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How to Determine Whether Foot and Leg Blisters Are Related to Water Retention or Diabetes

Updated on June 24, 2017
Patty Inglish, MS profile image

Degrees in medicine and psychology. Recognized contributions in allopathic & alternative medicine, brain research, and space medicine.

How are your legs today - smooth and feeling good, or achy and blistered?
How are your legs today - smooth and feeling good, or achy and blistered? | Source

Leg and Foot Health Issues

A number of medical patients confuse the symptoms of water retention (also known as fluid retention or edema) with the appearance of chronic diabetic skin blisters. Misunderstandings about the differences between the two conditions can cause undue anxiety in patients and their caregivers.

In simple terms, water retention happens inside the body cavities and tissues to cause swelling of such areas as joints and limbs. In contrast, diabetic blisters occur on the outside surface of the body to cause raised areas filled with liquid.

Disclaimer: The following information is intended to provide a general overview. It should not be used for official diagnosis or substituted for the expertise of a licensed healthcare practitioner. Please see your medical provider for complete diagnosis and treatment.

Water Retention

Click thumbnail to view full-size
This is a foot swollen in a state of edema.A case of lower leg and foot edema. The skin often stretches and can become shiny, as we can see in this case.This foot is swollen because of gout, a form of arthritis. For recurring swelling, see a physician.
This is a foot swollen in a state of edema.
This is a foot swollen in a state of edema. | Source
A case of lower leg and foot edema. The skin often stretches and can become shiny, as we can see in this case.
A case of lower leg and foot edema. The skin often stretches and can become shiny, as we can see in this case. | Source
This foot is swollen because of gout, a form of arthritis. For recurring swelling, see a physician.
This foot is swollen because of gout, a form of arthritis. For recurring swelling, see a physician. | Source

Foot, leg, and ankle swelling are the painless swelling of the feet and ankles as a common problem, especially among older people.

— US National Library of Medicine; Medline Plus, Article 003104

What is Water Retention?

Fluid retention, or edema, and diabetic blisters are different in a number of ways. The first difference is that edema occurs inside body cavities or tissues, while diabetic blisters appear on the skin, outside of the body where you can see them.

Edema does not cause blisters on the skin, but it can cause swelling below the skin layers, inside other tissues and body cavities. This swelling can stretch the skin above the edema and make it look shiny (please see photos above).

Patients can confuse edema with blisters associated with untreated and uncontrolled or poorly controlled blood glucose levels in the chronic varieties of type I and type II diabetes and even hypoglycemia. Pre-diabetes and gestational diabetes are temporary and not likely to produce blisters.

In some cases, a patient might feel it more socially acceptable and less embarrassing to attribute diabetic blisters to "retaining water", but this personal attribution can delay vital treatment. Knowing and accepting the differences between the two conditions is important and supportive family and friends can help the patient accept the correct diagnosis.

The major differences found when comparing edema with diabetic blisters are listed in the table below, with explanations.

Diabetic Blisters

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Blisters resulting from shoes may or may not be related to diabetes. If they are large or occur often and heal slowly, call your doctor.
Blisters resulting from shoes may or may not be related to diabetes. If they are large or occur often and heal slowly, call your doctor.
Blisters resulting from shoes may or may not be related to diabetes. If they are large or occur often and heal slowly, call your doctor. | Source

Edema Compared With Diabetic Blisters (Bullosis Diabeticorum)

EDEMA
DIABETIC BLISTER
DESCRIPTION: Excess body fluid, often lymph, is trapped inside body tissues or cavities.
DESCRIPTION: Raised areas of liquid-filled skin appear and can be quite large on the lower legs.
USUAL LOCATION: Arms, hands, legs, ankles, and feet. Pulmonary edmea occurs within the lungs.
USUAL LOCATION: Calves, shins, and feet. Can also appear on forearms, hands, and fingers.
USUAL CAUSES: Excessive salt ingestion, pregnancy, PMS, cardiopulmonary issues, vein damage in lower legs, lymphatic system compromise, kidney disease, cirrohsis, some medications, injuries, some cancer surgeries, long airline flights..
SUSPECTED USUAL CAUSES: Diabetics can be at higher risk for foot blisters from shoes, especially in the presence of neuropathy that causes numbness; Ultraviolet radiation exposure; possibly trauma, possibly small blood vessel disease (research is ongoing); insufficient blood glucose regulation (type I and type II diabetes and hypoglycemia).
COMPLICATIONS: Pain, stiffness, diffuclty walking (legs/feet), damage to body tissues, internal tissue scarring, increased risk of infection in affected areas.
COMPLICATIONS: Pain, staphylococcal infection that sometimes leads to amputation, bone infection near blister sites if blisters are recurring, ulceration of blisters.
Data from the Mayo Clinic, the National Institutes of Health, The Ohio State University College of Medicine, and the American Red Cross.
Diabetes Type I and II can cause a variety of symtpms, many of them related to the skin, including blisters.
Diabetes Type I and II can cause a variety of symtpms, many of them related to the skin, including blisters. | Source

What are Diabetic Blisters (Bullosis Diabeticorum)?

