What Causes People With Diabetes To Bruise Easily?

Bruises occur when there is an injury to tissues below the skin surface. The colorful marks you see result from damage to blood vessels and blood pooling below the skin. Minor bruises are not usually a cause for concern as they tend to heal on their own within days or weeks. 

However, you should seek medical intervention if your bruises are serious. Keep an eye on any other unusual symptoms so you can establish whether there is an underlying cause.   

Is bruising a symptom of diabetes?

If you bruise easily, you could have a serious underlying condition like a blood disorder, clotting issue, or something else, such as diabetes.

Diabetes is a metabolic condition where your blood sugar or glucose levels are too high. While diabetes itself does not cause bruising, the complications of diabetes can lead to easier bruising.  However, you can’t assume that you have diabetes because you easily bruise; your doctor will be able to diagnose you accurately.

Why does diabetes lead to bruising?

The amount of glucose in your blood affects your body: High glucose levels interfere with the blood vessel microenvironment and can make them stiffen or narrow. As a result, the amount of blood flowing to your cells reduces, and they get less oxygen and nutrients. Bruises may worsen if the cells responsible for wound healing aren’t functioning properly. 

Diabetes can also cause diabetic neuropathy. This is where high blood sugar levels damage nerves in the body. One of the symptoms of this condition is loss of feeling or numbness. Pain tells you when something is wrong. If you can’t feel an injury, you might cause bruising without knowing why.

Your skin is a protective barrier that prevents germs and foreign invaders from getting into your body. If a bruise breaks that barrier, your immune system fights off invaders and stops infections. With diabetes, your body produces hormones and enzymes that make your immune system less effective. This can result in infections that may cause bruises to take longer to heal and require medical attention.

Other causes of bruising

Usual causes 

1. Nutrient deficiency

A common cause of bruising is nutrient deficiency. Vitamin C supports the immune system and wound healing. If your body has inadequate vitamin C, you may bruise easily and take longer to heal. Vitamin C deficiency can cause irritability, weakness, fatigue, and swollen or bleeding gums. 

Iron deficiency can also increase your susceptibility to bruising. Iron keeps your blood cells healthy. If your cells are unhealthy, your body can’t get the oxygen it needs to function optimally. Iron deficiency can cause other symptoms such as fatigue, headache, weakness, shortness of breath, cold hands or feet, and dizziness. 

Vitamin K deficiency can also increase your susceptibility to bruising. This vitamin facilitates blood clotting, and its deficiency means that your blood will clot slowly. This causes more blood to pool underneath the skin, forming a bruise.

Other vitamin K deficiency symptoms include blood in the stool, bleeding in the gums or mouth, excessive bleeding from wounds, and heavy periods. 

Your doctor can alleviate bruising from deficiencies by prescribing iron tablets or other medications. They can advise you on dietary changes to meet your nutritional requirements. 

2. Medication

You may be more susceptible to bruising if you take certain medications. For example, over-the-counter medications such as naproxen (Aleve) and aspirin (ibuprofen) affect your blood clotting ability. Anticoagulants or blood thinners can have the same effect. When blood takes longer to clot, more of it leaks from the blood vessels and builds up under the skin. 

3. Thrombophilia

Another common cause of bruising is thrombophilia.¹ When you have this condition, your blood tends to clot even if you're not injured. It happens when your body makes too little or too many clotting chemicals. Blood clot development is usually the only symptom that shows in people with thrombophilia.

When your blood clots more easily than normal, your healthcare provider is likely to test for thrombophilia. If you have the condition, they will prescribe anticoagulants, which can increase your susceptibility to bruising.

4. Intense exercise

Sore muscles are a common side effect of exercising intensely. However, intense exercise can also lead to bruises around the affected muscles. If you strain your muscles, you can injure the muscle tissues deep under the skin.

This may burst blood vessels which will leak blood into the surrounding area. When blood pools under the skin, it can lead to a bruise. 

5. Von Willebrand disease

People with Von Willebrand disease (VWD) are more vulnerable to bruising. This genetic disorder is a lifelong condition that affects the blood's ability to clot. If you have Von Willebrand disease, you were born with it, but symptoms may show up later in life.

Since the blood is not clotting as it should be, bleeding can be intense or take longer than normal. 

Once the blood pools under the skin, it forms a bruise, which can be minor or large and lumpy. Other symptoms of Von Willebrand disease include: 

• Blood in the stool or urine

• Severe bleeding after surgeries, injuries, or dental work

• Heavy or long periods often accompanied by large blood clots

• Nosebleeds that last more than 10 minutes

Unusual causes 

1. Hemophilia A

If you have hemophilia A, you lack factor VIII, a critical blood clotting factor. This genetic condition interferes with blood clotting, resulting in bruising and excessive bleeding. You may also experience joint pain and swelling, spontaneous bleeding, and excessive bleeding after childbirth, surgery, or injury.

2. Hemophilia B

If you have hemophilia B, you lack factor IX, another important blood clotting factor. This condition affects your blood’s clotting ability. You may experience similar symptoms to hemophilia A. 

3. Ehlers-Danlos syndrome

Ehlers-Danlos syndrome refers to a group of inherited disorders that affect your connective tissues, including blood vessel walls, skin, and joints. If you have this syndrome, you have joints that move beyond the normal range of stretchy skin and motion. You will also have fragile, thin, and easily damaged skin, making you bruise easily. 

