Which response would the nurse give to a client with type 1 diabetes who asks what causes several brown spots on the skin?

• A. Those brown spots reflect the accumulation of blood fats in the skin; they should disappear
• B. Those spots indicate a high glucose content in the skin that may get infected if left untreated
• C. They are the result of diseased small vessels in the shins and may spread if not treated soon
• D. Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot

Answer: (D)

The brown patches come from damage to the tiny blood vessels in the skin, a result of diabetic microangiopathy. When these small vessels are damaged, small bleeds can occur and the red blood cells break down, leaving iron-containing deposits (hemosiderin) in the skin. This iron deposition gives the brown color you see. These patches are common on the shins in people with diabetes and don’t indicate an infection or a spreading skin disease; they’re a sign of vascular changes related to long-standing hyperglycemia. Maintaining good blood sugar control helps prevent further vascular changes and other diabetes-related complications.