Diabetes and Venous Disorders: What's the Connection?

Diabetes mellitus, often called diabetes, is a chronic disease that occurs when your body doesn't make or process insulin correctly. As sugar builds up in the bloodstream, symptoms sometimes progress to include problems with circulation. For example, diabetes may cause tingling in the hands and feet, as well as sores that heal slowly. People who are overweight or over the age of 45 are at greater risk of developing type 2 diabetes.

Age and weight can also increase a person’s risk of developing chronic venous disorders. For this reason, even though diabetes and venous disorders are separate diseases, they frequently co-occur in the same patients. When a patient experiences both diabetes and a venous disorder at the same time, the symptoms for one disease can often aggravate the symptoms for the other. 

In this article, we'll look at the way that diabetes and venous disorders both lead to poor circulation. Also, we'll discuss what compression therapy can do to help heal the ulcers caused by diabetes and venous disease. 

How Diabetes Impacts Circulation

Sustained high blood sugar levels can cause peripheral arterial disease (PAD) and a reduction in blood flow. According to Diabetes.co.uk, an online community for diabetes patients, "In people with diabetes, if high blood glucose levels are experienced over a period of years, our blood vessels can become damaged which can lead to plaque forming in the blood vessels rendering them unable to deliver a sufficient amount of blood to neighbouring cells." ("Poor Blood") Poor circulation leads to a reduction in blood flow to the extremities, which may develop into critical limb ischemia (CLI) and wounds that won't heal.

Ischemia and Ulcers

The American Heart Association defines PAD, writing, "Fatty deposits build up in the inner linings of the artery walls of the legs, making them narrower, hindering blood flow and can even stop blood flow to the legs and feet completely." ("Peripheral") CLI describes the advanced form of PAD that results when an artery lining is severely obstructed. Without healthy blood flow, even a small cut on the legs or feet has the potential to become a wound that won't heal, also called a diabetic ulcer. "Diabetic foot" describes a foot impacted by ischemia and ulcers, resulting from advanced PAD. 

Peripheral Edema

A significant number of diabetes patients experience swelling in the lower extremities, also called peripheral edema, as a side effect of diabetes. In a study published in Diabetes Research and Clinical Practice, researchers explain that, "Persons with type 2 diabetes mellitus especially, have a higher prevalence of peripheral edema than healthy subjects." (Wu et al. Introduction) Although the precise cause of edema can be difficult to identify, thanks to the presence of compounding symptoms, peripheral edema is associated with a poorer prognosis: "...[It] presented more commonly in patients who required amputation (58%) or died (55%)." (Introduction) The researchers recommend a reduction in lower extremity edema as a worthwhile goal for patients with diabetes, although they clarify that compression therapy can present health risks for people with PAD. 

Lymphedema

A 2015 study identified a link between the lymphatic barrier dysfunction and type 2 diabetes in mice. Researchers underscored that further research is needed to determine whether treating lymphatic leakage could reduce plaque formation: "Because diabetic patients are at increased risk for dyslipidaemia, atherosclerosis, and oedema, treating lymphatic dysfunction may selectively alleviate these risks. Future studies are required to determine whether rescuing lymphatic dysfunction in diabetes reduces atherosclerotic plaque formation." (Scallan et al. Discussion) As with peripheral edema, lymphedema may contribute to worsening diabetes symptoms. The study suggests that, in patients with diabetes, the walls of lymphatic vessels become increasingly defective and leaky. 

How Venous Disorders Impact Circulation 

The mechanisms by which venous disorders reduce blood flow and contribute to poor circulation differ from those presented by peripheral arterial disease. Whereas PAD impacts the arterial vessels (blood flowing from the heart to the extremities), venous disorders tend to reduce vein function (blood flowing from the extremities to the heart). Rather than clogging vessels with plaque, venous disorders involve the slackening and distending of vessel walls and the failure of venous valves. In many ways, you can think of PAD as the mirror of chronic venous insufficiency (CVI). PAD causes the vessels moving away from the heart to clog; CVI causes the vessels moving towards the heart to bulge. Yet, even though the two health conditions differ, they cause similar symptoms and can co-occur in the same patients. 

