Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educatoAsk-DMine_buttonr Wil Dubois. This week, Wil explores a complication that may or may not be related to diabetes, along with the truth about teeth in honor of National Dental Hygiene Month (which is going on now in October!). He's just full of advice, so read on...

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Bruce, type 2 from South Carolina, writes: I have leg pain when walking due to intermittent claudication and underwent testing and a nuclear stress test where the cardiologist suspects some arterial blockage.  He is going to do a heart cath and if there is significant blockage may insert a stent. This doc is part of a stand-alone heart hospital and they have performed literally thousands of heart procedures. I understand that the arterial blockage has little if anything to do with the leg issue, but are there any special problems that diabetics have with such procedures? By the way, my A1C is excellent, as are my blood pressure and cholesterol levels. Thank you.

Wil@Ask D'Mine answers: Ummmm.... I wouldn't be so sure that the leg pain and the blocked artery are unrelated. I'll bet the root cause is one and the same. But before we can get to that, we need to talk about PAD. This isn't where you crash for the night, how you keep your wife from bouncing checks, or an inked piece of rubber that the cops use to fingerprint you at the end of a bad day. Well, actually, it could be any of those things, but today you need to know that PAD is medical slang for Peripheral Artery Disease, which is one of those diseases that sounds scarier than it really is.

In kindergarten English, PAD is nothing more than narrow arteries. That's not to dismiss PAD as being unimportant. It's a huge risk factor for tombstone stuff like heart attacks and strokes down the road. PAD is a precursor to atherosclerosis according to some experts, and is a side effect of it according to others—it's one of those tricky chicken and egg areas of medicine with blurry, fuzzy edges. But what's not blurry are the statistics around PAD. It's a widespread condition. The older you get, the more likely you are to get it. And yes, of course, people with diabetes are at higher risk of getting it than pretty much anyone else.

clogged-arteriesWhat causes this narrowing of the arteries? Fatty deposits. Just like the ones near your heart they're getting ready to stent. The PAD deposits are just lower down in your body. Anyway, if these arteries get too narrow, not enough oxygen-rich blood gets to the tissues on the far side of the narrow spot, so the muscles get oxygen-starved and start screaming. Thus the classic PAD symptoms of tingling in the legs or leg pain ranging from mild to OhMyGod! And it also explains why many people with PAD, such as yourself, have trouble walking: Muscles in action need more oxygen (and sugar) than muscles at rest. When you try to walk, the needs of the muscles go up and the symptoms get worse.

The good news is that PAD is treatable and reversible. The first thing to do, if you are a smoker, is to quit. Right now. Today. Sorry, but smoking has a vaso-constricting effect; it makes your veins and arteries even more narrow. Next comes changes in diet, if your diet is fatty. Then commonly statins and other meds to lower bad cholesterol and raise good cholesterol. Failing all of those, you need to go under the knife: Stents are sometimes used, as are arterial bypasses in severe cases.

Meanwhile, on the radical fringes—and this is really cool—there's a non-invasive treatment called Enhanced External Conuterpulsation (EECP) that uses squeeze pads timed to the rhythm of your heart to force extra blood through the constricted area. Proponents claim that this can lead to revascularization around the constricted area: Basically, your body builds a permanent detour of smaller blood vessels around the constricted larger one.

So, Bruce, if they want to stent your heart, and you have PAD, it would seem you have a lot of fatty buildup inside your circulatory system. Bummer. As your cholesterol is good, you're probably wondering how this has happened to you.

I have no frickin' idea.

My best guess is that you are paying for the sins of your youth. You've got kick-ass good cholesterol now. But what about last year? Five years ago? Ten? Twenty? Those fat buildups can hang around a long time.

Now, you asked about special worries for D-folks and stenting. The news ain't great. We have a well-documented increased risk of "restenosis." That means exactly what it sounds like: Stents fail in D-folks more often than other folks, and those of us who need insulin have even higher failure rates. And it doesn't seem to matter if traditional or fancy medicine-soaked stents are used.

And, bummer and major suckage, we are also much more likely to die in the year following a stent placement, although the numbers aren't super high (5.7% vs. 2.9% for non-D-folks). Don't let that nearly 6% risk scare you off from getting the procedure if your doc says you need it. I can't find any mortality stats on people who refuse stents, but I'd bet more than a box of Krispy Kreme doughnuts that it's heaps higher than 5.7%.

That's all so depressing I think we need to change the subject and talk about something more upbeat... like going to the dentist. OK, I know I'm grasping at straws here, but it is National Dental Hygiene Month after all. No, really, it is.


Staci, type 2 from Kentucky, writes: I hate going to the dentist, it feels like visiting a medieval dungeon! But my doctor was telling me that simply getting my teeth cleaned twice a year can lower my A1C. Is that a bunch of bull? And if not, how does that work?

Wil@Ask D'Mine answers: I hear you on going to the dentist, sister, but the cleaning thing is no bull. The widely quoted number is that getting your teeth cleaned drops A1C about a full point. Wow! That's as good as any of our fancy-pants diabetes pills! A more systematic review of all the literature available suggests that it might not be quite that good in all cases, but good enough to warrant the advice that everyone with diabetes should consider his or her dentist (or hygienist) to be as important a member of the care team as the doc, the educator, and the pharmacist.

The mechanics of it are simple: No matter how much or how well you brush and floss and whiten, crap likes to grow in your mouth. All kinds of little critters hide in the recesses between your teeth and up into your gums. Your mouth is warm, wet, dark—and in us D-folks—often rich in glucose. It's a perfect incubator! Really, it's infection city in there. (Sorry in advance to all of you type 3s who didn't get a kiss this morning because your loved one started the day by reading me.)

And what does infection do? Any infection from UTI's to flu to plague to the common cold causes our blood sugar to go up. That's just what having an infection does. It stresses us out on a metabolic level. A gum infection like gingivitis, which affects between 70-90% of all adults, creates a low-grade on-going inflammatory process. It's like leaving a pot of soup on the lowest simmer setting on top of your stove. Maybe it will never boil, but it sure as hell will stay hot.

A regular cleaning is just making sure the stove is off.Pimp My Dentist

So I guess it's cheating to say that getting a cleaning actually lowers your blood sugar. It really just normalizes it, infection-wise. It keeps it from rising. Still, folks who don't get dental cleanings have higher A1Cs than those of us who do.

Now about the dungeon. I used to hate to go to the dentist. It was scary. They have tools that would make a CIA interrogator break out in a cold sweat just looking at them. You have to lie down. Lights blind you, water hoses drown you. The noises and smells are creepy and strangers have their hands in your mouth! And there is always the risk of pain...

So what's to love about all of that?

Not a thing. But here is what I found out: Not all dentists' offices are like that. Well, I guess they all have the tools and all, but the experience does not need to be a bad one. (Some practices have modern architecture and hip music and really nice receptionists.) I've found a very professional outfit that treats me great. I still get nervous and don't look forward to going, but I've never actually had a bad experience there.

So I think if you HATE going to the dentist, you are probably going to the wrong one. Hey it's dental month, so why don't you celebrate by taking a new dental team for a test drive? Then just lie back and enjoy your new (lower) A1C.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.