ulcer is cleaned and ointment dressings are applied to it as prescribed by the podiatrist.
Your doctor or surgeon will tell you how to treat ulcers in diabetes mellitus. An endocrinologist helps achieve strict diabetes control, often through insulin therapy. Do not self-medicate under any circumstances!
Since an ulcer usually develops an infection, a course of antibiotics is given.
Vasodilators are used to restore blood circulation.
Strict compensation for diabetes is a prerequisite for recovery.
In case of gangrene, unfortunately, one has to resort to amputation.
After healing, you will likely need to wear orthopedic shoes.
In case of such severe complications of diabetes as ulcers and gangrene, you should not:
To prevent gangrene of the lower extremities in diabetes mellitus, it is necessary:
Also, to prevent gangrene in diabetes mellitus, intramuscular courses of vitamins should be administered twice a year to treat neuropathy. Undergo physiotherapeutic treatment. If you have decreased sensation in your legs, notify your physiotherapist before starting sessions.
In case of circulatory problems, take courses of blood circulation-restoring drugs prescribed by your doctor. Some of these drugs are contraindicated for fresh hemorrhages in the fundus, so before using them, you must be examined by an ophthalmologist.
Maintain strict diabetes compensation.
Treat other diseases that contribute to the appearance of ulcers: atherosclerosis, varicose veins, flat feet.
If there are fungal diseases of the skin or nails, they must be treated by a dermatologist. To avoid fungal foot infections, never use someone else's shoes. In the pool or sauna, wear rubber slippers that cover the entire foot.
Regularly, once or twice a year, examine your feet with an endocrinologist or, better yet, with a special doctor - a podiatrist.
Flat feet are not a consequence of diabetes, but they lead to the fact that shoes made for a normal foot become uncomfortable, abrasions occur, infection penetrates into them, and severe lesions occur. Therefore, a diabetic should be regularly examined by an orthopedist.
The bones of the foot are curved and form longitudinal and transverse arches, due to which the foot acts as a shock absorber. These arches are firmly tied together by ligaments and strengthened by muscles. The muscles of the back of the foot extend the toes, and the muscles of the plantar, which are much stronger, bend. With age or as a result of increased stress, such as pregnancy or increased weight, the ligaments weaken and the bones of the foot move apart. It becomes flat and is unable to function as a shock absorber.
If the ligaments of the forefoot are more loose, the bones of this section begin to shift relative to each other, as a result, the heaviest load begins to shift from the base of the big toe to the bases of the second and third toes, which are completely unsuited for this. At this point, a painful callus forms on the skin, which can turn into an ulcer in a diabetic. The plantar muscles begin to pull the big toe to the outer edge of the foot, it gradually displaces the second toe, and it rises up, creeping onto the big toe. Ulcers can also easily form in the interdigital space between the thumb and second toe with constant friction. On the inner edge of the foot at the base of the big toe, due to increased friction, chronic inflammation of the joint develops, then a painful bone grows in this place. Similar changes can be found in perhaps every third person over 50 years of age.
“Retina” translated from Latin means retina; "pathy" - pathology.
The surface of the eye by which we determine its color and on which the pupil is located is called the cornea. Directly behind the pupil is a small, clear lens. Next comes the vitreous body, the white part of the eye, and finally, in the very depths, there is the most important part of the eye - the retina. If we compare the eye with a camera, the retina is a light-sensitive photographic film on which the image is printed. Here are the endings of the optic nerves and many of the finest vessels that nourish the retina. It is with these vessels that misfortune occurs during decompensation of diabetes.
Hypertensive retinopathy is a complication of the eyes in diabetes mellitus, associated with changes in the retina during a long course of arterial hypertension. With hypertension, pressure increases in all vessels. Naturally, the thin and delicate vessels of the fundus suffer from this more than large arteries and veins. In the fundus, the ophthalmologist can see changes in the diameter of blood vessels, and even minor hemorrhages; in the later stages, the optic nerve is affected.
