Dr. Saliveros Apostolos

Diabetes can cause complications arising from hyperglycemia that can either be macrovascular or microvascular. The macrovascular disease affects mainly the cardiovascular and cerebrovascular systems, and the microvascular disease includes nephropathy, retinopathy, and neuropathies. A debilitating complication of diabetes mellitus is diabetic ulcers, which leads to increased overall morbidity in patients and the inciting factor is most often a minor trauma.

Arteriopathy is caused mainly by atheromatosis which is the formation of plaques inside the arteries in people that usually are diabetic, smokers, hypertensive or have high levels of cholesterol. When the plaques grow enough they cause stenosis of the lumen of the vessels and compromise the blood flow. As a result the tissue may not be viable and there is necrosis and thus an ulcer is formed.

In patients with ulcers it is necessary that a vascular surgeon examines them so as to find the cause of the ulcer. If there is a problem in macrovascular level that can be fixed it is of outmost importance to fix it (either with surgery or endovascular techniques) so as to restore the proper flow to the leg. If the problem is in microvascular level then the patient should be given instructions for changing lifestyle (healthy diet and exercise), control all the factors that cause atheromatosis (ie blood sugar levels, arterial blood pressure, levels of lipids in the blood), proper care of the feet (special ointments, correct cutting of nails etc) and of course pharmaceutical treatment.