Dr. Scott Brannan talks about diabetes, neuropathy, and peripheral artery disease. These are all diagnoses that affect the lower extremities. In this video, he covers their relationship and what makes them different.
What are the differences between diabetic neuropathy and PAD?
Many people are becoming familiar with the diagnosis of peripheral neuropathy. As the diabetic epidemic in the United States grows, we are seeing more and more patients with neuropathy. However, it is still common for people that do not have diabetes to develop neuropathy. Therefore, many people are asking: What are the differences between PAD and neuropathy? Diabetes can lead to either neuropathy, peripheral artery disease, or both. Elevated blood sugar levels and increased fat cells traveling through the blood vessels are the contributors. It is very important to monitor diabetes because of the complications that can arise.
What is neuropathy?
Neuropathy is nerve damage that can be the result of conditions like diabetes and treatments like chemotherapy. This can cause the loss of nerve signals being sent, signaling when none should be occurring, and distortion in the signal. Depending on the nerve fibers, and how severe the damage is, the symptoms can range from mild to severe. Neuropathy is traditionally thought of as a result of diabetes in most cases.
Most people have the basic idea that diabetes too much sugar in the blood causes diabetes, the sugar blocks thing up, and it has an effect on the nerves. That makes sense until we look a little closer at neuropathy. Many patients that are not diabetic are presenting with neuropathy. We call these patients “pre-diabetic”. They don’t have the consistent elevation of blood sugar like a type II diabetic, but they have episodes of high blood sugar, called “transient hyperglycemia“. People are presenting with the signs and symptoms of neuropathy before they get the diagnosis of diabetes.
What is peripheral artery disease?
PAD is when the peripheral arteries narrow due to atherosclerosis, which is plaque buildup on the walls of the arteries. This decreases blood flow to the lower extremities. Physicians often recommend treatment for patients with PAD because it could cause complications, including gangrene, critical limb ischemia, and even amputation in some cases. The following risk factors increase the chance of developing PAD:
- Increasing Age
- High Blood Pressure
- High Cholesterol
When it comes to peripheral artery disease, estimates are that only 1 in 5 people know about it. We need to promote the understanding of the relationship between these three diagnoses.
How do they each relate to diabetes?
PAD affects around 12 million Americans and it is unknown what percentage of those have diabetes. It is estimated that around 20% of PAD patients that are symptomatic have diabetes. There is research that shows that diabetes contributes to PAD by increasing inflammation and reducing blood flow. The belief is that this is due to the immune system targeting fat buildup in the arteries, which increases inflammation. Since damage to the nerves causes neuropathy, it means that diabetes is the cause of nerve damage as it relates to diabetic neuropathy. There is not a definite understanding of how diabetes damages nerves, but it is likely due to the elevation of blood sugar levels and reduction of blood flow. Nerve damage is present in 50% of people that have diabetes.
What are the differences in peripheral artery disease vs. neuropathy?
We know that diabetes is one of the most common pathways to get to neuropathy. The path that it takes is through peripheral arterial disease. Diabetes causes the narrowing of the micro-and macro-arteries. That narrowing, and the decrease in blood flow is what leads to ischemia (meaning low blood flow) of the nerve. We understand now that is the mechanism that causes neuropathy to get worse. Patients with neuropathy that are older than 55 should have a peripheral vascular evaluation, because it may be contributing to their disease. Amputation below the knee could be a result of diabetes that leads to neuropathy. Many people with peripheral neuropathy or diabetes do not know about peripheral artery disease and miss the signs and symptoms, such as sores on legs, feet, or toes that don’t heal or numbness of weakness in the legs.
What can be done if you believe you have PAD or neuropathy?
If you have diabetes it is very important that you see a doctor regularly to help you monitor your health. You should ask your doctors if you could have neuropathy or peripheral artery disease if you start noticing that you are losing feeling in your legs or feet, or if you are feeling pain in your legs or feet. If you or someone you know is experiencing these signs or symptoms, please schedule a consultation with Modern Vascular. Our expert team will help you determine what is causing your symptoms and provide you with guidance.