The diagnosis of hypertensive retinopathy in diabetics is made after examination by an ophthalmologist, ophthalmoscopy and fluorescein angiography.
Treatment of retinopathy in diabetes mellitus includes normalizing blood pressure with drugs that improve blood circulation and nutrition of the retina.
To prevent hypertensive retinopathy of the retina, good compensation for diabetes mellitus and blood pressure control are needed.
The symptoms of hypertensive retinopathy in diabetes mellitus are almost the same as those of diabetic retinopathy:
Here you will learn about the symptoms and treatment of diabetic retinopathy, a complication of diabetes in the eyes.
Even if the patient does not have any vision complaints, he needs to undergo a preventive examination - ophthalmoscopy at least once a year. The first changes in the fundus are noticeable only to the ophthalmologist, and treatment must begin as early as possible. The doctor examines the retina in the fundus through an ophthalmoscope and makes a conclusion about the condition of its blood vessels. To clarify the diagnosis, fluorescein angiography (retinal blood flow study) is used, which reveals bloodless areas, newly formed vessels, and thrombosis of retinal vessels. Optical coherence tomography identifies retinal lesions at the cellular level.
The first symptoms of diabetic retinopathy are:
At the first stage, the ophthalmologist sees only unevenly dilated vessels of the fundus. The most important treatment method at this stage is strict compensation of diabetes mellitus. As adjuncts to the treatment of diabetic retinopathy, doctors prescribe vasodilators, agents that prevent vascular thrombosis, antioxidant therapy, drugs that strengthen the vascular wall, and drugs containing microelements and vitamins necessary for the retina.
If compensation has not been achieved and the process continues, the blood vessels burst and the ophthalmologist sees hemorrhages. At this stage, doctors most often prescribe laser coagulation - cauterization of retinal vessels.
This procedure does not restore visual acuity, but protects against the development of further complications. If it is not carried out on time and the “torture” of the fundus of the eye with high sugars continues, scar tissue grows at the site of hemorrhages, which ultimately leads to blindness. This stage is called proliferative retinopathy, from the word “proliferation” - growth.
The best prevention of blindness due to diabetes is good diabetes control and regular eye exams.
Like the walls of blood vessels, the lens is capable of absorbing glucose, which reduces its transparency and, consequently, visual acuity. Cataracts are common in older adults in healthy people, but they can develop earlier and more quickly in diabetics.
Symptoms of cataracts in diabetes are:
The diagnosis of cataracts in diabetes mellitus is made during an examination by an ophthalmologist. To treat this complication of diabetes, surgical removal of the lens is performed. The operation is simple and easily tolerated by patients.
Glaucoma is a serious disease of the organ of vision, named after the greenish color that the dilated and fixed pupil acquires during an acute attack of glaucoma. The same is the nature of the second name of this disease - “green cataract”.
Today, glaucoma is a chronic eye disease characterized by increased intraocular pressure.
Glaucoma can occur at any age, starting at birth, but the risks increase significantly in older age. If the percentage of congenital glaucoma is only one case per 10-20 thousand newborns, and after the age of 45, primary glaucoma is observed in approximately 0.1% of the population, then in people over 75 years of age it develops in more than 3% of cases.
Symptoms of glaucoma: temporary blurred vision, seeing rainbow circles around light sources, attacks of severe headaches, followed by decreased vision.
The disease also often develops in old age. Glaucoma occurs more often and faster in diabetes; if the disease is not treated, it can lead to complete blindness.
Diagnosis of glaucoma in diabetes mellitus is carried out during an examination by an ophthalmologist with measurement of intraocular pressure. Treatment is prescribed medicinal or surgical.
To prevent glaucoma, you need good compensation for diabetes and examination by an ophthalmologist.
Below we describe what nephropathy in diabetes mellitus is and how to treat it.