To improve circulation for patients with venous disorders, most doctors recommend compression therapy. By reducing the circumference of the veins, knee-length compression garments work well to improve the velocity of blood flow and reverse venous reflux. 

Chronic Venous Insufficiency

CVI refers to an advanced form of chronic venous disorder, which can involve spider veins, varicose veins, and venous ulcers. In a patient with CVI, vein damage has progressed to a stage where the valves and venous walls have failed, causing blood to pool in the legs. CVI also causes venous reflux, the backwards flow of blood through one-way valves inside the veins.

Venous Ulcers 

When blood pools in the legs and feet, it can cause an abnormal amount of pressure. Sometimes, sustained venous hypertension or varicose veins exert so much pressure against the skin that ulcers form. With continuous venous pressure against the wound, these ulcers can become prone to infection and slow to heal. Numerous studies have shown that graduated compression therapy helps to push back against venous pressure. In a comprehensive review of the existing scientific literature, researchers concluded, "There is high-quality evidence that venous ulcers heal more rapidly with than without compression therapy." (Lim E393-3940)

Edema 

Sometimes, CVI causes chronic leakage of venous fluid into the tissues of the legs. Venous edema compromises lymphatic function and shares many of the characteristics of lymphedema. ("Lymphadema") As the circumference of the vein begins to expand, the cells that line the interior surface of lymphatic and blood vessels cease to function normally. Swollen legs can be painful, and the pressure often causes skin changes and ulcers.

Lymphedema

Lymphedema often co-occurs in patients who suffer from poor circulation and venous conditions. Unlike peripheral edema, lymphedema does not necessarily improve when you elevate your legs overnight. Treatment for lymphedema involves manual drainage and different forms of compression therapy. A 1992 study in The Journal of Vascular Surgery explained that graduated compression garments, along with pneumatic compression, resulted in the long-term reduction in limb girth for 90% of lymphedema patients. (Pappas)

Compression Therapy for Chronic Venous Disorders

Dozens of studies show that compression therapy is an effective preventative tool for patients with chronic venous disorders. Graduated compression socks can help at-risk patients avoid vascular complications, such as varicose veins ("Compression") and deep vein blood clots (Sachdeva Abstract). For people with existing vascular conditions, compression therapy works to treat painful symptoms and prevent further degeneration of veins. Even for patients with advanced venous disorders that require surgery, it's common for doctors to recommend compression socks as part of post-operative care (Shouler 402). 

Compression socks are used to treat and prevent:

• Varicose veins and spider veins
• Deep-vein thrombosis (DVT)
• Edema (swelling)
• Chronic venous insufficiency (CVI)
• Post-thrombotic syndrome (PTS)
• Postural orthostatic tachycardia syndrome (POTS)
• Shin splints
• Plantar fasciitis 
• Lymphedema 

Diabetes and Compression Therapy 

Even though a reduction of the circumference of the veins can help to treat the symptoms of chronic venous disorders, a reduction in the circumference of the arteries could potentially worsen advanced PAD. Imagine a patient who suffers from ischemia; he already has arteries clogged with plaque. Further reducing the circumference of the artery with compression garments could prevent blood from reaching his extremities. In addition, many diabetes patients experience peripheral neuropathy (also called diabetic neuropathy), nerve damage and loss of sensation in the lower legs and feet. For someone without feeling in their extremities, a compression garment could become dangerous, especially if it bunched or folded over and cut off circulation. 

While some diabetic patients find relief from regular compression socks or diabetic compression socks, we do not recommend that diabetic patients engage with compression therapy without a doctor's supervision. It's important to work closely with a medical professional if you have circulation problems caused by diabetes. Often, a doctor may recommend a special diabetic sock or a light compression garment for a patient with advanced PAD. 

