Diabetic angiopathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Diabetic angiopathy (ancient Greek.
Vitreous hemorrhage in diabetic angiopathy
This vascular pathology is the main cause of complications from various organs and systems, disability and mortality in patients with long-term diabetes mellitus or severe progressive course. The target organs for angiopathy are most often the brain, kidneys, organ of vision, heart and lower limbs.
To varying degrees, vascular damage is noted in 9 out of 10 carriers of diabetes mellitus. People with type I diabetes (insulin-dependent) are at a greater risk of developing pathology.
Causes and risk factors
The main cause of angiopathy in diabetes mellitus is the damaging effect of glucose on the inner lining (endothelium) of the vascular wall, which leads to its functional and structural rearrangement.
Since in diabetes mellitus, the level of glucose in the blood plasma exceeds normal values [which is due to the lack of utilizing hormone (insulin) or its incorrect interaction with the cells of the body], its excess actively penetrates the vascular wall. As a result, fructose and sorbitol, which are end products of glucose metabolism, accumulate in the endothelium. Both substances are poorly transported across cell membranes, therefore, they are concentrated in rather large quantities in endothelial cells.
Diabetic angiopathy is a common complication of diabetes
Pathological changes associated with the saturation of the endothelium with glucose and its metabolic products:
- increased permeability and edema of the vascular wall;
- increased thrombus formation (activation of coagulation processes);
- a decrease in the production of endothelial relaxing factor, which is responsible for relaxation of vascular smooth muscles.
The so-called Virchow triad is formed, including damage to the endothelium, slowing blood flow and excessive hypercoagulation (thrombus formation).
Pathological changes cause hypoxia of organs and tissues supplied by the affected vessels. A decrease in oxygen concentration is a stimulus for the vigorous activity of fibroblasts (cells that produce connective tissue elements), which, in turn, leads to the development of atherosclerosis.
Forms of the disease
Depending on the caliber of the involved vessels, the following are revealed:
- microangiopathy;
- macroangiopathy.
According to the predominant localization of the pathological process, several forms of angiopathy are distinguished:
- retinopathy - damage to the retinal vessels;
- nephropathy - involvement of the vessels of the kidneys;
- encephalopathy - changes in the vessels of the brain;
- angiopathy of the vessels of the lower extremities;
- angiopathy of the vessels of the heart.
Diabetic angiopathy of the vessels of the lower extremities
Symptoms
Symptoms of diabetic angiopathy vary depending on the location of the pathological process.
Signs of retinopathy appear on average 3 years after confirmation of the diagnosis. Over the next 20 years, symptoms of retinal vascular lesions are observed in almost 100% of those diagnosed with diabetes mellitus. It:
- decreased visual acuity up to complete blindness in severe cases;
- distortion of the outlines of objects, inability to distinguish between small details;
- "Veil" and flashing "flies" before the eyes;
- light spots, stripes, sparks;
- in case of vitreous hemorrhage (normally transparent), a floating dark spot appears before the eyes, sometimes several.
Diabetic angiopathy of the retinal vessels is manifested by impairment of vision up to blindness
Diabetic retinopathy is characterized by a number of ophthalmological symptoms detected by instrumental examination. An early manifestation of these signs of a pathological condition is characteristic, while retinopathy is still asymptomatic and the patient does not present active complaints:
- narrowed, twisted, deformed arteries, sometimes with microaneurysms;
- punctate hemorrhages in the central zone of the retina;
- twisted, blood-filled, congestive veins;
- retinal edema;
- hemorrhages in the thickness of the vitreous body.
Nephropathy usually develops in people with a long history of diabetes, against the background of a severe course or incorrect treatment of the underlying disease. Symptoms of renal vascular damage:
- swelling, mainly on the face, in the morning;
- arterial hypertension;
- nausea, dizziness, drowsiness;
- change in laboratory parameters - proteinuria (protein determined in a general urine test), caused by damage to the kidney filter, which begins to pass large protein molecules that are not normally filtered.
Diabetic encephalopathy develops very slowly. Initially, patients complain of a feeling of a "stale" head, a violation of the sleep-wake cycle (daytime sleepiness and insomnia at night), difficulty falling asleep and waking up, impaired memory, frequent episodes of headaches, dizziness, and impaired concentration.
