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ADA Moderator : Welcome to ADA Live!
Today our guest is Peter Sheehan, Director, Diabetes Center of Greater New York, who will address your questions about vascular diseases.
Thanks for being here today Dr. Sheehan.
Dr. Sheehan: Thank you.
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ADA Moderator : Dr. Sheehan, this week is National Peripheral Arterial Disease or P.A.D. Awareness Week. Tell us why.
Dr. Sheehan: P.A.D. is a common disease that occurs when the arteries in the legs become narrowed or clogged with fatty deposits, or plaque. When leg arteries are clogged, blood flow to the legs and feet is reduced. People with diabetes are at higher risk for having P.A.D. Some studies have found that one out of three people with diabetes over age 50 has P.A.D., and P.A.D. is even more common in African Americans and Hispanics who have diabetes.
Having P.A.D. and diabetes can be a very serious problem. People who have both diabetes and P.A.D. are much more likely to have a heart attack or stroke than those who just have P.A.D., and they are more likely to die at a younger age. P.A.D. is a major cause of amputations in people with diabetes.
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ADA Moderator : P.A.D. seems to be a problem of the legs. Why the connection with heart attack and stroke?
Dr. Sheehan: The clogged arteries found in people with P.A.D. are a sign that they are likely to have clogged and narrowed arteries in other parts of the body especially in the heart and the brain. Because of this, people with P.A.D. are at much higher risk of heart attack, stroke, and death compared to people without P.A.D. In fact, as many as 30% of people with P.A.D. will have a heart attack, stroke or die within five years without proper treatment.
When the blood flow to the legs is greatly (or severely) reduced, people with P.A.D. may have pain in their leg muscles when walking, commonly forcing them to stop at one block or less. People with P.A.D. are commonly disabled and may not be able to go to work. P.A.D. may cause other problems that can lead to amputation of a toe, foot or a leg. These patients have a very poor quality of life.
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ADA Moderator : So, leg pain is a prime symptom of P.A.D.?
Dr. Sheehan: Actually, most people with P.A.D. do not have recognizable symptoms. Some people with P.A.D. do have one or more of the following warning signs:
Fatigue, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest.
Foot or toe pain at rest that often disturbs your sleep.
Skin sores or wounds on your feet or toes that are slow to heal.
Because many people with diabetes do not have feeling in their feet or legs due to nerve disease, they may have P.A.D. but cannot feel any symptoms. As a result, they do not know they have P.A.D., or they may have it for a long time before it is diagnosed.
Further, when blood flow to your feet and legs is narrowed or blocked due to P.A.D., it takes longer for cuts or wounds to heal, which may increase the risk for amputation.
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ADA Moderator : Do these treatment strategies also reduce the risk for amputations?
Dr. Sheehan: Absolutely. People with diabetes should also practice proper foot care to reduce the risk for foot problems and amputations. You should check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores that will not heal. Also, ask your health care team to check your feet at every visit.
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ADA Moderator : Are there treatments to help patients with P.A.D.?
Dr. Sheehan: P.A.D. can be treated with lifestyle changes, medicines and special procedures, if needed. Since people with P.A.D. are at high risk for heart attacks and stroke, they must take charge of controlling their risk factors related to cardiovascular disease. You can reduce your risk for heart attack and stroke by managing the ABCs of Diabetes:
A is for the A1C test that measures your average blood glucose over the past 2 to 3 months.
B is for your blood pressure.
C is for your cholesterol.
Ask your health care team what your ABC numbers are and work together to develop a plan to reach your target goals.
You should also be taking an antiplatelet medicine such as aspirin or clopidogrel to prevent blood clotting and reduce the risk for heart attack and stroke.
If you smoke, get immediate help to quit.
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ADA Moderator : How is P.A.D. diagnosed?
Dr. Sheehan: To assess for P.A.D., health care providers will review a patients medical history and perform a physical examination of the feet and leg pulses. The best test for diagnosing P.A.D. is the ankle-brachial index (ABI), a test that compares the blood pressure in the ankles to the blood pressure in the arms. If the blood pressure in the ankles is less than the blood pressure in the arms, this means the patient has P.A.D.
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ADA Moderator : That is a great overview, Dr. Sheehan. Lets answer some questions from the audience.
Dr. Sheehan: Sounds great.
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Canovanas, Puerto Rico: I have been diagnosed with Type 2 Diabetes since 2001, when I reached my 41st birthday. Is there a timeframe for developing PAD since the diagnoses? Thank You.
Dr. Sheehan: Actually, P.A.D. may develop before the diagnosis of diabetes. One recent study showed that about 22% of people recently diagnosed with diabetes also had P.A.D. You are young but there may be a possibility that you have P.A.D. - particularly if you have other risk factors such as history of smoking, high blood pressure or abnormal cholesterol. In a recent consensus statment published by the American Diabetes Association, an expert panel recommended that people with diabetes over the age of 50 be tested for P.A.D. Testing should also be considered for patients under the age of 50 if other risk factors are present (smoking, high blood pressure, abnormal cholesterol).
