Diabetes & PAD Risk

What is diabetes?

Diabetes is a serious, lifelong condition in which the body cannot properly control the level of sugar in the blood. Insulin is a hormone that regulates sugar (glucose) levels in the blood. In women with diabetes, the body does not make enough insulin or cannot use insulin as well as it should.

During digestion, carbohydrates from food are broken down into sugar, which is then absorbed into the bloodstream. In response to this absorption, the pancreas secretes insulin, allowing sugar to be absorbed from the blood into cells and tissues. Cells and tissues then use the sugar for energy. When you have diabetes, sugar builds up in your blood instead of being used for energy.

Women with diabetes may be more likely to develop deep vein thrombosis, or DVT (blood clots in the deep veins of the legs). Diabetes also puts you at risk for heart disease, stroke, and kidney, nerve, and eye damage. The good news is that proper treatment and lifestyle changes can drastically reduce the risk of future problems, including vein disease, in women with diabetes.

How does diabetes affect my vein disease risk?

Diabetes causes changes in the blood and arteries that make clots more likely to form. Women with diabetes are more likely to develop blood clots in the deep veins of the legs (deep vein thrombosis, or DVT) that can travel to the lungs (pulmonary embolism), compared with women who do not have diabetes. However, it is not clear whether the diabetes itself increases a woman’s risk, or if other conditions (such as heart disease and prolonged immobility) are responsible for the elevated clot risk.

DVT and PE are common in women with diabetes. An analysis of 21 studies that included 63,552 patients (70% were women) found that patients with diabetes have a 1.5-fold increased risk of DVT or pulmonary embolism compared with patients who do not have diabetes.

However, several large women-only studies have failed to find a link between diabetes and blood clots in the veins after taking other factors into account. The HERS study looked at 2,763 women with heart disease and found that diabetes was not linked to the risk of DVT, and the Nurse’s Health Study found that diabetes did not affect pulmonary embolism risk.

One explanation is that the effect of diabetes differs by age, and that diabetes has a larger effect on blood clot risk in younger women than in older women. A study of 92 million US hospital patients found that diabetes only increased DVT risk in patients younger than 50. In older patients, diabetes was much less important than other DVT risk factors such as heart disease and immobility.

According to some studies, diabetes itself may not cause blood clots in the veins. Instead, women with diabetes are more likely to have other conditions that make blood clots more likely to form. A study of 1,922 patients who had suffered a DVT or PE (54% were women) found that the link between diabetes and blood clots was explained by other medical problems the diabetic patients had. Those with diabetes were more likely to be hospitalized for major surgery or medical illness, or to be confined to a nursing home—situations in which lack of movement can act as a powerful DVT trigger.

Whatever the reason, it is clear that blood clots in the veins are a major concern for women with diabetes. It is important that you take steps to control your DVT risk factors and know what to do to avoid triggering a DVT.

Who should be tested for diabetes?

Everyone 45 years or older should be tested for diabetes. If you are younger than 45, you should be tested if you are overweight and have one or more risk factors for diabetes, especially high blood pressure or high cholesterol. If your test results are normal, you should be tested again every 3 years. If you have pre-diabetes, you should be checked every 1 to 2 years after your diagnosis.

How can I prevent vein disease if I have diabetes?

If you have diabetes, the best way to prevent vein disease is to get your diabetes under control and to take steps to control your other risk factors for blood clots. All women with diabetes should follow the ABCs of Diabetes Management and learn how to watch for diabetes complications.

The ABCs of Diabetes Management

There are three major treatment goals to keep your diabetes under control, called The ABCs of Diabetes Management. Following the ABCs lowers your risk of dying or having complications of diabetes, including DVT. Ask your doctor what your numbers are, what your individual goals should be, and what you need to do to reach and maintain them. The closer your numbers are to your goals, the less likely you are to develop vein disease.

  • A is for A1C test (short for hemoglobin A1C). This simple blood test measures your average blood sugar over the last 3 months, and you should have it done at least twice a year. Aim to have an A1C level less than 7%.
  • B is for blood pressure. You should aim for a blood pressure less than 130/80. Have your blood pressure checked at every doctor’s visit.
  • C is for cholesterol. Aim to have your LDL (bad) cholesterol less than 100 mg/dL. Have your cholesterol checked at least once a year.

Your health care provider can help you develop a plan for things you should do every day to take care of your diabetes, including following a healthy eating plan (eat your meals and snacks around the same time each day) and being physically active for a total of 30 minutes most days.

Watch for Diabetes Complications

It is also important that you keep an eye out for other problems that diabetes can cause. This means regular visits with an eye doctor to check for vision problems and checkups for foot and leg problems. Ask your doctor how to practice proper foot care, and check your feet everyday for cuts, blisters, red marks, or swelling. If you have any non-healing or slow-healing wounds or sores, call your doctor right away.

Get Your Other Risk Factors Under Control

You will also need to address any other conditions or characteristics that are putting you at risk for vein disease. Basic steps include lifestyle changes such as quitting smoking, eating a heart-healthy diet, maintaining a healthy weight, and getting regular exercise. To learn more about how to reduce your overall risk, see Preventing DVT: The Basics. You should also learn to recognize and watch for the signs of vein disease and contact your doctor if you notice any of them.

Because women with diabetes are more likely to be put in situations that increase the risk of blood clots (such as prolonged immobility in the hospital or recovering from surgery), you should learn about DVT triggers and how to lower your clot risk. How to avoid DVT in the hospital and how to talk to your healthcare team about DVT prevention.

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