A 25-year-old man with Type 1 Diabetes presents with pain in his legs after walking. The pain goes away with rest. He has a smoking history. His foot pulses are weak, and there is loss of hair on his legs. What is the potential issue, and what are the next steps?
This young man's leg pain with exertion that is relieved with rest, known as claudication, along with weak foot pulses and hair loss on his legs, suggests peripheral arterial disease (PAD), a condition in which the arteries that supply blood to the legs are narrowed, usually due to atherosclerosis. Smoking and diabetes are risk factors for PAD. The next steps would be to further assess the extent of his PAD, potentially with an ankle-brachial index or other vascular studies, and to initiate measures to reduce his cardiovascular risk. This would include smoking cessation, optimizing glycemic control, and considering medications such as statins or antiplatelet therapy. He may also benefit from supervised exercise therapy.