Diabetes and Lymphedema

Introduction

Anyone with diabetes and lymphedema faces special health challenges and should take extra care in managing both 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.” [1]

Diabetes and Lymphedema Treatment

When both diabetes and lymphedema are present, the affected tissues face a double threat. Treating 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 great 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. Self-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, for fear of triggering lymphedema or an infection. Illustrating 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. [3]

Insulin Injections

Some people with diabetes 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, a person with diabetes 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. Avoid placing the tube in tissues affected by, or at risk for, lymphedema and ask a physician about safe sites to use.

Peripheral Neuropathy

Peripheral neuropathy is a painful complication of diabetes and blood sugar levels that are not effectively controlled. For more information on this condition and associated recommendations, see the article on Peripheral Neuropathy and Lymphedema.

References

[1] Dr. Reid’s Corner

[2] Lymphedema and Diabetes by C. Lindholm, A, Bergsten, and E. Berglund. J Wound Care 1999 Jan;8 (1):5-10.

[3] Lymphedema 30 years after Radical Mastectomy by M. Brennan and J. Weitz. Am J. Physical Rehabil 1992; 71:12-14.

[4] Living Well with Lymphedema by A. Ehrlich, A, Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005, pages 91-93.

© LymphNotes.com 2009. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema and Other Conditions Updated: 2009-11-13