Peripheral arterial disease
Just as plaques can build up in the coronary arteries, similar fatty deposits can develop in the arteries of the legs. This reduces blood flow to your feet and legs. Narrowing of the leg arteries is called peripheral arterial disease. The characteristic symptom is intermittent claudication—cramping pain in the thighs, calves, and, sometimes, the buttocks that is brought on by exercise and subsides promptly with rest. It's called intermittent because it comes and goes. You may also feel numbness, tingling, burning, or cold in your feet and lower legs.
Smoking is the major risk factor for peripheral arterial disease, but diabetes doubles the risk. Peripheral arterial disease is most common in people with high blood pressure and high blood cholesterol levels (especially in cigarette smokers), so it's not surprising that people with peripheral arterial disease have a higher risk of CHD and heart attack, as well as strokes.
An estimated one of every three people with diabetes over age 50 will develop peripheral arterial disease. That's why the American Diabetes Association recommends that people with diabetes who are older than age 50 have an ankle brachial index (ABI) test. The test compares systolic blood pressure in your arm to that in your lower legs. If blood pressure in your ankle is lower than that in your arm, you may have peripheral arterial disease.
Symptoms of peripheral arterial disease usually progress slowly, but eventually the pain can interfere with normal activities and may even occur at rest. Reduced blood flow in the legs can also result in slow healing of foot blisters and other skin injuries and can lead to open sores (ulcers) and tissue death (gangrene) in the feet and legs. In severe cases, amputation may be necessary.
Treatment is identical to the "ABCs" for preventing peripheral arterial disease: HbA1c less than 7%, blood pressure below 130/80 mm Hg, and "bad" LDL cholesterol levels lower than 100 mg/dL (ideally, less than 70 mg/dL), with medication given if these goals aren't achieved. Quitting smoking is absolutely essential. In addition, antiplatelet drugs such as aspirin or clopidogrel (Plavix) may be prescribed to reduce the risk of blood clots.
Although it may seem surprising, walking a prescribed distance several times a week gradually increases the pain-free distance you can walk. Your doctor may also prescribe medications such as pentoxifylline (Trental) and cilostazol (Pletal) to relieve walking-related leg pains. But if exercise and drug treatments fail to prevent severe blockages, you may need leg surgery using angioplasty or bypass procedures to treat the plaque buildup.