The Relationship Between Peripheral Edema and Diabetes

Peripheral edema is swelling from the collection of fluid in the feet, ankles, and legs. It can occur in one or both of your lower extremities. If you have diabetes, you need to take extra precautions when you have edema.

Edema is the result of damage to capillaries or increased pressure causing 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.

Symptoms

• Stretched skin or shiny skin
• Swelling or puffiness
• Pitting or non-pitting, indicating different causes

Causes

There are many common causes of edema that are fairly benign. Some examples of more common causes of 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
• Poor diet

Edema may present in only one extremity (rather than both) due to:

• Deep venous thrombosis (DVT)
• Cellulitis
• Osteomyelitis
• Trauma
• Ruptured Baker's cyst
• 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 disease, and kidney disease.

Certain diabetes medications can also cause edema, specifically the thiazolidinedione drugs Actos (pioglitazone) and Avandia (rosiglitazone maleate). These drugs have come under a cloud because of their potential cardiac adverse effects, and should not be used in anyone who has had a history of congestive heart failure.

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 healthcare provider when they experience the signs and symptoms of edema.

Management

If you experience edema, let your healthcare provider 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 (and check with your healthcare provider if you have the arterial disease)
• Exercise
• Adhere to 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 healthcare provider as soon as possible if:

• Swelling does not improve or worsens
• You have liver disease and experience swelling in your legs or abdomen
• Your swollen extremity is red or warm
• You have a fever
• You notice decreased urine output
• You are pregnant and have sudden moderate to severe swelling.

When to See a Healthcare Provider

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 be evaluated for DVT. Call 911 if you experience shortness of breath or chest pain.