Diabetic angiopathy

The first signs of vascular disease are manifested in lowering the temperature of the lower extremities, a weak pulse or a complete absence of arterial pulse on the legs, the skin is dry, cyanotic in color, in places redness may occur, the hair on the affected part of the skin falls out, and ischemic swelling is noticeable.

Diabetic angiopathy is a lesion of small vessels of the lower extremities in diabetes mellitus.

[1], [2], [3], [4], [5],

Causes of the diabetic angiopathy

The causes of the development of this disease lie in the metabolic disorders caused by changes in blood vessels in diabetes. The causes of diabetic angiopathy also depend on the following factors:

• Disruption of the exchange of mucoproteins and lipids, which affects the state of the vascular system.
• The degree and severity of the course of diabetes mellitus, the duration of the disease.
• In secondary diabetes, which is preceded by a pancreatic injury, partial amputation or pancreatitis, the incidence of diabetic angiopathy increases many-fold.
• Also, changes in blood vessels are recorded in laboratory studies based on the introduction of the contrusulant hormone or physical effects on the islets of the pancreas.
• Also, there is a high likelihood of a hereditary transmission of the disease, four possible options.
• In addition, the category of risk includes those people who, in addition to hereditary endocrine pathology, have metabolic disorders.

The causes of diabetic angiopathy, as a rule, speak of a dangerous predisposition to this disease. Therefore, it is important to systematically undergo examinations to prevent the development of the disease and severe consequences.

[6], [7], [8], [9]

Symptoms of the diabetic angiopathy

By the nature of the lesions of the vessels distinguish between microangiopathy (changes in capillaries) and macroangiopathy (damage to the arterial and venous system). Symptoms of diabetic angiopathy depend on which vessels are damaged - it can be the retina of the eye, kidneys, coronary arteries and capillaries of the heart, damage to the vessels of the lower limbs and the vascular system of the brain. Diabetic angiopathy is characterized by the following symptoms:

• numbness of limbs, a feeling of cold, goose bumps.
• Pain, accompanied by cramps, lameness.
• depletion of the skin of the legs due to a prolonged lack of oxygen and nutrients.
• the appearance of trophic ulcers and suppuration, affecting the muscular and bone tissue. This is the final stage of tissue dystrophy in diabetes, so any microtrauma and bruise lead to the formation of an unhealed ulcer, often infected due to weak immunity. If the diabetes proceeds in a decompensated form, then the gangrene of the foot develops. This is a serious surgical disease that is treated surgically.

Symptoms of diabetic angiopathy indicate the onset of serious violations of trophic soft tissue and periosteum, but with the timely start of treatment, you can avoid severe pathologies and maintain the disease at an early stage.

[10], [11], [12], [13], [14]

Diabetic angiopathy of the eye

One of the complications developing with diabetes is diabetic angiopathy of the eye. It is accepted to distinguish two forms, characterized by the degree of vascular lesions - microangiopathy and macroangiopathy.

In the first case, changes occur only in small eye vessels, which causes minor bleeding and impaired blood flow. In the second case, large vessels of the eye are injured. With a burdened current, trophic tissue is disrupted, bleeding occurs, and visual acuity is reduced.

Visual disturbances in diabetes are more common in old age, but recently the disease has significantly grown younger. If the medical recommendations and medication are not observed, the pathology of the eye vessels develops. The lumen of the vessels narrows due to the edema of the capillary walls, and this is fraught with a violation of the trophism of the eye. When viewed from the ophthalmologist on the eyeball, spots of yellow color are noticeable, and on the site of the exit of the optic nerve there are numerous hemorrhages, which affects the visual acuity.

Symptomatic of vascular pathology in diabetes:

• vision becomes cloudy or partially disappears;
• progressive myopia;
• flashes or flashing of bright flies before the eyes;
• hemorrhage from the nasal cavity.

Diabetic angiopathy of the eye requires medical intervention, primarily it is based on the treatment of the underlying disease - diabetes. Completely prevent the pathology of blood vessels, but with the observance of diet, proper active lifestyle and observance of medical prescriptions, one can avoid sight loss.

