People with diabetes are more prone to blood flow problems known as peripheral vascular disease and nerve ending issues known as neuropathy. Excess glucose creates damage to the blood vessels and nerves especially the smaller vessels and weakens the veins. Although there is no direct link between diabetes and varicose veins, many people suffer from these conditions simultaneously. “50% of people 50 and over have varicose veins.” Although not as troublesome as neuropathy or PAD, varicose veins can be painful and troublesome. They are more common in women due to their fluctuating hormone levels but are seen in men as well. Varicose veins can have a negative impact on blood circulation. Let’s examine varicose veins:

What are Varicose Veins?

Varicose veins are enlarged, elongated, bulging blue and purple veins that resemble cords and are twisted directly under the skin due to relaxed vein walls. The veins have a one-way valve “that prevents blood from flowing backwards due to the pull of gravity.” Over time, and for specific reasons, the vein valves become faulty and relax. Some of the blood, which should be traveling to your heart, backs up and pools in the veins. This then continues to weaken the vein walls. Besides large varicose veins, the relaxed valves can cause spider veins which are smaller, superficial and mostly cosmetic. They are usually found on the calves or on the insides of the thighs. Varicose veins can also cause venous insufficiency which is a true circulation problem that can occur in deeper veins and cause blood clots.Varicose Veins Diagram

What are the Risk Factors of Varicose Veins?

One of the biggest risk factors is heredity and family history. Other risk factors are: being over the age of 50, being pregnant due to increased blood volume/hormones, and going through menopause due to hormone fluctuations. People who stand most of the day such as nurses, teachers, and operating room technicians have a higher risk of varicose veins. Obesity, due to pressure on the veins, is another risk factor for the development of varicose veins. Those who have chronic congenital heart valve conditions are more at risk for varicose veins.

What are Symptoms of Varicose Veins?

They can cause swelling in the ankles or legs, tingling in the legs, fatigue in the legs, redness, throbbing, aching, heaviness in the legs, chronic inflammation, cramping, darkening of surrounding skin, fullness, itching and a possible rash. The symptoms usually are worse after long periods of sitting or standing still.

What can Happen When you Have Varicose Veins?

Because of pooling blood in the veins you are more at risk for blood clots, infections, sores and skin ulcers in the area of the vein. Avoid sitting and standing still for long periods of time. Skin ulcers occur because of fluid buildup and pressure of the blood on the veins. People who have varicose veins can suffer from thrombophlebitis which is a blood clot within the varicose vein. Generally superficial, thrombophlebitis is more common with varicose veins. It can cause the vein to become red and hard. Usually the superficial kind of phlebitis is treated with an analgesic such as aspirin and elastic support hose. If not treated, the clot could travel to the lung called a pulmonary embolus and cause shortness of breath and a severe problem if not treated. Always report any change of color, tenderness or hardness in your varicose veins to your physician.

Having varicose veins may also increase your risk of cellulitis which can become critical. According to the Mayo Clinic, “cellulitis is a potentially serious bacterial skin infection. It appears as a swollen red area of skin that feels hot and tender.” Although it can appear anywhere, it is mostly seen in the lower legs where most varicose veins appear. Because diabetes can weaken your immune system, your risk for cellulitis increases especially with varicose veins. Cellulitis can appear as red blisters, tenderness, swelling or a fever. The vein swelling may cause a break in the skin which allows in streptococcus or staphylococcus bacteria. If not treated, the infection can spread to the blood stream and lymph nodes developing into a life threatening condition.

How are varicose veins diagnosed?

After a physical exam including height, weight and palpation of the veins, a complete medical history including family history is done. An ultrasound is then performed to check the blood flow in the legs. It is a non-invasive test given by an ultrasound technician by placing a hand held transducer against the skin. This allows an image to be seen on a monitor using high frequency sound waves. The ultrasound offers information to the physician who can then make informed decisions on how your vein problems should be treated.

