Foot and Leg Blisters: Water Retention or Diabetic Complication?
Disclaimer: I present the following information distilled from my own experiences while working in two health psychology practices for over a decade of employment, and in subsequent alternative health practice.
The information below should not be substituted for one's own healthcare practitioner's advise, based on one's own case history and current health status. When in doubt, see your physician or other practitioner.
American Diabetes Association Assertion
Diabetic Blisters (Bullosis Diabeticorum)
Rarely, people with diabetes erupt in blisters.
Diabetic blisters can occur on the backs of fingers, hands, toes, feet, and sometimes, on legs or forearms. These sores look like burn blisters and often occur in people who have diabetic neuropathy. They are sometimes large, but they are painless and have no redness around them. They heal by themselves, usually without scars, in about three weeks. The only treatment is to bring blood sugar levels under control. Reference: www.diabetes.org/living-with-diabetes/complications/skin-complications.html. Retrieved March 10, 2015.
NOTE: The American Diabetes Association states that the only sure treatment is to bring blood sugar levels under control to the advised healthy level.
However, there is such a condition as uncontrollable diabetes, just as there is uncontrollable high blood pressure. I have found among people I have known with these blisters that they may be painless until opened purposely by a patient or opened accidentally by clothing rubbing against them. The open areas are sites for the infiltration of bacteria and infections that can be deadly. They can be extremely painful.
Blisters can be caused by friction, when diabetics suffer related nerve damage (neuropathy) and can no longer feel their fingers, hands, toes, and feet. They sometimes cannot tell whether their shoes fit and some cannot bend over to see their feet and possible blisters, because of obesity. The blisters may become large, opened, and infected.
Candida albicans is a fungus that can infect diabetics and cause blisters. This causes a red itchy rash surrounded by blisters and scales in heavy moist folds of skin, like under the breasts, between digits, under foreskins, and armpits/groin. Prescription medications help.
A woman in my neighborhood suffered from diabetes for many years. She passed off the large and growing blisters on her leg as hereditary water retention that could not be treated.
This individual finally required surgery to the legs and feet to remove dead tissues and crumbling bones in one toe. This was followed by the removal of a toe on each foot.
Water retention, also known as fluid retention, refers to an excessive build up of fluid in the circulatory system, body tissues, or cavities in the body (not on the skin).— Christian Nordqvist; Medical News Today; September 8, 2015
Blood Glucose Levels Must Be ControlledClick thumbnail to view full-size
Embarrassment and Denial
Huge blisters on the lower legs and arms can present an embarrassment to the patient suffering complications of diabetes mellitus. A temptation exists to explain these monstrosities away as a manifestation of water retention on the part of both patients and some healthcare practitioners.
Some of these blisters are so exorbitant as to take up the entire surface area of a lower leg, thigh, or forearm. Various treatments may or may not work, causing extreme frustrations in suffering individuals. Some patients comply with all treatments, yet nothing works to relief and eliminate the blisters. A few patients take a stance of denial of diabetic complications in order to protect and sustain diabetes-risk behaviors that they do not want to give up. These individuals, I think must be more miserable than the res
Some individuals that persist in risky behaviors reach a point at which they can no longer wear long-legged pants/trousers or sleeves of any kind on blouses and shirts, because the material rubs the blisters down to raw open wounds.
A few people pop the blisters against the advise of the physicians and the resultant wounds become infected, some ulcerated, even to a life-threatening extent of deadly infection. These affected people thought that the blisters would go away if opened and the fluids allowed drained, yet some of them lost a leg or both legs as a result. However, this is not common.
Diabetic Complications Can be Widespread
While the few patients that deny their complications as related to diabetes rationalize all these potentially dangerous symptoms, they do so in order to protect and sustain self-destructive behaviors such as
- Ingesting large quantities of sugar and carbohydrates - sometimes daily,
- Refusing or forgetting to test their blood sugar levels, and
- Forgetting or refusing to take their diabetic treatment medications in tablet and/or injection forms.
Some suffering individuals mistakenly believe that if they take their medications as directed, they can simply eat as much sugar - and anything else - as they like. Others dismiss blood sugar rises with statements such as, "Sure my blood sugar goes up, but it comes right back down."
In some of these cases, the body's requirement for diabetic medications seems to increase in numbers of separate medicines prescribed and in rising dosages of each. For example, given increasing instances of diabetically risky daily behaviors, a patient may progress from A) taking one oral medication to B) requiring two oral medications and two different types of injection insulin on a daily basis (I saw this extreme only once).
Type II Diabetes (adult onset) can begin in teenagers and a few isolated parents may not notice or may refuse to consult a healthcare practitioner about it.
They may think symptoms will go away or are faked. However, overly-frequent urination is uncomfortable, embarrassing, inconvenient, and a sign that a medical condition may be present, particularly Diabetes Type I. Yet in isolated cases, a parent (especially on a trip) will refuse to allow the teen to stop for the restroom.
The young person begins hiding symptoms and refusing to go anywhere, because of difficulties in being allowed to use the restroom. Risky eating behaviors and diabetic complications escalate and are hidden in the future or rationalized as something less severe.
One example is a couple who are of average height, both over 350 pounds in weight, eat in restaurants for dinner 7 day a week - but TWO restaurants each night and two full dinners each. They also eat big unhealthy breakfasts and lunches. They crave carbohydrates rather than sugary desserts.
Another example of diabetically risky behavior would be an uninsured 400-pound woman only 5"0" tall who does not/can not comply with medical advise, medications, and instructions, and eats 400 chocolate candy bars a year in addition to unhealthy restaurant meals.
Diabetic Blisters and Help
- PHOTO ESSAY: Spontaneous Blisters in Diabetes
Several photos of diabetic blisters on extemities, with comments. Unviersity of California, Davis.
- Skin Complications: American Diabetes Association®
As many as 33 percent of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives.
The first best treatment for diabetic blisters is to lower the blood sugar level and to keep it at a healthy level through effective nutrition, exercise, and medications as needed.
One other medical treatment for diabetic blisters that some practitioners employ is the thorough cleansing of the affected blistered areas (the process can be painful if the blisters have been purposely popped or rubbed open by clothing), applying topical antibiotic medication, and if apparent on the limbs of the patient, wrapping these limbs tightly with gauze and then with elastic bandages over the gauze for several days.
Some patients use wrapped gauze on the legs under a type of elastic hosiery used to prevent blood clots in the legs. Please do not try this on your own without a doctor, because most official advice from the American Diabetic Association and other legitimate health organizations is that the blisters (un-popped) will heal themselves in 2 to 4 weeks, but blood sugar level must be controlled to sustain healing.
- Practice Resources for Diabetes Professionals. www.diabetes.org › Research & Practice. Retrieved March 31, 2017.
- National Diabetes Education Program; NIH. The National Institute of Diabetes and Digestive and Kidney Diseases. Continuing Education, Summer 2016.
- Blisters. Chapter Four, Practical Skin Pathology; pp 187 - 194.. Diya Mutasim. March 27, 2015.
- CDC: Diabetes. www.cdc.gov/diabetes/home/ Retrieved May 14, 2015.
- The Ohio State University, Wexner Medical Center and the Diabetes and Metabolism Research Center. Grand Rounds, 2014 - 2017.
© 2010 Patty Inglish