The kidneys are known to filter the blood. The artery, entering the kidney, is divided into many small vessels. These vessels enter the renal glomeruli, where waste products and excess water are filtered from the blood, forming urine. If this process is disrupted, the body begins to poison itself. This is how one of the most dangerous complications of diabetes mellitus on the kidneys develops - diabetic nephropathy.
“Nephro” from Greek means kidney, “pathia” means disease.
The cause of nephropathy in diabetes is the same changes in the blood vessels: the wall of the smallest vessels becomes hard and porous, the filtration of urine from the blood is disrupted, gradually large protein molecules begin to fall into the formed pores, and, consequently, the usual protein composition of the blood is disrupted. It is increasingly difficult for the heart to push blood through hard and thrombosed vessels, and in order for the kidneys to work at least somehow, the body increases blood pressure. However, this increase in pressure, like a hammer, drives glucose and cholesterol into the walls of blood vessels, speeds up blood flow and interferes with normal filtration. Thus, a vicious circle is closed. At the last stage, kidney failure develops, that is, self-poisoning of the body.
The danger of this complication is that it develops quite slowly and does not cause discomfort in patients for a long time. The patient begins to feel unwell only in the last stages, when it is already difficult to help him. Therefore, even if you feel well, you need to undergo regular examinations and receive appropriate preventive treatment.
The earliest sign of diabetic nephropathy is the appearance of tiny protein molecules, microalbumin, in the urine. At this stage, treatment is most effective. Therefore, every diabetic should do this test at least once a year.
At a later stage, the presence of protein in the urine is determined by routine tests. An increase in blood pressure and kidney swelling develops - first on the face, and then throughout the body. At this stage, treatment can still be quite effective if carried out consistently and systematically, and not occasionally.
To treat nephropathy in diabetes mellitus and prevent the disease, it is necessary:
The main cause of pain in the legs is diabetes, which makes it possible to develop such a complication. The older a person with diabetes, the higher the risk of developing leg problems, which in the future cause a lot of trouble for both doctors and patients themselves.
Against the background of diabetes, atherosclerosis develops, which narrows the blood vessels and they cannot normally deliver blood to the lower extremities. As a result, the leg tissues do not receive the required amount of blood and oxygen and send pain signals that begin to greatly torment the diabetic patient.
If an operation is performed in time to restore the correct flow of blood flow in the arteries, this will help get rid of the further development of complications.
As diabetes progresses, leg pain can occur due to two scenarios:
In the first scenario, when the patient has lost sensitivity and cannot feel pain, heat or cold, if he accidentally injures his leg, he does not pay attention to it, because doesn't feel anything. A small wound on the foot can lead to ulcers that do not heal for a long time.
The manifestation of swelling of the lower extremities in diabetes may appear as a result of nephrotic syndrome, against the background of which regular swelling begins. Atherosclerosis, which clogs the walls of blood vessels and prevents normal blood circulation, can also be the impetus for swelling of the legs.
In this case, it is recommended that careful adherence to the diet, physical activity determined by the doctor, which will help stabilize the condition, and treatment aimed at ridding the patient of the cause of edema - atherosclerosis or nephrotic syndrome.
Leg ulcers in diabetes mellitus develop for several reasons:
In many cases, the active development of trophic ulcers against the background of diabetes mellitus is facilitated by:
The immediate precursors to the appearance of an ulcer are:
Signs of ulcers and stages of their development
A diabetic patient must carefully and closely monitor not only the level of sugar in the blood, but also the condition of the entire body and the upper skin. As we have already noted, complications noticed in time can be stopped at the very beginning and even bigger problems can be avoided.
In diabetes, an ulcer does not appear immediately, but as a result of long-standing complications in the body, which may appear after several years.
In this article you will learn more about skin diseases in diabetes http://pro-diabet.com/oslozhneniya/kozha-pri-saxarnom-diabete.html
Here is detailed information about gangrene of the lower extremities in diabetics.