Natural Remedies for Varicose Veins

Possible natural ways to help with varicose veins- Always check with your health care provider prior to trying out natural ways to treat your varicose veins. If approved you might want to give these options a chance:

  1. Exercise, as with treating diabetes, is one of the best natural ways to help with varicose veins since it stimulates blood flow. Most forms of aerobic exercise work such as walking, running, cycling, climbing up and down steps or using an elliptical. One of the best forms of exercise for vein health is swimming. According to Dr. Jon Matsumura, chair of vascular surgery at The University of Wisconsin, “the contraction of your leg muscles and the pressure of the water helps move blood through the veins.” A 30-minute daily swim workout can achieve multiple benefits.
  2. Aromatherapy and Essential OilsConsider using pure essential oils if approved by your doctor. There is no current concrete research stating essential oils will help varicose veins but lavender, ginger and peppermint oil may ease pain and reduce inflammation along with giving a calming sensation. Rosemary oil may improve circulation. Always dilute these pure essential oils in water and gently place on a wash cloth or use your hands to gently rub into the area of concern only if there are no open skin areas. Never place oils on open skin.
  3. Some recent studies have suggested taking a 500mg bioflavonoid supplement daily. “Anti-oxidants called oligomeric proanthocyanidins did better than a placebo at reducing swelling, aching and pain associated with varicose veins.” Horse chestnut extract may help small varicose veins since it strengthens vein walls due to a compound called aescin. Some clinical trials showed that “horse chestnut may reduce inflammation and leakage.” Again, always check with your physician prior to starting any of these supplements since they may have a negative effect on the liver or kidneys. Try not to cross your legs and if you must, do so for short periods of time crossing at the ankle only.
  4. Eat an adequate amount of fiber. Fruits, vegetables and whole grains promote regularity and regularity eases pressure on the veins. Ask your physician if you should take a fiber supplement if you are not getting regularity results with foods alone. Remember to drink a sufficient amount of water while increasing fiber content.
  5. Avoid tight waist bands which put excess pressure on the veins as well as elevate legs above heart level when relaxing.
  6. Sleep with pillows under your knees to elevate feet and lower legs.
  7. Try to reduce sodium content in food which will help reduce leg and vein swelling.
  8. Get up frequently and do calf raises/toe raises to get blood circulating.
  9. Consider compression stockings which may ease pooling of the blood and preserve the already weakened vein. You may need to check on proper fitting of these stockings since they come in various pressures on different areas of the legs. You should purchase at least two pairs so you can wear one daily and keep one pair freshly washed and ready to go. Compression stockings should be replaced every six months since the fibers weaken over time.

Medical Forms of Treatment

There are multiple ways to treat varicose and spider veins performed by board certified vascular surgeons or cardiologists with special training. Ambulatory Microphlebectomy is performed in the office with local anesthesia. Tiny cuts are made over the veins and they are “teased out with surgical hooks.” There is minimal pain and down time. Ultrasound-guided Chemical Ablation or Sclerotherapy is a procedure used for deeper veins that can’t be treated by a laser. A chemical such as salt solution or foam is injected into the vein with guidance from an ultrasound. A pressure bandage is then placed to help seal the vein shut and help the vein be reabsorbed into surrounding tissue. The blood is now diverted to normal functioning veins. There may be some bruising and swelling, but these symptoms are usually mild and disappear quickly. Endovenous Ablation involves a thin catheter with laser energy being threaded down the vein by the physician and is used to cauterize or burn the vein. The laser then seals it off. It is usually performed on the great saphenous vein which can back up and cause a varicosity or bulging in smaller veins. Treatment is only an hour but recovery can take up to two months. Newer treatments are now cropping up. VenaSeal is relatively new and not covered by insurance and it seems even simpler than the laser. It is also an outpatient procedure. “An adhesive similar to super glue is injected into the vein and seals them off after applying pressure.” The risks of complications are low with this procedure and patients experience minimal down time and bruising. MOCA is Mechanochemical Ablation that uses an infusion catheter that “agitates the vein lining with a rotating wire tip and injects a liquid sclerosant to seal the vessel.” There is no need for anesthesia and this option poses a low risk of nerve damage.

Although varicose and spider veins are often just a cosmetic problem, many people also suffer with painful symptoms. With diabetes, your risk can be increased for these vein issues so be aware of what can be done to minimize the problem.

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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