4. Cushing syndrome

You can develop Cushing syndrome if you have excessive cortisol in the blood. Excessive cortisol in the blood may be due to an increase in its natural production or overuse of corticosteroid drugs. This syndrome causes thinning of the skin, leading to easy bruising.

You may also experience other symptoms such as acne, fatigue, unexplained weight gain, increased urination, increased thirst, and purple stretch marks on the arms, thighs, abdomen, and breasts. 

5. Chemotherapy

If you have cancer, you may have a low blood platelet count if you’re undergoing chemotherapy. Blood clotting is slower if you have insufficient platelets. A minor injury or bump can lead to lumpy or large raises.

You may also struggle with eating, which can cause a nutrient deficiency, affecting your blood's clotting ability. 

6. Non-Hodgkin's lymphoma

You may be more vulnerable to bruising if you have non-Hodgkin's lymphoma. This cancer begins in the lymphocyte cells of your immune system and causes painless swelling in the lymph nodes in your armpit, groin, and neck. 

Non-Hodgkin's lymphoma can spread to the bone marrow and reduce the number of blood cells in your body. This causes a drop in platelet count, interfering with your blood's ability to clot and increasing susceptibility to bruising and bleeding. 

Cancer causes other symptoms such as fever, night sweats, and fatigue. It may also cause breathlessness, difficulty swallowing, and coughing if it affects the chest area. If it’s present in the bowel or stomach, it can cause weight loss, stomach pain, and indigestion. 

7. Immune thrombocytopenia (ITP)

Immune thrombocytopenia is a bleeding disorder. The cause is a low platelet count, which makes it difficult for your blood to clot. You can develop bruises for no reason if you have ITP. Other symptoms include nosebleeds, bleeding gums, heavy menstrual periods, and blood in the urine or stool. 

Other symptoms of diabetes

If you bruise easily, this may indicate that you have diabetes. However, the problem can be due to many causes. You may want to look out for other symptoms of diabetes, including:

• Increased urination

• Increased hunger

• Blurry vision

• Increased thirst

• Tingling, numbness, or pain in the feet or hands

• Unintended weight loss

If you experience one or more of these symptoms alongside bruising, and you don’t already have a diabetes diagnosis, you should see your doctor. They'll do some diagnostic tests and recommend the next steps. 

If you know you have diabetes, your bruising could be due to slow wound healing or pricking of the skin when testing blood sugar or injecting insulin. 

How will I know if a bruise is serious?

Minor bruises often disappear in a few days or weeks and are not a cause for concern. However, a bruise could be indicative of a more serious condition that requires medical attention if:

• It keeps getting larger after the day of the injury 

• It lasts for more than two weeks

• It reappears for no apparent reason

• It makes the affected limb feel swollen or very tight

• It occurs around your eye and affects vision or makes it hard to see in different directions

• If you feel unwell with other symptoms such as fever, weight loss, and night sweats

How to treat bruising caused by diabetes

1. Check your diet

Switch to foods with nutrients that maintain healthy skin, blood vessels, and proper blood clotting, including folate and vitamins C, K, and B12. Fruits such as mango, berries, cantaloupe, and citrus are good sources of vitamin C. Leafy green veggies provide vitamin K and folate. Fortified cereals and beef are great for increasing vitamin B12.

A healthy diet is important as it helps your body regulate blood sugar levels. 

2. Ice therapy

If your bruises are painful, you will want to relieve the pain. Ice therapy can help, especially if you use it on the day of the bruise trauma. Icing the bruise can reduce its size and speed up healing.

Blood in the affected region will flow slowly due to the cold temperature of the ice, reducing leakage out of the vessels. 

Wrap your skin or the ice with a towel or washcloth before placing the ice against your skin. You should also put the ice on for a short time (about 10 minutes) to avoid harming your skin. 

3. Control your glucose levels

Managing your blood glucose levels can reduce bruising and ensure fast healing. Lifestyle modifications, including exercising regularly, weight management, and eating a healthy diet, can improve your blood sugar levels. You should continue taking any prescribed medications. 

4. Heat therapy

Hot compresses can treat bruising, but you should only use them 2-3 days after the bruise has developed. Place a clean cloth soaked in warm water on the bruise after 48-72 hours. A gentle massage on the bruise from the center outward using a heating pad or a warm towel can move the clotted blood away from the injured skin. 

How to reduce bruising

You can take some precautions to reduce bruising. These include:

• Wearing protective gear during contact sports such as hockey or soccer

• Placing slip-resistant rugs in the house 

• Ensuring clear walking paths and doorways within the home

• Removing clutter from the floor

• Getting enough vitamin C

When should I see a doctor?

If your bruising becomes serious, you should see your doctor. Seek medical care if:

• Your bruises are large and painful

• Bruising persists for more than two weeks

• Bruising occurs in the torso or head 

• You have bruises alongside frequent nose bleeds, bleeding gums, or blood in the stool

• You otherwise feel unwell

Your doctor is likely to review your family and personal medical history during your visit. They may ask you if you have any family member with an inherited blood disorder. They will want to know about other symptoms you are experiencing and any medications and supplements you are taking.

The lowdown

People with diabetes often bruise easily, but bruising can also be due to many other causes. Minor bruises often disappear within days without medical intervention. But if your bruising is serious, you should see your doctor or primary health provider.