Dr. Scott Brannan talks about diabetes, neuropathy, and peripheral artery disease. These are all diagnoses that affect the lower extremities. We are going to cover their relationships and their differences.
What are the differences between diabetes, neuropathy, and PAD?
Many people are familiar with, or 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. Many patients that don’t have diabetes can still get neuropathy, though. 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 caused by conditions like diabetes and treatments like chemotherapy. This can cause the loss of nerve signals being sent appropriately, improper signaling when none should be occurring, and distortion in the signal being sent. Depending on the affected 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. The most basic understanding that people have is that there is too much sugar in the blood, the sugar blocks up the system, and the nerves stop functioning properly. That was a good explanation until we looked a little closer at neuropathy.
We found that many patients that are not diabetic are presenting with neuropathy. These patients are called “pre-diabetic”. They don’t have the consistent elevated blood sugar of a type II diabetic, but they have episodes of high blood sugar, called “transient hyperglycemia“. They 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 are narrowed due to atherosclerosis, which is plaque buildup on the arterial walls. This decreases blood flow to the lower extremities. If PAD is left untreated it could cause complications, including gangrene, amputation, and critical limb ischemia.
The following risk factors increase the change of developing PAD:
- Increasing Age
- High Blood Pressure
- High Cholesterol
If we look at the diagnosis of peripheral arterial disease, estimates are that only 1 in 5 people have ever heard of it. We need to promote the understanding that these three diagnoses are related.
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 has been research that shows that diabetes contributes to PAD by increasing inflammation and reducing blood flow. It is believed that this is due to fat buildup in the arteries being targeted by the immune system, which increases inflammation.
Since neuropathy is caused by damaged nerves, it means that the diabetes is the cause of nerve damage as it relates to diabetic neuropathy. It is not entirely understood how diabetes damages nerves, but it is likely due to elevated blood sugar levels and reduced 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 artertial 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. Anybody that has neuropathy that is older than 55 needs to 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. If you start noticing that you are losing feeling in your legs or feet, or if you are are feeling pain in your legs or feet, you should ask your doctors if you could have neuropathy or peripheral artery disease. 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.