John, type 1 from Montana, writes: Hello, do you have a newsletter for people with type 1 diabetes? Also, I am a 71-year-old male and my toes are turning blueish. Could that be due to poor circulation in my toes? 

Wil@Ask D’Mine answers: We sure do have a newsletter! It comes out once a week, and features our top stories of the week on all things T1D. You can sign up here in a jiffy. Now, as to your blue toes, there are a number of possible causes, including, as you suspected, issues with circulation.

The white coats call blueish toes peripheral cyanosis. “Peripheral” being the outermost part of anything, and “cyan” being a color of blue you can find at the Sherwin Williams paint store. These blues can be caused by either the blood in the periphery of your body being short on oxygen, or by a lack of blood reaching the periphery.

Apparently, the blue/grey color comes from the fact that while normal oxygen-rich blood is bright red, it turns deep burgundy when the oxygen levels are low. This, in turn, results in more blue light being reflected, and hence the blue our eyes see. Yeah, I know. It sounds crazy, but there you have it. And I couldn’t really find a good explanation of why you get the same color when blood has plenty of oxygen but is in short supply.

At any rate, to better understand what’s going on when blood is short on oxygen, you can picture a chain of agricultural communities along a river during a drought. The farmers up river get plenty of water for their fields, but the guys down river end up with diddly squat because the fields up river have used up all the water.

Similarly, in the case of a body short on blood oxygen, plenty of blood flow gets to the end of the line, but the cells upstream have stripped it of oxygen. Common causes of this would be acute lung infections like pneumonia, or chronic lung conditions like COPD. Basically, anything that causes the body to be unable to get enough oxygen. This said, when the entire body is short on oxygen, the cyanosis tends to be more widespread than just the toes. Lips turn blue next, and then sometimes, the entire skin. And we’re not talking about it in a charming way, like the Blue Man Group.

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Blood flow disruptions and heart issues can be the culprits if your toes are turning blue.

Moving on to circulation issues when the blood has enough oxygen, there are no end of possibilities in this department, but they break down into two wide categories: Things that obstruct the blood flow, and things related to the pumping action of the heart. In the latter case, the toes are a loooong way from the heart, so if the heart is not up to the task—if it’s pumping too weakly—then there may not be enough pressure in the system to adequately reach the toes, giving them the blues. The menacingly named heart failure (not as fatal as it sounds) would be a good example. But it doesn’t need to be a heart condition: beta blocker heart medications, which cause the heart to beat slower, sometimes cause blue toes as a side effect, simply because they’re working too well. John, did your doctor recently start you on a beta blocker?

If the heart is pumping away as it should, any medical condition that restricts the flow of blood can cause blue toes. Fatty buildups in the circulatory system, such as seen in peripheral arterial disease, can reduce the flow of blood enough to give your toes the blues. As can problems with the lymphatic system. And, God forbid, blood clots can set up road blocks in the circulatory system as well. If any of you ever experience blue toes, especially only on one foot, and a lot of pain upstream, get yourself to the emergency room pronto!

Now, if you notice that your toes turn blue mainly when they’re cold, but seem to recover when they’re warm again, it could be due to something called Raynaud’s Phenomenon. This, for lack of a better description, is like being allergic to cold temperatures. In people with Raynaud’s, cold temps cause the blood vessels to spasm and close down temporarily (called a vasospasm), and sort of like an internal tourniquet this reduces blood flow to the extremities. Who the heck was Raynaud? Auguste Gabriel Maurice Raynaud was a French doctor who first described the cold-triggered blues in his 1862 medical school graduation thesis. How’s that for famous out-of-the-gate?

In rare cases, extreme bacterial infections of the blood can trigger blue toes; and less rarely, even skin tight leather pants. If you take your pants off and your toes recover, the problem is solved. Otherwise, something is amiss with your lungs, your heart, or your blood stream. That means it’s time to check in with your doctor.

Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.