Diabetic encephalopathy is characterized by a feeling of "stale" head, sleep disturbances, frequent headaches
With further progression, the following symptoms appear:
- unsteadiness of gait;
- lack of coordination;
- lack of convergence;
- the formation of pathological reflexes.
For diabetic lesions of the vessels of the heart, the following manifestations are characteristic:
- compressive, pressing, burning pains of an angina pectoris behind the sternum radiating under the scapula, into the left arm, the left half of the lower jaw, neck, into the epigastrium at the height of physical or psycho-emotional stress
- heart rhythm disturbances;
- decrease or increase in heart rate;
- violation of the contractile function of the heart muscle [shortness of breath during exertion and (in severe cases) at rest, edema, pain and heaviness in the right hypochondrium, etc.].
Diabetic damage to the vessels of the heart is manifested by pressing and squeezing pains in the chest
Angiopathy of the vessels of the lower extremities is considered one of the most serious complications of diabetes and manifests itself in a number of characteristic signs. Among them:
- numbness, coldness of the limbs;
- creeping sensation;
- absence or significant decrease in the strength of the pulse on the back of the foot;
- muscle soreness, especially the calf (both at rest and during exercise);
- convulsions;
- rare or complete hair loss;
- a feeling of weakness and painful sensations arising from walking (of varying intensity);
- dystrophic skin changes (dryness, pigmentation, bluish discoloration, peeling);
- painless trophic ulcers, often localized on the feet, in the ankle area.
Diabetic foot for diabetes
In the later stages of angiopathy of the lower extremities, the so-called diabetic feet are formed, which are characterized by a change in the shape and color of the nails, dry skin of the feet with cracks and corns, deformation of the first toe.
Diagnostics
Diagnosis of diabetic angiopathy is carried out using both laboratory and instrumental research methods.
Laboratory methods:
- determination of blood glucose concentration;
- general urine analysis (proteinuria, acetonuria, glucosuria are detected);
- glucose tolerance test;
- determination of residual nitrogen, urea, blood creatinine (indicators of renal dysfunction);
- determination of the glomerular filtration rate, GFR (the main marker of impaired renal excretory function).
A blood sugar test is one of the laboratory methods for diagnosing diabetic angiopathy
Necessary instrumental research methods:
- fundus examination;
- Ultrasound of the heart, kidneys;
- ECG;
- angiography (if necessary);
- Doppler examination of the vessels of the lower extremities, kidneys;
- computed or magnetic resonance imaging of the brain.
Among other things, it is necessary to consult an ophthalmologist, neurologist, vascular surgeon, cardiologist.
Treatment
First of all, treatment is required for the underlying disease that led to the development of angiopathy - diabetes mellitus. Depending on the type of diabetes, the severity of the symptoms and the presence of complications, either pill hypoglycemic drugs or insulin preparations are used.
Treatment of diabetic angiopathy primarily involves the treatment of the underlying disease - diabetes mellitus
Pharmacotherapy of directly multicomponent angiopathy is carried out using the following means:
- angioprotectors;
- antispasmodic drugs;
- drugs that improve microcirculation;
- nootropic drugs;
- antiplatelet agents;
- anticoagulants;
- metabolic stimulants;
- hypolipidemic agents;
- aldose reductase inhibitors; and etc.
On request, patients are prescribed nitrates, antihypertensive drugs, diuretics, drugs that reduce heart rate, antiarrhythmic drugs, correctors of cerebral circulation disorders, biogenic stimulants, etc.
Possible complications and consequences
Diabetic angiopathy can cause serious complications:
- gangrene of the lower extremities;
- complete or partial loss of vision;
- acute or chronic renal failure;
- myocardial infarction;
- acute violation of cerebral circulation.
Forecast
The prognosis for diabetic angiopathy is conditionally favorable: with timely diagnosis and adequate therapy, the progression of the pathological process can be significantly slowed down or completely stopped, work capacity and social activity in this case do not suffer.
The risk of developing vascular lesions is individual and directly depends on the correctness of the therapy, the patient's adherence to treatment and the implementation of recommendations for lifestyle modification.
Prevention
Preventive measures are as follows:
- Compulsory adherence to food recommendations, diet.
- Regular monitoring of blood glucose levels.
- Systematic preventive examinations with a mandatory visit to an ophthalmologist, neurologist, cardiologist.
- Dosed physical activity.
- Quitting smoking, alcohol abuse.
- Thorough care of the skin of the lower extremities.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
