Lymphedema and Diabetes

INTRODUCTION

Anyone with both diabetes and lymphedema faces special health challenges and must take extra care in managing these conditions to minimize complications.

WHAT IS DIABETES?

• Diabetes is a chronic condition in which the body either does not produce enough insulin or does not use insulin effectively. Uncontrolled diabetes is characterized by abnormally high or low blood sugar levels and can be fatal.
• High blood sugar levels make infection more likely and slow the healing process. Over time, high blood sugar levels cause damage to tissues throughout the body. Another name for blood sugar is blood glucose.
• By monitoring your blood sugar levels regularly, you can know when your sugar is too high or too low and control it by adjusting your food intake, exercise, and medication. Your diabetes educator and other health care providers can help you with this process.

As described by Dr. Tony Reid, in his article on diabetes,

“. . . Diabetes generally causes damage to the arteries and capillaries, and lymphedema is the result of damage to the lymphatic system. Together, these diseases result in damage to both the arterial and lymphatic systems and both lead to damage to the subcutaneous tissue, connective tissue and skin. The result is increased swelling, decreased levels of oxygen in the skin and connective tissue and susceptibility to infection.”

TREATMENT OF THESE TWO CONDITIONS

When both diabetes and lymphedema are present, the tissues of the body face a double threat. Accurate treatment of both conditions properly is essential.

Lymphedema treatment may need to be modified to accommodate the conditions caused by the diabetes.

• Excellent skin care, including moisturizing the skin before bandaging with a lotion such as Eucerin Original, is helpful in minimizing itching and reducing the risk of infection. Some therapists have found Vaseline is more effective as a skin moisturizer for diabetics.
• Manual lymph drainage and self-massage may need to be performed with greatest care since skin can become very thin, fragile, or dry because of diabetes.
• Before bandaging the therapist, patient, or caregiver, should carefully examine the tissues to be bandaged for any signs of circulatory problems. Bandaging is not performed if there are indications of circulatory difficulties. The therapist uses his or her professional judgment about proceeding with this treatment.
• Bandaging and the use of compression garments may be modified to avoid skin irritation. Ointment or powder may be used if there is itching associated with dry skin related to diabetes.

CHECKING BLOOD GLUCOSE LEVELS

• Glucose monitoring requires a tiny amount of blood that is obtained by using a special lancet to prick the skin of the finger or forearm. The sides of the fingers are frequently used for blood glucose checking because they are less sensitive than the finger pads. To minimize the risk of infection, clean the area before and after obtaining a blood sample.
• Avoid glucose checking on limbs that are affected with lymphedema, or at risk for lymphedema. An illustrating of this danger is the case of a woman who was diagnosed with diabetes 30 years after her mastectomy. Shortly after she began pricking the fingers of her “at risk” arm to check her blood glucose, she developed lymphedema in that arm.

INSULIN INJECTIONS

• Some diabetics require additional insulin, either by injection or via an insulin pump.
• Insulin may be injected into the layer of fat located just under the skin of the abdomen, arms, thighs, hip, or buttocks.
• Since injections should not be made into lymphedema-affected tissues, the patient should ask his or her physician to recommend safe injection sites.
• Sometimes an insulin pump is used to provide insulin or a continuous glucose monitor is used to measure blood sugar levels. Since each of these devices require a placing a thin tube under the skin, it is important to avoid infection or skin irritation. The physician who is placing these devices must be made aware if the patient also has lymphedema. This allows for the selection of safe sites for placement of these devices.

PERIPHERAL NEUROPATHY

Peripheral neuropathy is a painful complication of diabetes that occurs when blood sugar levels are not effectively controlled. The patients physician should be consulted to ensure so that the patient's blood sugars should be monitored an ensure appropriopriate blood sugar levels.

REFERENCES

• Dr. Reid’s Corner

• Lymphedema 30 years after Radical Mastectomy by M. Brennan and J. Weitz. Am J. Physical Rehabil 1992; 71:12-14.
• Living Well with Lymphedema by A. Ehrlich MA, A, Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005, pages 91-93.

© LymphNotes.com 2014. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema and Other Conditions Updated: 2014-10-09