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Diabetic Vascular Disease
 
Basic Facts
Diabetic vascular disease refers to hardening of the arteries throughout the body caused by diabetes mellitus, a condition in which too much sugar, or glucose, builds in the blood because of a lack of insulin or because the body is unable to effectively use insulin.
Diabetic vascular disease typically affects the smaller arteries of the body, including those of the feet, fingers, toes, eyes, and kidneys.
People with diabetes are 5 times as likely to have a stroke than people without diabetes, 2 to 4 times as likely to have coronary artery disease, and up to 5 times as likely to have peripheral arterial disease.
Controlling blood sugar levels may help to prevent or slow the development of vascular disease.
Diabetic vascular disease refers to hardening of the arteries throughout the body because of diabetes mellitus. Diabetes is linked to a number of vascular problems, including;

  • Retinopathy (an eye condition);
  • Nephropathy (a kidney condition);
  • Atherosclerosis (hardening of the arteries); and
  • Coronary heart disease.
These problems arise mainly from having too much glucose (blood sugar) in the blood, called hyperglycemia. Additionally, in type 2 diabetes, the more common form of diabetes, the body becomes resistant to the effects of insulin. This leads the pancreas to secrete more insulin. As a result, the body can end up accumulating too much insulin over time, a state known as hyperinsulinemia. Hyperinsulinemia is associated with events in the bloodstream that lead to vascular damage.

Diabetes patients may develop foot ulcers.
Diabetes patients may develop foot ulcers.
WHAT ARE THE SYMPTOMS?

The symptoms of diabetes include:
  • Frequent urination;
  • Nausea and vomiting;
  • Itchy skin;
  • Extreme thirst;
  • Infections that do not heal;
  • Fatigue;
  • Weight loss; and
  • Hunger.
Patients with diabetes-related vascular problems may experience the following:
  • Blurry vision;
  • Floaters (floating spots in vision);
  • Swelling of the face or extremities or unexpected weight gain;
  • Urine that is foamy in appearance;
  • Foot ulcers (sores);
  • Loss of feeling or a burning sensation in the hands or feet;
  • Claudication (pain in the legs when walking);
  • Hypertension (high blood pressure); or
  • Chest pain.
CAUSES AND RISK FACTORS

Although researchers are unsure what causes diabetes, it is known to be a hereditary condition, meaning that it runs in families.

Type 1 diabetes typically begins in childhood. Type 2 diabetes is more likely to occur in adults who are overweight.

Vascular disease in people with diabetes is accelerated by the following factors:
  • Duration of diabetes;
  • Hypertension;
  • Hyperlipidemia;
  • Smoking;
  • Lack of exercise;
  • Obesity; and
  • A diet that is high in saturated fat.
DIAGNOSIS

For diabetes testing, patients fast for at least 8 hours and then have blood tests to measure their glucose level.

Other tests that diagnose diabetic vascular disease include:
  • Ophthalmoscopy;
  • Fluorescein angiography;
  • Urine tests;
  • Kidney biopsy;
  • Exercise treadmill testing;
  • Ankle/brachial index;
  • Duplex ultrasound; and
  • Blood tests for lipid levels.
TREATMENT APPROACH

Commonly prescribed medications include:
  • Insulin or glucose-lowering medications;
  • Antihypertensive medications;
  • Lipid-lowering medications; and
  • Antiplatelet medications.
When used in conjunction with medication therapy, a mind-body technique called thermal biofeedback may help improve symptoms of diabetic disease.

Surgery

Patients who have retinopathy must undergo laser eye surgery.

When foot ulcers develop or leg circulation is impaired, a surgeon may need to perform a skin graft or bypass surgery to prevent amputation. Another treatment option is angioplasty and stenting to widen the blocked leg artery.

LIFESTYLE

Lifestyle adjustments, such as the following, help slow the progression of the disease:
  • Quitting smoking;
  • Eating a low-fat diet;
  • Maintaining a healthy weight; and
  • Exercising.
To minimize the risk for foot ulcers, all people with diabetes should examine their feet every day and protect their feet from surface injury and moisture.

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