[15], [16], [17]

Diabetic angiopathy of lower extremities

The main cause of the pathological condition is a serious disturbance of metabolic processes in the body, associated with insulin insufficiency. Diabetic angiopathy of the lower extremities is a serious disease that develops in patients with diabetes mellitus. It manifests itself in the defeat of the vascular system - from the smallest to the largest vessels. Appendages appear on the inner surface of the vessel, as in obliterating atherosclerosis. This is due to the fact that diabetes creates a beneficial environment for the development of related pathologies. Sometimes the disease at an early stage is similar to the course of obliterating endarteritis, but has the following differences:

1. The manifestation of polyneuritis of different intensity (burning and hypo-sensitivity as a small area of the skin, that and the entire foot, up to the expressed pain syndrome).
2. Pulsation in the peripheral arteries is preserved even with a burdened form (trophic ulcers, gangrene of fingers).
3. Combination of angiopathy with nephropathy and retinopathy.

The most common of all vessels of the disease is the popliteal artery and its branches. If we compare the pathology of blood vessels in diabetes with the obliterating form of atherosclerosis, then with diabetic changes the probability of gangrenous lesion of the lower extremities is high.

Diabetic angiopathy of the lower extremities can be diagnosed at the first signs of circulatory failure, but with timely access to a specialist at this stage, you can avoid serious complications.

[18], [19], [20], [21], [22]

Stages

Depending on the degree of defeat, it is common to divide the course of angiopathy into six stages:

• There are no concrete complaints on the zero stage in the patient, but with a detailed examination it is already possible to diagnose the initial degenerative changes in the vessels.
• At the first stage, the pale skin appears, on the lower extremities appear small ulceration, but there is no severe pain syndrome.
• The areas of ulcerative lesion become deeper, sometimes affect the entire muscular layer, reaching the bone. The pain is pronounced.
• Necrosis of soft tissues along the edges of ulceration develops. The necrosis is accompanied by a strong reddening, swelling, purulent abscesses, phlegmon, inflammation of the bone tissue.
• Necrosis affects the phalanx of the fingers, feet.
• Last, fifth degree. Necrotic lesion covers the entire foot, as an effective method of surgical treatment shows amputation.

Diabetic angiopathy is a rather serious disease, it requires special care and when diagnosed at an early stage, proper treatment will help to slow trophic changes in tissues.

[23], [24]

Diagnostics of the diabetic angiopathy

Infringements of a trophism of kidneys, a retina, heart, a brain can be extremely dangerous to a life, therefore it is not necessary to neglect all appointed laboratory and tool researches. Timely diagnosis of diabetic angiopathy includes a set of measures - for a detailed study you need not only blood and urine samples, but it is also very important to monitor the functionality of those organs that suffer primarily in this disease.

To confirm the diagnosis it is necessary to pass such tests:

• Blood for residual nitrogen (not more than 14 - 28 mmol / liter). An increase in his level indicates a violation of the urinary system. The most informative indicators that speak about kidney problems are urea increase (norm 2.5 to 8.3 mmol / liter) and creatinine (the norm for women is 55-100 μmol / liter, for men it is 62 to 115 μmol / liter) .
• Urine for protein, glucose, ketone bodies, b2-microglobulin (its presence in the urine indicates the pathology of the kidneys). At the beginning of the disease, the protein content in the blood is about 300 mg in the daily urine norm, the sugar percentage is 10 mmol / liter. At a late stage of the disease in the urine, the presence of ketone bodies can be documented. The glomerular filtration rate indicates the extent to which the kidneys are affected - at the early stage of the disease this figure is 140 ml per minute, in severe late-flow 15 ml per minute.
• Determination of lipid spectrum of blood. With diabetic angiopathy, the level of lipoproteins and cholesterol (more than 6 mmol) increases.

From instrumental research methods to confirm the diagnosis are recommended:

• comprehensive examination of the oculist;
• carrying out electrocardiography, echocardiography, coronaroangiography;
• showing dopplerography, arteriography of the legs;
• carrying out ultrasound of the kidneys.

