What Is the Relationship Between Diabetes and Blood Circulation?

Diabetes affects much more than blood sugar. Over time, elevated blood glucose can damage blood vessels and nerves, increasing the risk of circulation problems throughout the body.

One of the most important vascular complications associated with diabetes is peripheral artery disease (PAD), a condition in which narrowed or blocked arteries reduce blood flow, most commonly to the legs and feet.

For people living with diabetes, understanding the connection between blood sugar, blood vessels, nerve health, and circulation can help identify problems earlier and reduce the risk of serious complications.

Quick Answer: What Is the Relationship Between Diabetes and Blood Circulation?

Diabetes and blood circulation are closely connected because prolonged high blood glucose can damage blood vessels and nerves.

Over time, diabetes can contribute to atherosclerosis, the buildup of plaque inside the arteries. As plaque narrows the arteries, blood flow can become reduced.

Diabetes also increases the risk of peripheral artery disease (PAD), which can reduce circulation to the legs and feet.

PAD may cause symptoms such as:

• Leg or hip pain during walking
• Feet that feel unusually cold
• Changes in skin or foot color
• Slow-healing wounds
• Foot or leg ulcers

Diabetes can also cause peripheral neuropathy, leading to numbness or decreased sensation in the feet. When poor circulation and loss of sensation occur together, small injuries may be harder to notice and more difficult to heal.

Diabetes-related vascular damage can also increase the risk of heart disease and stroke.

Diabetes Statistics in the United States

According to the Centers for Disease Control and Prevention’s National Diabetes Statistics Report:

40.1 million
Estimated number of people with diagnosed or undiagnosed diabetes in the United States in 2023.

12.0%
Estimated percentage of the U.S. population with diabetes.

29.1 million
Estimated number of people with diagnosed diabetes in the United States, including 28.8 million adults aged 18 years or older.

11.0 million
Estimated number of U.S. adults living with diabetes who are undiagnosed.

27.6%
Estimated percentage of U.S. adults with diabetes who are undiagnosed.

Source: Centers for Disease Control and Prevention, National Diabetes Statistics Report.

Diabetes and Atherosclerosis: Why It Matters for Blood Flow

Atherosclerosis occurs when plaque builds up inside the arteries. This buildup can cause arteries to narrow and become less flexible, limiting the amount of blood that can reach tissues and organs.

Diabetes is an important risk factor for atherosclerotic cardiovascular disease.

The effects can occur in several areas of the body.

In the Heart

When atherosclerosis affects the coronary arteries, blood flow to the heart muscle can become reduced, contributing to coronary artery disease and increasing the risk of heart-related complications.

In the Brain

Atherosclerosis can affect arteries supplying the brain and increase the risk of stroke.

In the Legs and Feet

When arteries carrying blood to the lower extremities become narrowed or blocked, the result may be peripheral artery disease, or PAD.

The American Heart Association identifies atherosclerosis as the most common cause of PAD.

Diabetes and Peripheral Artery Disease: A Direct Connection

Peripheral artery disease is one of the clearest examples of how diabetes can affect circulation.

PAD develops when arteries supplying the legs—and sometimes the arms—become narrowed or blocked. Diabetes increases the risk of PAD because persistently elevated blood glucose can damage blood vessels and contribute to processes that promote atherosclerosis.

When blood flow to the legs and feet decreases, symptoms may include:

• Leg, calf, thigh, or hip discomfort during walking
• Numbness or weakness
• Feet that feel unusually cold
• Changes in skin or foot color
• Wounds that are slow to heal
• Foot or leg ulcers
• Pain in the foot or leg at rest in more advanced disease
• Tissue damage in severe cases

These symptoms should not automatically be dismissed as a normal part of aging.

Some people with PAD, particularly those with diabetes, may have few symptoms or symptoms that are mistaken for arthritis, neuropathy, muscle weakness, or other conditions.

Why Circulation Problems Are Especially Important for the Feet

Changes in the feet can be warning signs of circulation problems.

Healthy tissue depends on a continuous supply of oxygen and nutrients delivered through the bloodstream. When arterial blood flow decreases, injuries and wounds may take longer to heal.

Diabetes can create another problem at the same time: nerve damage.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), high blood glucose and elevated levels of fats such as triglycerides can damage nerves as well as the small blood vessels that nourish them.

Up to one-half of people with diabetes have peripheral neuropathy.

This combination can be particularly concerning.

A person with reduced sensation may not notice a small cut, blister, sore, or other injury. If circulation is also impaired, the wound may have greater difficulty healing and may be more likely to develop complications.

Regular foot checks are therefore especially important for people with diabetes.

