Peripheral vascular disease

[livabet1]

Hi,
I seem to have the symptoms of PAD (thickened toenails, loss of hair on legs) in spite of having a Hb1Ac of 34. I have been a type 1 for 60 years. My BMI is 28. I walk on average 12km/day. Why is this happening to me?

 

[tim2000s]

Hi @livabet1 Congratulations on 60 years with Type 1. That's a long slog. Have you spoken to any healthcare professionals about your concerns? That might be a good place to start.

As it stands, whilst a low Hba1C is a good indicator of the relative risk of complications, it's not a definite indication, just a strong correlation, and over that 60 years, the highs, lows and simply exogenous insulin play a part in complications, as do genetics. Good luck with your investigations. I hope the answer turns out to be the one you want.

 

[TheBigNewt]

Hi,
I seem to have the symptoms of PAD (thickened toenails, loss of hair on legs) in spite of having a Hb1Ac of 34. I have been a type 1 for 60 years. My BMI is 28. I walk on average 12km/day. Why is this happening to me?

Those are not the typical signs of PVD, they are pretty nonspecific. PVD is not a common complication of Type1DM, it's much more common in Type 2, and particularly in those who smoke and/or have high lipids. It's considered a "macrovascular" complication/disease (like coronary disease which I treat, or carotid disease which goes with high blood pressure) Type 2's are prone to these. We are more prone to get "microvascular" disease like retinopathy and nephropathy (kidneys).
Simple screening for PVD is pretty easy: Search for the "pedal pulses". The dorsalis pedal pulse is on the top of the foot usually between the great toe and the second toe a ways up. The posterior tibial pulse is behind the medial malleolus the bone that sticks out on the inside of the ankle. If you (or someone) can feel those 4 pulses without difficulty you don't have significant PVD. The classic symptoms are aching/cramping of the calf muscles with exertion, like hiking uphill, relieved by rest. You say you walk 12k/day so I'm assuming you don't have to stop because your calves cramp up. I'm betting you don't have it. Check for the pulses just for grins.

 

[Fairygodmother]

Those are not the typical signs of PVD, they are pretty nonspecific. PVD is not a common complication of Type1DM, it's much more common in Type 2, and particularly in those who smoke and/or have high lipids. It's considered a "macrovascular" complication/disease (like coronary disease which I treat, or carotid disease which goes with high blood pressure) Type 2's are prone to these. We are more prone to get "microvascular" disease like retinopathy and nephropathy (kidneys).
Simple screening for PVD is pretty easy: Search for the "pedal pulses". The dorsalis pedal pulse is on the top of the foot usually between the great toe and the second toe a ways up. The posterior tibial pulse is behind the medial malleolus the bone that sticks out on the inside of the ankle. If you (or someone) can feel those 4 pulses without difficulty you don't have significant PVD. The classic symptoms are aching/cramping of the calf muscles with exertion, like hiking uphill, relieved by rest. You say you walk 12k/day so I'm assuming you don't have to stop because your calves cramp up. I'm betting you don't have it. Check for the pulses just for grins.

Wow, that's really informative and reassuring. Could the reduction of hair on legs be age-related, and thickening toenails possibly due to either footwear or a fungal infection?

 

[TheBigNewt]

Wow, that's really informative and reassuring. Could the reduction of hair on legs be age-related, and thickening toenails possibly due to either footwear or a fungal infection?

I imagine so. Think about it: if the circulation to his legs was so bad the hair falls out do you think he'd be able to get enough blood to his leg muscles to walk 12k/day? Right?

 

[LIANNEJO]

I have pvd and have had for 4 yrs now and I agree with the above, if you are able to walk without being in a lot of pain, or needing to rest because of such pain then it is unlikely to be pvd. Because of pvd my walking was affected immediately and has remained the same since. I can only walk slowly,with no speed so also means no running and I can't jump either, these activities are now physically impossible for me now!!
Best scenario tho with any changes you notice to your body,(and in particular your legs/feet) is to make sure you mention it to one of your health care profession cos if it does turn out to be something that needs treated, better it gets picked up sooner rather than later.

 

[Diamattic]

This may be totally off topic but is the hair loss on your legs the entire leg, or in patches / specific places?

I ask because 12km per day is a lot of walking, and I know when I get really active my legs develop bald patches from where my pants / socks/ underwear/ etc rub on my legs. The same thing happened to my father when was working in a factory - he wore the same uniform everyday and it rubbed in a way that it would rub all the hair off of his calves - we always teased him lol
No that he has retired it has grown back, but my point is - could the loss be from something else?