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Peripheral Edema and Diabetes

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Updated October 09, 2010

Peripheral Edema and Diabetes
Elizabeth Woolley

Peripheral edema is the collection of fluid in the feet, ankles and legs. Extra consideration is needed for people who have edema and diabetes. It can occur in one or both lower extremities.

Damage to capillaries or increased pressure can cause capillaries to leak fluid into surrounding tissues and result in swelling.

People with diabetes often have circulation problems that can cause wounds to heal slowly or not at all. Edema makes it more difficult for wounds to heal. Therefore, controlling edema is essential.

Causes of Peripheral Edema

There are many common causes of edema that are fairly benign. Some examples of more common causes for peripheral edema, not specifically related to diabetes, include physical inactivity, standing or sitting for long periods of time, surgery, burns, hot weather, pregnancy, menstruation, menopause, contraceptive pills, certain medications, excessive salt intake, malnutrition or a bad diet.

Edema may present in one extremity due to deep venous thrombosis (DVT), cellulitis, osteomyelitis, trauma, a ruptured Baker's cyst or a lymphatic obstruction.

Peripheral edema can also be associated with more serious conditions - many of which can be associated with diabetes complications such as heart disease, venous insufficiency, liver and kidney disease. Certain diabetes medications can also cause edema, specifically the thiazolidinedione drugs Actos and Avandia.

In 2007, the Food and Drug Administration issued a safety alert regarding Avandia and the increased risk of heart attacks or other cardiac events. The FDA recommends physicians watch patients taking this drug for signs of heart failure--including edema.

People with diabetes are twice as likely to have heart disease or heart failure (such as congestive heart failure). If the patient has neuropathy, the symptoms of heart disease or failure may not be felt. It is important for a patient with diabetes to alert their physician when they experience the signs and symptoms of edema.

Signs and Symptoms of Peripheral Edema

  • Stretched skin or shiny skin.
  • Swelling or puffiness.
  • Edema can be pitting or non-pitting, indicating different causes.

What to Do if You Have Peripheral Edema and Diabetes

If you experience edema, let your doctor know so he or she can rule out serious complications. Here are some things you can do to help manage foot and leg edema.

  • Elevate the affected leg or foot throughout the day.
  • Wear support stockings (check with your doctor if you have arterial disease).
  • Exercise.
  • Follow a low-sodium diet.
  • If you have a wound, cellulitis, dermatitis, scaling or itching make sure these are addressed in your care plan.

Call your doctor as soon as possible if swelling does not improve, worsens, if you have liver disease and experience swelling in your legs or abdomen, if your swollen extremity is red or warm, you have a fever, you notice decreased urine output or if you are pregnant and have sudden moderate to severe swelling.

New onset edema either bilateral (in both extremities) or unilateral (in one extremity) should be evaluated urgently. UNILATERAL EDEMA MAY INDICATE AN URGENT NEED TO EVALUATE FOR DVT

Call 911 if you experience shortness of breath or chest pain.

Sources:

Armstrong DPM, David G and Nguyen DPM, Hienvu C. "Improvement in healing with aggressive edema reduction after debridement of foot infection in persons with diabetes." Archives of Surgery 2000 135:1405-1409

Bowering MD FRCP, Keith C. "Use of layered compression bandages in diabetic patients: Experience in patients with lower leg ulceration, peripheral edema, and features of venous and arterial disease." Advances in Skin and Wound Care May/June 1998 11:129-135

Calianno RN CWOCN MSN, Carol; Holton CRNP CRRN CWOCN MSN, Susan J. "Fighting the triple threat of lower extremity ulcers." Nursing2007 March 2007 37(3):57-63

Diabetes, Heart Disease and Stroke. National Diabetes Information Clearinghouse. Accessed: May 27, 2010. http://diabetes.niddk.nih.gov/dm/pubs/stroke/#connection

Mudalair MD FACE, Sunder; Chang MD, Anna R; Henry MD, Robert R. "Thiazolidinediones, peripheral edema, and Type 2 diabetes: Incidence, pathophysiology, and clinical implications." Endocrine Practice September/October 2003 9(5):406-416

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