If you have any of the following conditions, consult a doctor before wearing compression socks:

• Peripheral neuropathy
• Peripheral artery disease (PAD)
• Skin infections
• Dermatitis 

With a doctor's oversight, many diabetics can also benefit from mild compression or medium compression socks. In particular, we’ve designed socks with 15-25 millimeters of mercury (mmHg) to prevent DVT, promote proper circulation, reduce swelling, and help heal foot ulcers. Our signature Companions come with extra toe and heel padding to protect your feet. In addition, they're made of SmartSilver antimicrobial fabric, and they have slide-free cuffs and linked seams (instead of sewn) for extra comfort. Knee-high compression socks give you an inexpensive, easy way to improve your circulation. 

If you're struggling with the compounding symptoms of diabetes and chronic venous disorders, you're not alone. The two conditions share common risk factors, and they often co-occur. Compression socks have been proven to prevent venous disorders from worsening. Before diabetes and venous disorders combine and create deteriorating symptoms—swelling, hypertension, and ulcers—ask your doctor about compression therapy. Compression socks can give you the support you need, allowing you to push back against the progress of these chronic conditions. 

Sources:

Cho, Shaun, and J Edwin Atwood. “Peripheral Edema.” American Journal of Medicine, vol. 113, 2002, pp. 580–586, http://www.medecine.unige.ch/enseignement/apprentissage/module2/circ/apprentissage/intranet/pb2/cho_2002.pdf.

“Compression socks can help prevent varicose veins.” The Scope, University of Utah, Jan 10, 2018, https://healthcare.utah.edu/the-scope/shows.php?shows=0_u6yd3xaw.

“Diabetes Risk Factors.” Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, 24 Mar. 2020, https://www.cdc.gov/diabetes/risk-factors/index.html. 

Lim, Chung Sim and Alun H. Davies. “Graduated compression stockings.” CMAJ. Vol. 186, Iss. 10 pp. E391-E398. July 08, 2014, https://www.cmaj.ca/content/cmaj/186/10/E391.full.pdf.

“Lymphedema and Venous Edema.” UW Health, University of Wisconsin Hospitals and Clinics Authority, 21 Mar. 2018, www.uwhealth.org/physical-therapy-occupational-therapy-speech-therapy/lymphedema-and-venous-edema/13987.

Pappas, Chrisos J, and Thomas F O'Donnell. “Long-Term Results of Compression Treatment for Lymphedema.” Journal of Vascular Surgery, vol. 16, no. 4, Oct. 1992, pp. 555–564. ScienceDirect, https://www.sciencedirect.com/science/article/abs/pii/0741521492901633.

“Peripheral Artery Disease and Diabetes.” Heart.org, American Heart Association, Inc., 31 Jan. 2016, www.heart.org/en/health-topics/diabetes/why-diabetes-matters/peripheral-artery-disease--diabetes. 

“Poor Blood Circulation.” Diabetes.co.uk, Diabetes Digital Media Ltd, 10 Mar. 2020, https://www.diabetes.co.uk/diabetes-complications/poor-blood-circulation.html. 

Sachdeva, Ashwin. “Graduated compression stockings for prevention of deep vein thrombosis during a hospital stay,” Cochrane Vascular Group, Nov 3, 2018, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001484.pub4/abstract.

Scallan, Joshua P., et al. “Lymphatic Vascular Integrity Is Disrupted in Type 2 Diabetes Due to Impaired Nitric Oxide Signalling.” Cardiovascular Research, vol. 107, no. 1, 2015, pp. 89–97, https://academic.oup.com/cardiovascres/article/107/1/89/513636. 

Shouler, P J, and P C Runchman. “Varicose veins: optimum compression after surgery and sclerotherapy.” Annals of the Royal College of Surgeons of England vol. 71, iss. 6, 1989, pp. 402-404, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2499037/.

Wu, Stephanie C., et al. “Control of Lower Extremity Edema in Patients with Diabetes: Double Blind Randomized Controlled Trial Assessing the Efficacy of Mild Compression Diabetic Socks.” Veins and Lymphatics, vol. 6, no. 1, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429175/.