Diabetes: Why Are My Ankles Swelling?

If you’re suffering from diabetes, you may also be experiencing swollen legs and ankles. It is due to fluid retention (edema) in the affected parts.

This fluid retention is the result of fluid accumulation in your veins, which often occurs because of poor blood circulation. Edema can occur anywhere on the body but is most prominent in the extremities, particularly in the feet and ankles, where gravity causes pooling and requires healthy circulation to move the blood.

Fortunately, you can manage swollen ankles from diabetes and even prevent it altogether by improving your lifestyle choices. There are also some medical and therapeutic procedures that can help in the treatment and prevention of swelling caused by diabetes.

How is diabetes related to ankle swelling?

Diabetes is a chronic disease caused by the body’s inability to regulate and utilize circulating blood sugar. This can either be from an inability to produce enough insulin (type 1 diabetes) or from poor blood sugar regulation due to your body’s resistance to the available insulin (type 2 diabetes).

In both cases, diabetes results in abnormally high levels of glucose in the blood, which damages the lining of small blood vessels. Damage to vessels such as capillaries and veins results in poor circulation. It leads to edema and, on rare occasions, can also cause leakage into the surrounding tissue.

Ankle swelling, therefore, is a result of the damage that high blood sugar does to your circulatory system. This will eventually lead to cardiovascular and kidney issues, which also cause edema and swollen feet and ankles. 

This problem is not exclusive to diabetics alone. Even healthy individuals can experience swollen ankles and feet after long periods of inactivity, wearing tight clothing, hormonal changes, excessive salt intake, or being overweight. 

When you suffer from diabetes, however, the effect of these factors could be exacerbated.

Can diabetes cause ankle and leg swelling?

As mentioned above, diabetes is one of the main causes of edema and thus ankle swelling. That’s because it has many direct and indirect effects on the body that can lead to fluid retention. 

As a diabetic, it is highly likely that the disease is the underlying cause or exacerbating factor of the swelling in your legs.

Other common causes of ankle swelling

Fluid retention from diabetes can also result from the following underlying conditions that commonly occur with the disease, especially if poorly controlled.

Congestive heart failure

Congestive heart failure is a condition in which one or more chambers of your heart become less effective at pumping blood. This causes blood to back up in the legs, feet, arms, and other extremities.

Congestive heart failure can also cause swelling in the abdomen and fluid accumulation in the lungs (pulmonary edema), resulting in shortness of breath.

Kidney disease

Diabetes is the leading cause of kidney disease (nephropathy) and affects 20% to 40%¹ of people with diabetes. Excessive blood glucose affects the delicate blood vessels and filtering system in the kidneys, which reduces their effectiveness in removing excess fluid and waste from the body.

Since the kidneys play a central role in regulating fluids in the body, kidney disease causes fluid retention, mostly in the arms, legs, and lungs. It can also cause other problems such as high blood pressure, excessive potassium levels, damage to the blood vessels in the back of the eyes (retinopathy), and foot sores, among others.

Damage to the veins

High blood sugar levels can weaken veins and the one-way valves in them. Obesity-associated with diabetes also causes additional strain on veins deep inside the body, leading to a condition known as venous insufficiency.

Venous insufficiency causes fluid retention in the ankles, feet, legs, arms, and wrists. It can also result in more serious conditions such as blood clots in the veins (thrombosis) and leg pain. If such a clot breaks free and travels to the lungs, it can cause pulmonary embolism (PE).

While rare, PE is a life-threatening condition with symptoms such as difficulty breathing, chest heaviness, and a sense of impending doom.

Inadequate lymphatic system

Just like the blood circulation system, the lymphatic system is a complete system consisting of vessels and organs such as lymph nodes and the spleen. It collects excess fluid that drains from cells, tissues, and organs and returns it to the bloodstream.

Diabetes can damage ducts and vessels in the lymphatic system, impacting the lymphatic function, clearance, and permeability, causing fluid retention and possible leakage into surrounding tissue. This condition is known as lymphedema.

Cirrhosis and liver damage

For type 2 diabetics, unregulated sugar levels often lead to excess fat in the liver and liver damage through various mechanisms. Insulin resistance promotes the release of free fatty acids from adipose tissue.

There is also an increase in oxidative stress, producing free radicals, which, in turn, induces inflammation and cellular death. When fat builds up in the liver, it leads to a condition known as non-alcoholic fatty liver disease (NAFLD). Diabetes and NAFLD are closely connected, as it is estimated that NAFLD has a prevalence of 70%² among type 2 diabetes patients.