Trophic ulcers, according to the stages of their development, can be divided:
1.Previous stage of ulcer manifestation:
3. Progressive stage of ulcer:
Treatment of ulcers in diabetes mellitus
Average statistical data from diabetologists indicate that more than 80% of patients with diabetes seek help with complications too late, when it is necessary to apply intensive treatment of ulcers, which does not always give the expected results.
All methods of treating ulcers can be divided into conservative, aimed at eliminating the cause of the ulcer, and surgical, a radical method used as the main or additional one.
The conservative method is used only with a doctor’s prescription and under his strict supervision; all contraindications and features of the course of diabetes mellitus are taken into account.
Program for conservative treatment of ulcers in diabetes mellitus:
Surgical program for the treatment of ulcers in diabetes mellitus:
If the treatment does not produce the expected results, then the scope of surgical treatment increases, up to and including amputation of the limbs.
Complications from ulcers in diabetes mellitus:
Depending on the severity of the disease, three directions developed by modern medicine can be used for treatment:
After trophic ulcers that develop against the background of diabetes mellitus, the second serious disease that occurs with diabetes is diabetic foot, in which pathological changes occur on the patient’s foot. The result of neglect and lack of treatment is amputation of a limb at any level.
This complication occurs in 90% of patients with diabetes who did not notice the initial signs of the development of the disease - pain in the legs, swelling.
Causes of diabetic foot syndrome
The development of a diabetic foot is a rather complex mechanism, which involves various processes of the body against the background of diabetes mellitus.
Long-term diabetes and regular surges in sugar levels lead to gradual destruction of blood vessels in all tissues of the body. It all starts with damage to small capillaries, and leads to global destruction of blood vessels, impaired circulation, death of nerve endings, failure of metabolic processes and skin damage.
When the skin is injured in a healthy person, the healing process occurs quite quickly, but in diabetes, when the movement of blood through the vessels is completely disrupted, minor injuries lead to serious consequences - ulcers, diabetic foot, and purulent processes are added.
Signs of diabetic foot
Symptoms of the disease may differ slightly depending on what form of the disease is already present:
Treatment of diabetic foot
Today there are two methods of treating this disease - conservative and surgical.
Conservative treatment method:
Surgical treatment of diabetic foot:
All developed programs and methods for treating leg pain will be ineffective if a patient with diabetes mellitus does not take independent steps to alleviate his condition.
Many doctors say that if all those suffering from diabetes noticed the beginning complications in time, many problems could be avoided with little blood.
For example, when a patient begins to feel even slight numbness in the lower extremities, increased leg fatigue and swelling, he should immediately consult a doctor and use home therapy, which consists of foot massage, an active lifestyle and physical therapy exercises. These methods will help restore blood circulation, improve the condition of blood vessels and get rid of pain.
Before starting moderate physical activity and using massage, you should consult a doctor who will develop an individual treatment program according to the characteristics of diabetes mellitus and the properties of your body.
And even if a patient with diabetes does not see any signs of complications, does not feel pain in the legs, there is no need to relax - take preventive measures to prevent the development of problems with the legs.
One of the reasons why legs hurt in patients with diabetes is diabetic angiopathy. It develops as a result of damage to small (microangiopathy) and large (macroangiopathy) blood vessels. The complication occurs against the background of incorrectly selected treatment or its absence. High levels of glucose in the blood, as well as sudden and repeated changes during the day, have a destructive effect on capillaries and large arteries.
As a result, glucose begins to intensively seep into the thickness of the walls of the blood vessels of the legs. It disrupts their structure and reduces permeability. The pathological process is accompanied by the accumulation in the walls of blood vessels of glucose metabolic products (fructose and sorbitol), which have the ability to accumulate fluid. The vascular walls filled with moisture swell, swell and thicken. Their lumen narrows sharply.
High glucose levels activate the process of thrombus formation. Blood clots forming on the walls of blood vessels further narrow the lumen and impair blood circulation.
