Vascular disorders in diabetes mellitus

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Vascular disorders in diabetes mellitus

In patients with diabetes mellitus, both small vessels (microangiopathy) and large ( macroangiopathy ) are affected .

In the first form, the function of the capillaries of various tissues and organs is disrupted. Changes in the capillaries of the retina cause visual impairment and subsequently can lead to blindness. Damage to the capillaries of the glomeruli of the kidneys disrupts their basic functions and causes the development of renal failure (up to uremia). Capillary changes are found in the skin, striated muscles, intestines, gallbladder, and nerve fibers. The reasons for their appearance have not been finally clarified. It has been established, however, that the development of vascular lesions is promoted by prolonged insulin deficiency, excessive secretion of pituitary growth hormone and adrenal glucocorticoids .  

Also, complications more often occur in diseases with a long duration, in people with diabetes from childhood and adolescence, in patients with an unfavorable course of diabetes, sharp fluctuations in blood sugar levels, when metabolic processes are not compensated. These disorders cause a change in the protein- carbohydrate complexes of the vascular wall, an increase in its permeability, and then more pronounced structural abnormalities. In patients with diabetes mellitus, there are other eye lesions, in particular, cataracts (clouding of the lens), glaucoma (increased intraocular pressure), changes in refraction and accommodation. 

In microangiopathy of the lower extremities, four stages are distinguished. The first stage is preclinical (there are no complaints and objective data). In order to identify this stage, tissue blood flow of the lower leg is usually examined (capillarography of the legs), the degree of its saturation with oxygen (polarography).

In the second stage, the function of the limb is preserved, but there are subjective disorders: fatigue when walking, pain in the foot during and after walking, paresthesia (feeling of numbness, tingling), fever and cold. There are no trophic disorders. The disease can begin with muscle atrophy of one third of the lower leg. The pulsation of the vessels of the lower extremities is good.

The third stage is characterized by pronounced hypotrophy of the lower leg muscles, an increase in the arch (instep) of the foot, and the disappearance of hair on the lower leg. Pigmentation, cyanosis (blue discoloration) of the lower leg, pronounced peeling of the skin appear, but the pulsation of the vessels of the lower extremities persists.

The fourth stage is ulcerative-necrotic. Less painful ulcers are localized on the sole and heel. If the ulcer begins to hurt, this indicates the addition of infection and infiltration (edema) of the walls of the ulcer. A sclerotic ulcer is very painful, since the vessels are affected. Good vascular pulsation may be observed.

Sometimes generalized (widespread) microangiopathy is noted , that is, damage to the small vessels of the leg, heart, lungs, tonsils, and so on.

For the prevention of these complications, timely examination of patients, their thorough and comprehensive treatment in order to achieve complete and stable normalization of metabolic processes are of great importance.

In the second form of vascular lesions ( macroangiopathy ), atherosclerosis of the coronary arteries that feed the muscle of the heart, cerebral vessels and arteries of the lower extremities occurs. The narrowing of the arteries is accompanied by the appearance of pain in the calf muscles when walking, coldness of the feet, and in severe cases – the development of trophic disorders and even gangrene (necrosis) of the tissues of the feet and legs. Timely treatment eliminates metabolic disorders and delays the development of the atherosclerotic process.

To prevent all of the above problems, you need to carefully monitor your condition and, if the slightest pathological changes appear, immediately consult a doctor in order to pass all the necessary examinations on time and receive recommendations for treatment.

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