BMJ 1 Dec 18 Diabetic Dermopathy
Shin spots occur in 17-40% of people with type one and two diabetes. The spots can also be seen in the forearms. They tend to be irregularly shaped, brown and they don’t itch or bleed.
The older you are and the longer you have had diabetes, the more you are likely to have. They are thought to be due to small blood vessel changes similar to the kind that cause other complications like retinopathy and neuropathy.
Comment: Do any of you have them? I haven’t even noticed them before but I will keep an eye out for them now.
British Journal of General Practice December 18
Adapted from Tendinopathy in type 2 diabetes by Richard Baskerville et al
People with diabetes have three times the risk of all musculoskeletal conditions and particularly tendon problems. Tendon problems are also more resistant to treatment in diabetics.
Half of people with type two diabetes who are given exercise programmes for a variety of health conditions drop out due to musculoskeletal symptoms. Tendon problems can be for example, Achilles tendinopathy, rotator cuff problems in the shoulder, tennis elbow and trigger finger.
In a typical GP practice 18% of diabetic patients will be affected for around three months for each episode over a five year period.
Tendonitis means that the person has an acute condition with inflammation of the tendon. Tendinopathy is a degenerative process that lasts weeks or months.
Tendinopathy is due to too much wear and not enough repair of the tendons. Diabetics also have the added problem of sugar molecules binding onto collagen. Instead of the collagen fibres running over each other like silk sheets, they get stuck together like Velcro. Blood supply, collagen production and healing are impaired. Obesity, high blood pressure, ageing, alcohol and smoking are all independent factors that worsen tendon healing.
Tendinopathy is more likely in people who are on insulin or who have had the condition more than five years. Other conditions which are related such as bursitis, carpal tunnel syndrome, Dupuytren’s contracture, frozen shoulder and plantar fasciitis are also more common in diabetes.
The onset of tendinopathy tends to be gradual but a trivial event can bring it to light. The symptoms are of unusual pain and stiffness on certain activities. If the condition is not better by two months it is usually due to a tendinopathy.
The tendon is painful when pressed or moved. The area does not have increased warmth. There is often reduced muscle strength. Tendonitis on the other hand is usually an acute condition with redness, warmth and a crackling feeling under the examining finger.
Early physiotherapy is the mainstay of treatment. The aim is to improve general fitness, stretch the muscles and load the muscles in a controlled way. Recovery is often painful and slow.
Acute tendonitis can be managed with non steroidal anti inflammatory drugs and gels. Renal, gut, cardiac disease and hypertension can limit treatment. Steroid injections can help in the short term.
Tendinopathy is often recurrent. It is best to keep HbA1c and blood glucose variability low. If an episode has not settled in six weeks physio is recommended.