Destroyed by glucose, the endothelium (the layer of cells lining the inner surface of blood vessels) loses the ability to produce a substance that regulates the width of blood vessels. Their narrowing can be so strong that blood circulation in the capillaries can completely stop. Blood vessels are more likely to break down in the lower extremities, which is why people with diabetes have leg pain.
Vasoconstriction is promoted by the atherosclerotic process, which occurs due to lipid metabolism disorders. Cholesterol deposits formed on their walls increase due to the proliferation of connective tissue. Due to a critical deterioration in blood circulation, tissues suffer from hypoxia (acute lack of oxygen).
Diabetic angiopathy is characterized by a feeling of numbness, coldness and “crawling goosebumps” in the legs. With severe narrowing of the lumen of blood vessels in the lower extremities, cramps and pain appear.
Pain in the legs in diabetes is so severe that it causes a person to limp. Pain syndrome usually occurs during movement, when tissues need additional portions of oxygen.
Legs hurt in diabetes when diabetic neuropathy develops. The complication is characterized by damage to the nervous system. The nervous system consists of nerve fibers collected in bundles, which are held together by a sheath of connective tissue (perineurium). The perineurium contains blood vessels that supply nerve fibers.
In diabetes mellitus, sharp fluctuations in blood sugar concentration are observed:
High levels of glucose in the bloodstream cause fructose and sorbitol to accumulate in nerve fibers, causing swelling. As a result, the nerve bundles partially lose their functions. Along with diabetic changes, the myelin sheaths that insulate the nerve fibers are destroyed. Because of this, nerve impulses are scattered and do not reach their final goal. Over time, the fibers atrophy and stop transmitting nerve signals. If diabetes mellitus is accompanied by high blood pressure, nerve cells may die as a result of spasm of small capillaries.
Leg pain in diabetes mellitus occurs in response to any minor skin irritation. Sometimes the patient may wake up at night from the pain caused by the touch of the blanket. Damage to nerve fibers usually occurs symmetrically on both lower extremities. Unpleasant sensations appear on the skin in the form of tingling, burning, and “goosebumps.”
Sometimes a sharp dagger pain pierces the legs. They reduce sensitivity. This condition is called sock syndrome. A person feels objects touched by his foot indistinctly, as if he were wearing socks. His lower limbs are constantly cold. Due to decreased sensitivity in the legs, the patient's coordination of movements is impaired. The lower limbs do not obey him. Restricted movement and poor blood circulation cause muscle atrophy. They lose strength and decrease in size.
Decreased sensitivity does not allow a person to feel pain in the legs when injured, or to feel a sharp or hot object. He may not notice an ulcer on his leg for a long time. This condition is dangerous to the patient's health.
Diabetic arthropathy develops against the background of neuropathy. Due to decreased sensitivity in the legs, a person is often injured. But bruises, sprains, micro-tears of ligaments and muscle fibers go unnoticed by them.
Due to lack of treatment, foci of inflammation occur in injured tissues. The small joints of the feet are predominantly affected. Pathological processes cause an increase in blood flow in bone tissue. Its consequence is the leaching of minerals from the bones. The pathology also progresses due to deterioration in the nutrition of the cartilage tissue of the joints, which occurs against the background of a decrease in the lumen of blood vessels.
Such leg diseases develop less frequently in type 2 diabetes than in type 1 diabetes. Features of the disease:
At the initial stage of the disease, swelling of the extremities in the joint area appears. The skin in this area turns red and becomes hot. Slight pain may be observed if the pathological process has not caused serious damage to the nerve fibers. With diabetic arthropathy, foot deformity is clearly visible. The patient suffers from frequent dislocations and fractures of the leg bones. Diabetic changes usually appear in both legs with little time difference.
Inflammatory processes are often complicated by the addition of a secondary infection, which provokes phlegmon and abscesses.
