In the Global PAD Association’s New Patient Orientation, we got the straight talk on the connection between Diabetes and poor leg circulation, known as Peripheral Artery Disease, from Interventional Cardiologist Dr. Paul Michael from Sebring, Florida. He offered a profound perspective shift on how we think about this disease that affects millions of Americans.
“Diabetes is a vascular disease,” Dr. Michael stated plainly. Not just a blood sugar disease, not just a metabolic condition – but fundamentally a disease of our blood vessels.
This distinction matters more than you might think, especially if you’re experiencing symptoms like burning, tingling, or numbness in your feet and legs.
Too often, these symptoms are brushed off as “just neuropathy” – an inevitable consequence of diabetes that you simply have to live with.
But what if that “just neuropathy” diagnosis is missing a critical piece of the puzzle?
The Dangerous Disconnect
For over 50 years, diabetics have been systematically excluded from cardiovascular trials and studies. As Dr. Michael explained, diabetes “mucks up the data” because it affects virtually every bodily system. This exclusion has led to a dangerous disconnect in how we diagnose and treat diabetic patients.
Here’s the reality check: insulin resistance, the driving force behind type 2 diabetes, is at the root of over 80% of cardiovascular disease. Yet when diabetic patients present with symptoms like leg pain, non-healing wounds, or numbness, doctors often fail to investigate whether those symptoms could be caused by poor circulation rather than nerve damage alone.
This is where Peripheral Artery Disease (PAD) enters the picture – a condition where narrowed arteries reduce blood flow to your limbs, particularly your legs. And if you have diabetes, you’re at significantly higher risk.
When Your Doctor Says “It’s Just Neuropathy”
Too often, I hear stories from patients who were told their symptoms were “just diabetic neuropathy” without ever having a simple vascular assessment. Here’s why that’s dangerous:
- The symptoms of PAD and diabetic neuropathy can overlap
- Diabetes damages arterial walls, accelerating plaque buildup
- Diabetes makes blood thicker and more difficult to flow through narrowed vessels
- PAD risk is 2-4 times higher in diabetic patients compared to non-diabetics
- Without proper blood flow, even minor injuries won’t heal, potentially leading to amputation
As Dr. Michael powerfully put it: “Critical limb ischemia (severe PAD) literally severs a body part from the whole body. But that’s exactly what diabetes does – it starts to sever pieces of the body from the body. It starts to sever the person from their community.”
Below-the-Knee Disease: The “Untreatable” Myth
Perhaps most concerning is the persistent myth that below-knee arterial disease – which is particularly common in diabetics – is “untreatable.” I regularly speak with patients who’ve been told: “Those vessels are just too small and they’ll just close up again, so why delay the inevitable? Let’s just amputate.”
This outdated thinking ignores the remarkable advances in endovascular techniques and tools specifically designed for these smaller vessels. Today’s interventional specialists can navigate vessels as small as 1-2mm in diameter – about the width of a spaghetti noodle.
A 2020 study in the Journal of Vascular Surgery demonstrated successful revascularization of below-knee vessels in diabetic patients with critical limb ischemia, with limb salvage rates exceeding 80% at one year. Yet many patients are never offered these options.
The Root of the Problem: Process Living
What makes Dr. Michael’s approach so refreshing is his focus on the root causes of diabetes and PAD, not just the symptoms. He describes how our “hyper-processed” lives – from the foods we eat to our disconnection from our bodies – create the perfect conditions for insulin resistance and vascular disease.
“When we hyper-process food, we remove meaning out of food, which means we no longer have anything that’s nutritious,” he explained. “That combination of processed carbohydrates and bad fats doesn’t exist in nature. So we weren’t designed for that.”
This modern diet creates a cycle of insulin resistance, which then fuels the vascular damage that can lead to PAD and eventually, for too many patients, amputation.
Breaking the Cycle: A Different Approach
Rather than simply prescribing more medications, Dr. Michael advocates for a complete approach that addresses both the physical and psychosocial aspects of diabetes and vascular disease:
- Addressing insulin resistance through personalized nutrition plans
- Recognizing early signs of vascular problems before they become limb-threatening
- Comprehensive vascular assessment for ALL diabetic patients with leg/foot symptoms
- Interventional treatment when needed, even for below-knee disease
- Patient education that empowers you to regain control
“In our practice, we are geared towards taking people off medicines, not prescribing medicines,” Dr. Michael shared. “And I think that’s really the measure of what a healing-type healthcare practice should look like.”
Don’t Become an Amputation Statistic
Every four minutes, someone in America loses a limb to diabetes and vascular disease. Yet studies consistently show that 80% of these amputations are preventable with proper diagnosis and treatment.
If you’re experiencing:
- Burning, tingling, or numbness in your feet
- Leg pain when walking that resolves with rest
- Sores or wounds on your feet that won’t heal
- Cold feet or legs compared to the rest of your body
- Loss of hair on your feet and lower legs
…don’t accept “it’s just neuropathy” as the final answer. Insist on a vascular assessment that includes:
- Ankle-Brachial Index (ABI) testing
- Arterial duplex ultrasound
- Pulse volume recordings
And most importantly, if you’re told amputation is your only option, ALWAYS get a second opinion from a vascular specialist experienced in treating below-knee disease.
The Global PAD Association Is Here to Help
We created the Leg Saver Hotline precisely because too many patients don’t know where to turn when facing a potential amputation. Our team can help you:
- Understand your symptoms and what tests you should ask for
- Connect with specialists experienced in limb salvage techniques
- Navigate the healthcare system to get appropriate care
- Find support from others who’ve been in your situation
Don’t let diabetes sever you from your limbs, your mobility, your community, or your identity. Call our Leg Saver Hotline at 1-833-PAD-LEGS or visit globalpad.org to learn more.
As Dr. Michael so eloquently said: “The number one risk factor for PAD is diabetes, and diabetes is fueled by human behavior, and that human behavior severs us from our body, it severs us from the community, and it severs us from ourself.”
It’s time to reconnect.
The Global PAD Association is a patient advocacy organization dedicated to reducing preventable amputations through education, advocacy, and patient support. If you or someone you love is experiencing symptoms of PAD or has been told amputation is necessary, contact our Leg Saver Hotline at 1-833-PAD-LEGS.
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