Diabetes and Cholesterol: Another Piece of the Puzzle

Cholesterol also plays an important role in arterial health.

LDL cholesterol can contribute to plaque formation inside the arteries. When diabetes and abnormal cholesterol levels occur together, cardiovascular risk can increase further.

The NIDDK recommends that people with diabetes work with their healthcare professionals to manage cholesterol, blood pressure, blood glucose, and other cardiovascular risk factors.

This is why diabetes care involves more than monitoring glucose alone.

How Can People With Diabetes Protect Their Circulation?

Managing diabetes and other cardiovascular risk factors can help protect blood vessels and lower the risk of serious complications.

Monitor Blood Glucose

Work with your healthcare team to establish appropriate blood glucose and A1C goals based on your individual health needs.

Control Blood Pressure

High blood pressure can place additional stress on the arteries. Regular monitoring can help identify hypertension and guide appropriate treatment.

Monitor Cholesterol

Ask your healthcare professional how often your cholesterol should be checked and whether treatment is needed based on your cardiovascular risk.

Stay Physically Active

Regular physical activity can support cardiovascular health and is an important part of PAD management for many patients.

People who already have PAD, foot ulcers, significant neuropathy, or other medical conditions should discuss an appropriate exercise program with their healthcare professional.

Quit Smoking

Smoking damages blood vessels and accelerates atherosclerosis.

When smoking and diabetes occur together, the risk of PAD and other cardiovascular complications increases further. Quitting smoking is one of the most important steps a person can take to protect vascular health.

Check Your Feet Regularly

Look for:

• Cuts
• Blisters
• Redness
• Swelling
• Changes in skin color
• Sores or ulcers
• Wounds that are not healing

People with decreased sensation may have an injury without realizing it.

Follow Your Treatment Plan

Take prescribed medications as directed and keep regular appointments with your healthcare team.

Managing blood glucose, blood pressure, cholesterol, smoking, physical activity, and other risk factors can help protect the heart, arteries, legs, and feet.

Can Diabetes-Related Circulation Problems Be Treated?

Yes. Treatment depends on the type of circulation problem, its severity, symptoms, and a person’s overall health.

For peripheral artery disease, treatment may include:

• Management of diabetes and other cardiovascular risk factors
• Smoking cessation
• Medications
• Structured exercise
• Foot care
• Procedures to restore blood flow when medically appropriate

If PAD is suspected, a vascular specialist can evaluate circulation through a medical history, physical examination, and appropriate vascular testing.

For some patients with significant arterial narrowing or blockage, restoring blood flow through an endovascular or surgical procedure may be recommended.

The best treatment depends on the location and severity of the disease as well as the patient’s symptoms and overall medical condition.

When Should Someone With Diabetes See a Vascular Specialist?

A vascular evaluation may be appropriate if you have diabetes and experience:

• Recurring calf, thigh, or leg pain when walking
• Leg discomfort that improves with rest
• One foot that is noticeably colder than the other
• Changes in the color of the feet or toes
• A wound or ulcer that is slow to heal
• Foot or leg pain at rest
• Known diabetes with symptoms suggesting PAD
• Ulcers or tissue changes that require further evaluation

A nonhealing wound or significant change in the appearance or temperature of a foot should be evaluated promptly.

Sudden severe leg or foot pain, marked coldness or paleness, new numbness or weakness, or a sudden loss of circulation can represent a vascular emergency and requires immediate medical evaluation.

The Bottom Line: Diabetes and Blood Circulation Are Closely Connected

Diabetes can affect circulation because prolonged high blood glucose can damage blood vessels and contribute to atherosclerosis.

Over time, this can increase the risk of peripheral artery disease, heart disease, and stroke.

Diabetes can also damage nerves and the small blood vessels that nourish them. When nerve damage and poor circulation occur together, foot injuries may be harder to detect and wounds can become more difficult to heal.

Managing diabetes, blood pressure, cholesterol, smoking, physical activity, and other cardiovascular risk factors can help protect vascular health.

If you have diabetes and experience persistent leg pain, cold feet, skin color changes, numbness, or a wound that is not healing, speak with your healthcare provider about whether a vascular evaluation is appropriate.

Frequently Asked Questions About Diabetes and Blood Circulation

Medical Sources

Centers for Disease Control and Prevention (CDC)
National Diabetes Statistics Report
https://www.cdc.gov/diabetes/php/data-research/index.html

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Diabetes, Heart Disease, & Stroke
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Peripheral Neuropathy
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy

American Heart Association
Peripheral Artery Disease & Diabetes
https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/peripheral-artery-disease–diabetes