Infrequently, individuals with diabetes can erupt in blisters on the hands, fingers, lower legs, and feet. Blisters even less frequently may occur elsewhere, like the forearms or thighs.

The blisters look somewhat like second-degree burn blisters and are sometimes large, but they are painless and have no redness around them. They usually heal by themselves, without scars, in about about two to six weeks. The only sure treatment is to bring blood sugar levels under control (Source: diabetes.org/living-with-diabetes/complications/skin-complications.html. Retrieved March 10, 2015).

In some cases in which glucose blood levels are not well controlled, large blisters on the legs may be opened purposely by a patient or opened accidentally by friction from clothing, shoes, or tools. Bacteria enter and the resulting infections are painful and sometimes deadly.

Chronic diabetes can result in a number of skin conditions, described in depth at Skin Complications: American Diabetes Association. Up to 33 percent of people with diabetes will have one of the mentioned skin disorders.

The American Diabetes Association states that the only sure treatment for diabetic blistering is to bring blood sugar levels under control to the advised healthy level.

Embarrassment, Denial, and Effective Treatment

Leg bandages covered by a compression bandage.
Leg bandages covered by a compression bandage. | Source

Very large blisters on the lower legs and forearms can present an embarrassment to patients and their families. A temptation exists to explain away blisters as water retention. Various home treatments frequently fail, causing frustration and additional pain. A few patients pop the blisters against the advise of physicians and then suffer infected wounds or ulcerated areas.

An Example of Severe Diabetic Blisters

A former neighbor of mine aged 55, with moderate obesity, suffered a group of blisters along both calves and shins, each blister reaching three to four inches in diameter. Suffering from Type II Diabetes, she regularly used oral medications, did not want to use injected insulin, and did not test her blood sugar levels. She opened the blisters, hoping they would heal, but suffered bacterial infections.

Her physician cleaned the affected areas, applied a topical antibiotic, and wrapped the legs with gauze, applying tight elastic bandages over the gauze (Please see photo below). Unfortunately, the patient unwrapped her legs, which became reinfected. This happened several times, the last instance requiring hospitalization, before she consented to accept insulin therapy. With a few months of beginning the new therapy, her legs healed and blisters did not reappear. Within nine months, she lost a substantial amount of weight.

Do not try wrapping your own legs at home if you have large blisters, but do see your healthcare practitioner for help.

In the United States, Bullous disease of diabetes has been reported to occur in approximately 0.5% of diabetic patients. Male patients have twice the risk as female patients.

— Maureen B Poh-Fitzpatrick, MD, et.al.Bullous Disease of Diabetes in Medscape; August 24, 2015

When in Doubt, Call a Healthcare Professional

Blisters anywhere on the body may or may not be caused by a chronic form of diabetes. Large blisters on the lower legs often prove to be just that. If your experience smaller blisters that are numerous or recurring, call a healthcare practitioner for help.

Sources

  • American Diabetes Association. (March 31, 2017). Practice Resources for Diabetes Professionals. . Retrieved from www.diabetes.org › Research & Practice
  • CDC: Diabetes. (May 14, 2015). Retrieved from www.cdc.gov/diabetes/home/
  • Grand Rounds. (2014 - 2017). The Ohio State University, Wexner Medical Center and the Diabetes and Metabolism Research Center.
  • Mutasim, Diya. (March 27, 2015). Blisters. Chapter Four. In Practical Skin Pathology; (pp 187 - 194).
  • National Diabetes Education Program; NIH. (Summer 2016). The National Institute of Diabetes and Digestive and Kidney Diseases. Continuing Education.
  • Poh-Fitzpatrick, Maureen B., MD, et.al. (August 24, 2015). Bullous Disease of Diabetes in Medscape. Retrieved from http://emedicine.medscape.com/article/1062235

© 2010 Patty Inglish

Comments and Experiences

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    • Patty Inglish, MS profile image
      Author

      Patty Inglish 2 years ago from North America

      A long-distance acquaintance of mine who lives alone is soon to have foot surgery to remove necrotic tissues and decayed bones. He could not feel his feet for years and could not bend over far enough to see them, preventing him from discovering open lesions and broken toes. He learned of all this when he could not put on his shoes with his long shoehorn and called the EMTs.