Metabolic disorders cause the development of dermatological diseases. Patients often develop brown spots on their legs due to diabetes. They are a sign of diabetic dermopathy. Round or oval lesions are covered with small flaky scales and do not cause discomfort to a person. For dermopathy, no treatment is prescribed.
Due to a violation of carbohydrate metabolism, spots with a coating may appear on the skin of the legs, the color of which varies from yellow to red or bluish. This disease is called necrobiosis lipoidica. The skin becomes very thin and vulnerable. As the disease progresses, painful sores may develop. Over time, they disappear on their own. A brownish stain remains in their place. Necrobiosis lipoidica is found mainly in patients with type 1 diabetes mellitus.
Peeling skin on the legs is a sign of diabetic atherosclerosis. They are covered with painful and difficult to heal wounds. Diabetic atherosclerosis can cause pain in the leg muscles.
Diabetic blisters are subcutaneous nodules. They resemble a regular burn. The disease goes away on its own without treatment after a few weeks.
With diabetes mellitus, yellow formations (plaques) may appear on the skin of the legs. They are a sign of xanthamatosis. Xanthomas can reach 2–3 cm in diameter. They appear as a result of lipid metabolism disorders and are lipid deposits.
Darkening of the skin around the joints of the legs may indicate acanthosis nigricans. It develops in patients with type 2 diabetes mellitus against the background of increased insulin resistance. In the affected areas, the skin thickens, itches and emits an unpleasant odor.
If signs of diabetes complications appear, you should consult a doctor. He will diagnose the disease, determine the stage of its development and tell you what to do in this case. If necessary, treatment will be prescribed.
Therapy is aimed at lowering blood sugar levels and preventing sudden spikes. Patients are prescribed meglitinides (Nateglinide, Repaglinide) or sulfonylurea derivatives (Gliclazide, Liquidon, Glimepiride).
Treatment of legs for type 2 diabetes mellitus is carried out with the help of drugs that increase tissue sensitivity to insulin. These include thiazolidinediones (Rosiglitazone, Ciglitazone, Troglitazone, Englitazone). To reduce the absorption of carbohydrates in the intestine, alpha-glucosidase inhibitors (Acarbose, Miglitol) are used.
To reduce pain, non-steroidal anti-inflammatory drugs (Nimesulide, Indamethacin) are prescribed. Local anesthetics are also used (Versatis with lidocaine, Ketoprofen gel). For severe pain, tricyclic antidepressants (Amitriptyline) are used. To eliminate painful convulsions, anticonvulsants (Gabalentin, Pregabalin) are prescribed.
Neurotropic drugs (Milgamma, vitamins B1, B6 and B12) help treat diabetic legs. They relieve inflammation, help restore nerve fibers and improve the conduction of nerve impulses.
Simvastatin, Lovastatin or Atorvastatin are used to lower cholesterol levels. Lowering blood pressure is achieved by taking Veralamil, Nifediline, Lisinopril. To strengthen blood vessels, the attending physician will prescribe Pentoxifylline, Bilobil or Rutoside. In addition, diuretics (Furosemide, Spironolactone) are indicated. To prevent blood clots, take Aspirin or Sulodexide.
To improve metabolic processes, injections of Solcoseryl or Trifosadenine are prescribed.
Sometimes, after treatment, the symptoms of leg diseases may worsen. This reaction indicates the restoration of nerve fibers. A decrease in pain and discomfort occurs after two months.
People with diabetes need to examine their feet daily, including the toes and the areas between them. They must be washed regularly with warm water (not hotter than 37°C). After using the toilet, the skin should be carefully dried.
It is not allowed to warm your feet, walk barefoot or wear shoes without socks. Treatment of calluses and other skin diseases can only be carried out after consultation with a doctor and under his supervision.
Avoid wearing tight shoes with rough edges, inseams or unevenness. Socks with seams should not be used. They need to be changed daily. Nails should be cut with blunt-tipped scissors. In this case, you should not round the corners of the nail plate. If unusual sensations appear, the patient should consult a doctor.