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seattle, WA: I have brown spots completely covering lower legs in a band about 3 inches long. Dr. describes them as petechiole. Is this a symptom of vascular illness and what is better, exercise or elevating legs, or neither?
Dr. Sheehan: Petechia are small red spots that occur when red blood cells leak into to skin. They are probably a result of congestion or swelling of the veins. The best way to prevent them is to wear compression stockings. These stockings can be purchased at a surgical supply store.
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goliad,texas 77963: I am troubled with diabetic neuropathy and presently taking lycria. It does not offer me much relief. Can you suggest other medications? My hands (especially) and feet burn and sting constantly. Mary
Dr. Sheehan: Talk to your doctor to make sure you are getting the maximum dose of Lyrica. An alternative drug approved by the Food and Drug Administration is Cymbalta. If neither drug is effective for you, you should consult a specialist in pain management.
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Kendall Park, NJ: The ABCs of Diabetes to improve vascualr health say for C to keep you cholesterol below 100. Is that a typo? I have only heard to keep my LDL cholesterol below 100, not my total cholesterol (to be kept below 200). If the information given to diabetics is this conflicting, how ia diabetic supposed to know what to do to help their vascular health? Unfortunately I will not be able to be online for the chat due to constraints at my job. Would it be possible for an e-mail answer to be returned to me at aclare@trcsolutions.com? Thanks.
Dr. Sheehan: In the ABCs of Diabetes, the "C" stands for Choleterol (LDL). You are correct that the target for LDL cholestol for most people with diabetes is less than 100 mg/dl. People with diabetes that are at very high risk for having a heart attack or stroke, may aim for a more aggressive LDL target of less than 70 mg/dl. Talk to your health care team to determine the best goal for you.
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Bedford, Texas: My husband has Type 2 diabetes that he controlled with medication but now has gone to insulin. The arch on his left foot fell and our primary said it was probably he twisted it, but after about 2 months, we went to a podiatrist that took x-rays and discovered it. Not much can be done with that now. Recently, maybe about a month, after he has been on his feet awhile, his legs and feet swell. The only time that they don't is when he is in bed. Why do they swell? Anything that can be done? Karla Insco kinsco@devry.edu
Dr. Sheehan: You probablly have what is called a Charcot Foot, which is a complication of neuropathy (nerve disease). The best treatment is immobilization of the foot, preferably by wearing a special cast for one to two months. The swelling is due to inflammation in the joints of the foot. Swelling should subside after the casting.
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Guadalajara, Jalisco, MEXICO: Drinking red wine is dangerous or it can be a factor to develop Vascular Disease?
Dr. Sheehan: Drinking light to moderate amounts of alcohol is associated with a low risk of heart disease, perhaps by raising HDL (good) cholesterol levels. There isn't enough information to recommend that people who don't drink should start drinking alcohol to reduce heart risk. But, for those who do drink alcohol, 1 serving daily for women and up to 2 servings daily for men have been associated with good health. Drinking more than 1 to 2 drinks per day isn't helpful; it contributes unnecessary calories and may actually raise your blood pressure and triglycerides. In addition, it can cause other health problems. It's best to discuss drinking alcohol with your health care provider to find out whether it may be helpful for you.
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Guadalajara, Jalisco, MEXICO: Do you think that I must restrict eating peanuts, because their fat can obstruct the arterys or because they contain a lot of calories?
Dr. Sheehan: Peanuts are high in fat, but the fat in peanuts is the "healthy fat" that helps to protect the arteries. Because of their high fat content, peanuts are high in calories and should be eaten in moderation.
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Edisto, SC: I have nerve disease and bad circulation due to diabetes. Do I need to wear special shoes?
Dr. Sheehan: Yes, you should wear special shoes. You should get a prescription for extra-depth, extra-wide shoes with prescription inlays. These special shoes are covered by Medicare, Medicaid and most insurance plans.
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Weatherford, TX: Is postprandial testing 2 hours after I start eating or 2 hours after I've finished eating?
Dr. Sheehan: Generally, postprandial is 2 hours after the start of a meal.
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ADA Moderator : We're close to the end today.
Do you have any thoughts you'd like to leave us with Dr. Sheehan?
Dr. Sheehan: If you have diabetes and are over the age of 50, you should be screened for peripheral arterial disease (P.A.D.) through the ankle-brachiel index - a simple test that compares the blood pressure in the ankles with the blood pressure in the arms. If you have P.A.D., you should get preventative foot care from a foot care specialist, such as a podiatrist. You should also work closely with your health care team to manage risk factors for heart attack and stroke. Key items to address include management of blood glucose, blood pressure and cholesterol, smoking cessation and the use of antiplatelet medicines.
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ADA Moderator:
That's it for today. Thanks so much for taking the time to be here Dr. Sheehan.
Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.
Keep up to date with all the ADA Live events and reference the archives here.
We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid pharmacists and diabetes specialists at 1:00 p.m. ET October 5, 2006. See you then.
Dr. Sheehan: Thanks to everyone for joining and asking great questions. It was a pleasure to be here.
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