NAFLD often has no visible symptoms, although it may manifest as increased feelings of fatigue or abdominal pain. However, it can advance to become non-alcoholic steatohepatitis (NASH), which causes inflammation and scarring in the liver. 

NASH eventually leads to liver cirrhosis, which happens when scar tissues replace healthy tissues in the liver. Cirrhosis is found in 30%,³ and if not properly managed and controlled, it can also degenerate into total liver failure. 

When cirrhosis occurs in the liver, it slows down blood flow in the liver’s portal vein, which increases its internal pressure. This causes fluid accumulation in the lower extremities and in the abdomen.

Pregnancy

Pregnancy can put pressure on the main leg vein (inferior vena cava) that brings blood from the legs back to the heart. This can cause blood and fluid retention in the lower extremities.

A more serious condition known as preeclampsia occurs during pregnancy in some women that can lead to edema. Preeclampsia is thought to happen as a result of placental hypoxia/ischemia, inflammation, and oxidative stress, causing abnormalities in the lining of blood vessels. This leads to high blood pressure and other organ damage, leading to edema in the hands, feet, and face.

Low albumin levels

Low protein levels can cause edema because protein, mainly albumin, in the blood helps maintain the pressure inside the blood vessels. Low protein levels can cause fluid to leak, leading to edema.

Low protein levels for diabetics can result from insufficient insulin, malnutrition, kidney disease, or liver disease. Diabetics are advised to have their urine tested regularly for albumin to detect protein loss through the urine (proteinuria), which can help diagnose diabetic kidney disease.

What are the signs of ankle swelling?

Ankle swelling due to diabetes is easy to diagnose. Some of its signs include:

• Skin that is stretched, shiny, or puffy

• Skin with pits; that is, it stays dimpled for several seconds after pressing

• Aching limbs

• Stiff joints

• Discolored skin

• Pain or loss of sensitivity in your hands or feet

• Your hands or feet feel heavy and hard to move

You should make an appointment with your doctor if you notice any of these signs as a diabetic. Your doctor may conduct further tests to confirm the diagnosis or understand its underlying causes, including ordering an X-ray, an electrocardiogram (EKG), blood tests, or a urine test (urinalysis).

How to manage swollen ankles

If you have swollen ankles and are a diabetic, consult your doctor before attempting any home remedies. That’s because diabetic edema is treated differently depending on the underlying cause.

Diabetes can also cause more serious problems than swollen ankles, including diabetic sores, nerve damage, blood clots, and gangrene from infected wounds and injuries that won’t heal. 

How to reduce the swelling

Once your doctor has diagnosed the problem and the underlying causes, you can incorporate the following home remedies to reduce swelling in your ankles.

Keep your feet elevated

Standing for long periods of time causes blood and other fluids to pool at the lower extremities. When seated or lying down, put your feet up in an elevated position above the level of the heart. 

For this, consider getting an ottoman or a foot hammock that you can put under your desk at work. You can also use pillows or special elevation devices in bed to keep your feet elevated and help the blood to flow back into the heart.

Wear compression socks

Compression socks are garments made of elastic materials that gently squeeze the legs. They help boost circulation by supporting the veins and reducing the backup of fluids. Compression socks are consumer-grade, so you can buy them online or from various stores.

Keep in mind that compression socks have different levels of compression. Talk to your doctor, who will determine the exact level of compression you need to manage your swollen feet and how to use them correctly.

Hydrate

Even though it might sound counterintuitive, drinking more water helps you get rid of edema and swollen feet. That’s because insufficient hydration causes the body to retain water in the cells and tissue while drinking more water helps it flush out excess fluids. 

Aim to drink 8 to 10 glasses of water throughout the day and reduce or eliminate your intake of sugary drinks such as sports drinks and soda. You should also minimize your caffeine intake while eating a lot of vegetables and fruits.

Reduce your sodium intake

The sodium in salt and many foods causes dehydration and triggers your body to retain more fluids to maintain the optimum water/sodium ratio. Therefore, too much of it can cause or worsen edema and swelling in the ankles.

You should limit your daily sodium intake to 1,500 mg or less to stay healthy and manage swelling in the feet and ankles. A tablespoon of salt contains about 2,000 mg, and most foods also have sodium. Therefore, you will need to watch your sodium intake ‌carefully to stay under the recommended levels. 