[25], [26]

Treatment of the diabetic angiopathy

Vascular disorders in the pathology of the metabolic process require medical intervention. Treatment of diabetic angiopathy primarily involves the treatment of the current disease - diabetes. In the neglected state, the treatment of complications will be most effective. So, retinopathy is treated with the help of photocoagulation - the growth of the vessels is slowed down by pinpoint cauterization. This makes it possible to save the patient's eyesight for another 10-15 years. In addition, the introduction of parabulbarno preparations (corticosteroid preparations) is also shown, and preparations preventing the branching of blood vessels (Ranibizumab) are administered intravenously.

With severe kidney damage, hemodialysis is recommended.

If the circulatory disturbance leads to the same complications as gangrene, then surgical treatment is indicated, namely, the amputated limb is amputated.

The treatment of diabetic angiopathy is based on the normalization of the sugar content in the blood. At the second stage, medications that normalize blood flow, strengthen blood vessels and improve tissue trophism are relevant. It is important to remember that drugs that lower the level of sugar should be taken with constant monitoring of glucose level, and also it is necessary to control liver enzymes. At the level with drug treatment, dietetics play an important role - adherence to diet and diet contributes to the maintenance of blood sugar levels.

Treatment of diabetic angiopathy of lower extremities

Three key directions for the rehabilitation of vascular pathologies in the case of abnormalities in the metabolic process:

• restoration of normal metabolism;
• the appointment of drugs that restore the neuro-vascular regulation, strengthen the vascular walls and normalize blood coagulability;
• control the contrinsular hormones and auto-allergens to prevent their hyperproduction.

This is how the treatment of diabetic angiopathy of the lower extremities should be planned.

The main role in the normalization of metabolic processes is given to drugs that lower the level of glucose. This category includes long-acting insulin preparations, medicines for oral use, or combinations of the two. In parallel, the recommended intake of B vitamins (B6, B12, B15), P, PP - to maintain liver function, normalize metabolic processes, strengthen blood vessels and improve blood flow.

In vascular pathologies, the use of anabolic steroids gives a good result - they normalize the protein metabolism and inhibit the activity of glucocorticoids. The next category - drugs that improve the permeability of the vascular wall, improve resorption of hemorrhages and proteolytic. With complex application, the general condition improves, the sugar level stabilizes, and the vascular manifestations of diabetes decrease. In addition to medical treatment, electrophoresis with Novocaine solution, heparin, massage, as well as a set of therapeutic physical exercises, selected individually.

With trophic ulcers, local treatment, in particular - antiseptic dressings, you can use Vishnevsky ointment, insulin, intravenously shows the introduction of blood substitute drugs. In some cases, surgery on the plastic arteries (to restore blood flow to the tissues).

In case of complication in the form of dry gangrene, such conditions are created so that the affected area does not become wet. If necrotic lesions spread, pain increases or moist gangrene develops, then the only indication is amputation above the lesion.

Prevention

It is in compliance with all medical prescriptions - the use of drugs that reduce the level of sugar, improve nerve conduction and blood flow, use of vitamin complexes, constant monitoring of sugar content and compliance with diet and diet. Prevention of diabetic angiopathy is very important at an early stage of diabetes.

1. If signs of angiopathy are already there, then it is very important not to allow the transition of the disease to a more serious stage. To do this, it is enough to periodically take an analysis to determine the viscosity of blood and the quality of its coagulability, which will provide information about its rheological properties. Determining the level of cholesterol in the blood will help to model the diet, which is equally important for maintaining healthy blood vessels.
2. Moderate exercise on an individually selected set of exercises will help maintain the body in a tone and improve blood flow. However, it is important to set commensurate with their own forces, as fatigue in angiopathy can result in an attack of angina, stroke or a heart attack.
3. Of course, in order to prevent complications in other body systems, it is necessary to visit not only the therapist but the oculist and endocrinologist systematically, as patients with type 1 and type 2 diabetes are at risk of developing severe vascular pathologies.

Prevention of diabetic angiopathy or monitoring it at an early stage is an easier method than dealing with complex complications at a neglected stage.

[27], [28], [29], [30],