Microangiopathic late complication
Small and very small blood vessels are damaged mainly by elevated blood glucose levels over a longer period of time which leads to disorders in function and structure of the sensible endothelium.
The endothelium gets thicker (sclerosis) and permeable which causes deposits of blood particles and proteins in the tissues disordering the function of the organs.
Micro capillaries in the retina of the eye are damaged. This late complication is the most common reason for blindness in the western part of the world.
Please refer to Diabetic Retinopathy for further information.
Kidneys are important organs as maintaining the function of a filter for the human body but also as a regulator of the liquid balance including micro elements and influencing production of blood cells as well.
If the kidneys are damaged due to poor metabolic control the filter effect is reduced.
Please refer to Diabetic Nephropathy for further information.
This diabetic late complication results in a damage of the nerves. The reason for that is that nerve cells are under-nourished by blood vessels which are damaged due to the micro angiopathy. Strongly fluctuating blood glucose levels can also lead directly to damage of the nerve cells.
One distinguishes a peripheric neuropathy disordering mainly long strains of nerves of the legs or arms from autonomic neuropathy where mainly inner organs or regulation of sweat production at the feet are influenced.
Please refer to Diabetic Neuropathy for further information.
Damage of big blood vessels like carotid artery, aorta, coronary vessels or big blood vessels of the feet are concluded under this definition.
This damage occurs together with atherosclerosis which progresses quickly and aggressively at diabetics.
It has to be taken into consideration that in common with type 2 diabetes beside high blood glucose levels also a qualitative and quantitative metabolic disorder and hypertension mainly occur.
The level of LDL cholesterol („the bad cholesterol“) is of high importance. LDL molecules of diabetics are particularly small and dense and can therefore easily penetrate in the walls of blood vessels, stay there and lead together with inflammation cells and calcium particles to so-called “Plaques”. These can lead to stenosis of the blood vessels. If they spontaneously burst by eliminating their content this could lead to an acute closure of the blood vessels by activating blood coagulation.
Due to localisation of this closure this can result in a heart attack, stroke or reduction in circulation of the leg. In order to prevent this development it is important to optimize diabetes control (HbA1c < 7.0%) but also to minimize all other risk factors of atherosclerosis.
That means lowering of blood pressure < 130/80 mmHg, lowering of LDL cholesterol <100mg/dl and elevating HDL levels (good cholesterol) to > 40mg/dl for men and > 50mg/dl for women.
Another important factor is consumption of tobacco. Smoking and diabetes is a bad combination. Every diabetic should even reduce or better stop smoking.
Medical regular checks (once a year) are a colour-coded Duplex Sonography of the brain vessels, the measurement of the circulation in the leg vessels and an EKG. Additionally hypertension patients should undergo an echocardiography and an ergometry.