Question: I am diabetic and take Lantus, Januvia, and Metformin. I have had several angioplasty surgeries for blockages in my grown area, but I still have blockages. What are my current options as you see them?

Dr. Hibberd's answer:

Angioplasty surgeries are minimally invasive procedures to open larger vessels that are blocked. Unfortunately, all diabetics with vascular disease have a microangiopathy also. That is their small vessels are diseased and involved also, and these small vessels are too small for angioplasty.

Sometimes a vascular bypass procedure is needed to supply better flow, but even then if the small vessel disease is to extensive, even improving the regional flow is sometimes left until it’s too late and tissue loss or damage becomes inevitable.

If you are a smoker, you need to stop now, because your vascular disease is aggravated by at least three times by virtue of smoking. Unfortunately, sometimes other options are unavailable, and tissue is lost to gangrene requiring amputation, sight is lost from advanced retinopathy, kidney function is lost, and there can be damage to the heart and brain.

The only preventive strategies you have are weight and diet management, meticulous diabetic control, aggressive cholesterol and blood pressure management.