Diabetes and Edema

Edema is a medical condition caused by the abnormal fluid retention in the spaces between the body's cells or in the circulatory system. 

This medical condition causes puffiness and swelling in several areas of the body, including legs, arms, feet, hands, lungs, heart, or stomach area. 

Is there a connection between edema and diabetes? Let’s find out. 

There are basically three main types of edema associated with diabetes - macular edema, pulmonary edema, and foot and leg edema. The causes of diabetic edema include: 

• Acute liver failure, cirrhosis
• Renal artery stenosis
• Chronic hepatitis
• Cardiovascular complications
• Nephrotic Syndrome or acute renal failure
• Medications used to treat diabetes

Other factors such as premenstrual fluid retention, thiamine deficiency, protein-losing enteropathy, pregnancy and acute anaphylaxis, also contribute to diabetic edema. 

Diabetes and Edema (Macular) 

Macular edema is a condition in which the macular tissue area, near the center of the retina, gets filled with fluid. This area is mainly responsible for vision. 

Macular edema caused by diabetic retinopathy is a complication of diabetes. The vision loss can progress, leading to eventual blindness. 

There are two types of macular edema, focal macular edema, and diffuse macular edema. The first one is caused by vascular abnormalities and can be treated using focal laser treatment. 

The second type is caused by dilated retinal capillaries. This condition can be treated with grid laser treatment, which is used to seal the leakages. 

Macular edema is caused by the increased deposition of fluids and proteins on or under the macula of the eye. The macula is identified as a pale yellow area close to the center of the retina.

A local swelling results from fluid and protein retention in the macula. The swelling soon directly presses against the cones of the retina needed to maintain sharp vision, details, form, and color.

This leads to the decline of central vision and eventually blindness if left untreated.

Macula edema is not only a complication of diabetic retinopathy; it can also be seen soon after cataract surgeries when it can be successfully treated with corticosteroid eye drops and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

In diabetic macular edema, the fluid accumulation is from leaking capillaries.

Drugs can also be combined with laser photocoagulation for more effective treatments. Different studies have found intravitreal injections of two drugs, Ranibizumab and Bevacizumab to provide more benefits for treating diabetic macular edema when combined with laser therapy.

Diabetes and Edema (Pulmonary) 

Pulmonary edema may be caused due to cardiovascular disease/ complications or use of diabetic medications. 

According to September 2001 issue of the Mayo Clinic Proceedings, pulmonary edema treatment involves placing a ‘catheter’ to drain the fluids. 

Diabetes and Edema (Foot and Leg) 

Foot and leg edema may be caused by cardiovascular disease, venous insufficiency, liver conditions, cardiomyopathy, or kidney complications.  

This condition may increase the already high risk of non-healing wounds for the diabetic patient. Treatment includes manual decongestive therapy and diuretics which drains fluids out of affected areas. 

Subsequent to medications and decongestive therapy, compression garments or hosiery may also be prescribed.  It is important to remember that the edema resulting from a complication of diabetes is not the same as lymphedema. 

Swelling from lymphedema is a result of distortion of the lymph system or injury, damage, trauma or destruction to the lymph system due to infections, lymph node removal, and radiation treatments, to mention a few causes.  

Lymphedema can be complicated by diabetes.

Because the immune system is compromised in lymphedema patients, there is also an increased risk of infections in the swollen limb. With diabetic patients, this risk is even doubled because of non-healing wounds associated with the disease.

Therefore, care should be taken that the diabetes is well controlled and the lymphedema is quickly treated.

Lymphedema can be treated using manual decongestive therapy, compression garments and compression bandages and diuretics. Others treatment methods such as compression pump therapy and surgical management may also be used. 

If you have diabetes, keep your blood sugar levels under control to help reduce the risk of edema and other diseases. 

Inform your doctor immediately if you experience sudden changes in your vision or swelling in your feet or legs.  

Treatment for Lymphedema and Diabetes

Manual Decongestive Therapy

Manual decongestive therapy is also known as manual lymphatic drainage. It is the most important treatment when lymphedema presents in diabetic patients.

Manual lymphatic drainage is a massage technique that is best done by professional therapists.

Each session of the therapeutic massage begins by raising and supporting the edematous limb above the level of the heart for 10 – 15 minutes. This allows gravity to return some of the fluid retained in the tissue matrix back into the lymphatic system in the upper leg.

Thereafter, the limb affected by the edema is massaged with firm strokes. These strokes should start from the toes and move up the legs.

When properly done, manual lymphatic drainage follows the map of the lymphatic system in the affected limb. The aim is to return the fluids pooling in the limbs back to the lymph nodes in the groin area.

Diuretics

Diuretics are also effective in treating edema patients. There are 3 classes of diuretics: loop diuretics, thiazide diuretics, and potassium-sparing diuretics.

The loop diuretics, exemplified by Lasix or Furosemide, are the most popular.

They are especially useful for treating patients with peripheral edema and diabetes who also suffer from any of these conditions: renal impairment, liver cirrhosis, nephrotic syndrome and heart failure.

Thiazide diuretics are also effective but they are not recommended for diabetic patients. This is because thiazides affect the ability of the body to maintain optimal glucose control.

In addition, thiazides promote the accumulation of uric acid. This may complicate lymphedema by causing gout in some people.

Potassium-sparing diuretics differ from the other two types of diuretics because they not flush out potassium ions along with sodium and water. They are recommended for patients who may show symptoms of hypokalemia.

Compression Products

There are different compression products used in the treatment of edema complicated by diabetes. These include compression stockings, compression gloves, compression bandages, compression sleeves and compression garments.

The general principle of compression wear is to provide sufficient pressure on the body part affected by the edema. This pressure is placed to encourage blood circulation and the return of fluids to the lymphatic system.

The compression pressure is often graduated with the highest pressure provided in the area where the greatest constriction allows fluids to pool the most.

For example, compression stockings put the highest pressure on the ankles so that the squeezing force of the elastic material encourages increased blood fluid in the veins and the movement of fluids in the lymphatic system to the lymph nodes at the groin.

Exercise

Exercise is also important for treating edema complicated with diabetes. As long as a degree of mobility is still achievable, exercise should be encouraged.

Short, regular, aerobic exercises are the ideal. Exercises help the muscles to flex and blood circulation to resume. These prevent more fluids from pooling in the extracellular spaces and force the fluids retained to be redistributed to the lymphatic system for emptying.

For more information about edema treatments, read these articles: Edema Diet: Foods to Avoid, Leg Edema Treatment, and Types of Edema.