    • Patty Inglish, MS profile image
      Author

      Patty Inglish 5 years ago from North America

      100% TRUE AS YOU SAY! A friend began taking insulin treatment and her blisters disappeared.

    • nina64 profile image

      nina64 5 years ago from chicago, Illinois

      Hello Patty, I'm a type 2 diabetic and those blisters are nothing to joke about. In the beginning, I've had these blisters quite frequently; they are extremely painful and bothersome. The key to keeping these blisters under control is to monitor your blood sugar levels and to take your diabetes medication as directed by your doctor. A couple of years ago, I had to have surgery to remove a large painful boil because my blood sugar levels were elevated. If not treated right away, these blisters can spread. We must take care of ourselves!!!!!!

    • Patty Inglish, MS profile image
      Author

      Patty Inglish 5 years ago from North America

      Thanks for your experiences, everyone.

      Has anyone experience with Type 2 diabetics becoming violent when blood sugar dips too low? A neighbor is experiencing this and some research literature says it occurs. What if the person refuses to eat on time? It's a quandary.

    • profile image

      kelleyward 5 years ago

      I'm a type 1 diabetic and high blood sugar levels even just over 140 mg/dl for 1 hour have been shown to raise cardiac enzymes associated with the development of heart disease. Blood sugar control is key. Thanks for your interesting hub!

    • BlissfulWriter profile image

      BlissfulWriter 6 years ago

      High sugar levels is very damaging to the body. I try not to consume too much sugar. It is sometimes frustrating because I am unable to find things in the grocery store that doesn't have too much sugar. Many things have either added sugar or "diet" with sugar substitutes. I think manufactures knows that sugary-taste makes their products sell better and that it is somewhat addictive (so that you buy more of it). But I don't think it is as addictive as cocanie.

    • Hello, hello, profile image

      Hello, hello, 6 years ago from London, UK

      A very helpful and important information. Thank you.

    • D.Virtual.Doctor profile image

      Funom Theophilus Makama 6 years ago from Europe

      This is such an awesome hub about diabetes. Its an invaluable information for people with diabetes to know. Not only for such people but even for non-diabetic individuals too, for a good spread and proper education on diabetes. Nice hub and thanks for sharing..

    • Alison Graham profile image

      Alison Graham 6 years ago from UK

      Thanks for all the information here. My Dad had Diabetes Type 2 so I am watchful myself as I do not want to suffer the complications he had. I did not know this about the blisters, voted up and useful.

    • Eiddwen profile image

      Eiddwen 6 years ago from Wales

      My partner is diabetic and he has these little water blisters, however we didn't know they were related to diabeties until wa read this. I am bookmarking this one in my 'most useful' hubs.

      Thank you for sharing Patty.

      A brilliant and informative hub.

      Take care.

    • Patty Inglish, MS profile image
      Author

      Patty Inglish 6 years ago from North America

      Well, let's all control blood sugar to the best of our abilities, get medical advice if we need it, and be supportive of diabetics. Someone once asked me if there is a required or recommended daily amount of sugar intake suggested by the US government - I had to answer "0". It's a problem with Halloween candy overflowing store shelves right now.

    • Seakay profile image

      Seakay 6 years ago from Florida

      My daughter is diabetic. She is now an adult but it's still a scary thing to deal with.

      Thanks for the additional information! Any time I see writings on diabetes, I'm interested!

    • SteveoMc profile image

      SteveoMc 6 years ago from Pacific NorthWest

      Very informative. Thank you for the explanations.

    • Om Paramapoonya profile image

      Om Paramapoonya 6 years ago

      I'm not diabetic (yet!), but diabetes runs in my family. So I've been trying to educate myself about diabetes as much as I can. This hub is very informative and well presented. Thanks for sharing, Patty. :)

    • Patty Inglish, MS profile image
      Author

      Patty Inglish 6 years ago from North America

      Thanks, susannah42 - The blisters are particular are frustrating to sufferers and interfere with life. I'll be looking for more research in this area.

    • susannah42 profile image

      susannah42 6 years ago from Florida

      Good Hub. Always looking for information about diabetes, my dad has it and I want to learn as much as I can.