Exercise more often

Regular exercise is a highly effective way of reducing ankle swelling. It increases the heart rate and helps improve blood circulation, which eventually leads to the excess fluid being eliminated through sweat and urine. 

Exercise also improves bone health and stabilizes blood sugar levels, which helps you manage diabetes in general and keep swelling at bay. However, rigorous exercise can be dangerous for diabetics, so consult your doctor first to develop a safe and healthy exercise regimen for you.

Increase your magnesium intake

Magnesium-rich foods and magnesium supplements can help reduce swelling by regulating blood sugar levels and improving nerve function. 

Taking 200 to 400 mg daily of magnesium has been shown to be associated with lower risks of hypertension, cardiovascular disease, and diabetes, which all contribute to the development of edema. 

However, magnesium supplements should be used with caution if you already have a heart or kidney issue. It can make the conditions worse. It can also get accumulated in the blood if it is not excreted properly by the kidney. Talk to your doctor first before taking supplements.

Get an Epsom soak

In addition to taking magnesium orally, transdermal (outside the skin) application through soaking in a bath of Epsom salts is an age-old home remedy for swelling. The magnesium sulfate in Epsom salts is absorbed through the skin and helps remove water from cells.

Even though there is limited research in the area, there is a lot of anecdotal evidence that this treatment works. The high concentration of magnesium sulfate also reduces inflammation and helps draw water out of tissue through reverse osmosis. 

Manage your weight

Being overweight can cause or worsen fluid retention. For one, excessive body weight puts a lot of strain on the lower extremities and can cause fluid retention in the core, arms, and legs.

Obesity can also cause additional health conditions that lead to fluid retention, such as heart failure, kidney disease, and hormonal changes.

Take care of your feet

If you move around a lot, take much better care of your feet to improve circulation and minimize fluid retention. Wear comfortable shoes that are not too tight, as this restricts blood flow. Also, keep away from high heels and shoes without proper arch support. 

Experts recommend buying shoes that are one size bigger if you experience swelling. Consider talking to a podiatrist to help find the best shoes for you.

Treatment for swollen ankles

Swelling caused by edema will usually go away on its own once you treat the underlying causes. However, severe edema may require medical intervention to get rid of excess fluid.

One treatment is a type of medication called diuretics. Diuretics such as Furosemide (Lasix) help the kidneys form urine and thus get rid of excess water. If the swelling is due to a blood clot obstructing blood flow, doctors may administer blood thinners or perform minor surgery to get rid of the clot.

Other types of treatment to target allergies, hormonal imbalance, infection, or inflammation can help treat the underlying cause of edema.

Prevention

To prevent edema, do your best to avoid factors that make it worse. It may be challenging or impossible for diabetics to completely prevent fluid retention and swelling, but you can minimize it by maintaining a healthy lifestyle and following the doctor’s recommendations.

Here are some things you can do.

• Stay active; stand up and walk around every hour, even on flights or during work

• Elevate the legs above heart level whenever you’re relaxing and sitting down

• Minimize your sodium intake, not just salt intake

• Drink a lot of water and eat lots of fresh low-glycemic fruits and vegetables to reduce water retention

• Have regular foot massages to improve circulation and reduce swelling

• Wear compression garments according to your doctor’s instructions

• Talk to your doctor about alternatives to edema-causing nonsteroidal anti-inflammatory drugs

• Watch your blood glucose levels and stay within recommended levels

• Manage your weight

When to consult a doctor

If the swelling on your ankle, foot, legs, or arms is something newly experienced, or if it is chronic but doesn’t improve even after these home remedies, see your doctor. 

You should also seek urgent medical care if the swelling is only on one side of your body, as this could signify a blood clot in your veins.

Other causes for concern include the following:

• Increasingly painful swelling

• Reduced sensation in the legs or arms

• Difficulty moving the affected limbs

• Scarring between layers of tissue

• Sores, bruises, and infections in the affected area

• Shortness of breath

• Difficulty breathing

• Chest pain

The last three are medical emergencies that could signal a pulmonary embolism or heart attack. Always keep your doctor in the loop and follow their recommendations to manage your diabetes and reduce ankle swelling.

The lowdown

Do you have diabetes and swollen legs? This condition, called edema, occurs when excessive fluid builds up in your legs and other extremities. 

While it is usually a result of abnormally high blood sugar levels damaging blood vessels and causing poor circulation, underlying conditions such as heart problems and damaged veins can also cause edema.

You can manage edema by improving circulation through exercise, wearing compression socks, drinking a lot of water, and managing your weight.