Diabetic angiopathy

The first signs of vascular disease are manifested by a decrease in the temperature of the lower extremities, a weak pulse or complete absence of arterial pulse in the legs, dry, bluish skin, there may be redness in places, hair on the affected part of the skin falls out, ischemic edema is noticeable.

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

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Causes diabetic angiopathy

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

• Disruption of the metabolism of mucoproteins and lipids, which affects the state of the vascular system.
• The degree and severity of diabetes mellitus, duration of the disease.
• In secondary diabetes, which is preceded by trauma to the pancreas, its partial amputation or pancreatitis, the incidence of diabetic angiopathia increases significantly.
• Changes in blood vessels are also recorded in laboratory studies based on the introduction of counter-insular hormone or physical impact on the islets of the pancreas.
• There is also a high probability of transmission of the disease through heredity, with four possible variants.
• In addition, those people who, in addition to hereditary endocrine pathology, have metabolic disorders fall into the risk category.

The causes of diabetic angiopathy usually indicate a dangerous predisposition to this disease. Therefore, it is important to undergo regular examinations to prevent the development of the disease and its severe consequences.

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Symptoms diabetic angiopathy

Depending on the nature of the vascular lesions, microangiopathy (changes in the capillaries) and macroangiopathy (damage to the arterial and venous system) are distinguished. The symptoms of diabetic angiopathy depend on which vessels are damaged - this can be the retina, kidneys, coronary arteries and capillaries of the heart, damage to the vessels of the lower extremities and the vascular system of the brain. The following symptoms are characteristic of diabetic angiopathy:

• numbness of the limb, feeling of cold, goosebumps.
• pain accompanied by cramps and lameness.
• depletion of the skin of the legs due to prolonged lack of oxygen and nutrients.
• the appearance of trophic ulcers and suppurations affecting muscle and bone tissue. This is the final stage of tissue dystrophy in diabetes, so any microtrauma and bruise lead to the formation of a non-healing ulcer, often infected due to weak immunity. If diabetes occurs in a decompensated form, then gangrene of the foot develops. This is a severe surgical disease that is treated surgically.

Symptoms of diabetic angiopathy indicate the onset of serious disorders of soft tissue trophism and periosteum, but with timely initiation of treatment, severe pathologies can be avoided and the disease can be supported at an early stage.

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Diabetic angiopathy of the eye

One of the complications that develops with diabetes is diabetic angiopathy of the eye. It is customary to distinguish two forms, characterized by the degree of vascular damage - microangiopathy and macroangiopathy.

In the first case, changes occur only in small eye vessels, which causes minor bleeding and blood flow disturbance. In the second case, large eye vessels are injured. In aggravated cases, tissue trophism is disrupted, bleeding occurs, and visual acuity decreases.

Visual impairment in diabetes mellitus is more common in old age, but recently the disease has become much younger. If medical recommendations and drug treatment are not followed, vascular pathology of the eyes develops. The lumen of the vessels narrows due to swelling of the capillary walls, and this is fraught with a violation of the trophism of the eye. When examined by an ophthalmologist, yellow spots are noticeable on the eyeball, and at the site of the exit of the optic nerve - numerous hemorrhages, which affects visual acuity.

Symptoms of vascular pathology in diabetes:

• vision becomes blurred or partially disappears;
• progressive myopia;
• flashes or flickering of bright spots before the eyes;
• hemorrhages from the nasal cavity.

Diabetic angiopathy of the eye requires medical intervention, primarily based on the treatment of the underlying disease - diabetes. It is impossible to completely prevent vascular pathologies, but by following a diet, a healthy active lifestyle and following medical prescriptions, you can avoid vision loss.

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Diabetic angiopathy of the lower extremities

The main cause of the pathological condition is a serious metabolic disorder in the body associated with insulin deficiency. Diabetic angiopathy of the lower extremities is a serious disease that develops in patients with diabetes. It manifests itself in damage to the vascular system - from the smallest to the largest vessels. Growths appear on the inner surface of the vessel, as in obliterating atherosclerosis. This is explained by the fact that diabetes creates a favorable 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. Manifestation of polyneuritis of varying intensity (burning and hyposensitivity of both a small area of skin and the entire foot, up to severe pain syndrome).
2. Pulsation in the peripheral arteries persists even in aggravated forms (trophic ulcers, gangrene of the fingers).
3. Combination of angiopathy with nephropathy and retinopathy.

The popliteal artery and its branches are most often affected by the disease. If we compare vascular pathologies in diabetes with the obliterating form of atherosclerosis, then with diabetic changes there is a high probability of gangrenous lesions of the lower extremities.

Diabetic angiopathy of the lower extremities can be diagnosed at the first signs of circulatory failure, but if you contact a specialist in a timely manner at this stage, you can avoid serious complications.

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Stages

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

• The patient has no specific complaints at stage zero, but with a detailed examination it is already possible to diagnose initial degenerative changes in the vessels.
• At the first stage, the skin becomes pale, small ulcers appear on the lower limbs, but there is no pronounced pain syndrome.
• The ulcerated areas become deeper, sometimes affecting the entire muscle layer, reaching the bone. The pain is pronounced.
• Necrosis of soft tissues develops along the edges of ulcers. Necrosis is accompanied by severe redness, swelling, purulent abscesses, phlegmon, and bone tissue becomes inflamed.
• Necrosis affects the phalanges of the fingers and feet.
• The last, fifth degree. Necrotic damage covers the entire foot, amputation is indicated as an effective method of surgical treatment.

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

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Diagnostics diabetic angiopathy

Trophic disorders of the kidneys, retina, heart, and brain can be extremely life-threatening, so do not neglect all prescribed laboratory and instrumental studies. Timely diagnostics of diabetic angiopathy includes a set of measures - for a detailed study, not only blood and urine samples are needed, but it is also very important to monitor the functionality of those organs that suffer primarily from this disease.

To confirm the diagnosis, you need to take the following tests:

• Blood for residual nitrogen (no more than 14 – 28 mmol/liter). An increase in its level indicates a disorder of the urinary system. The most informative indicators indicating kidney problems are an increase in urea (the norm is 2.5 to 8.3 mmol/liter) and creatinine (the norm for women is 55 – 100 μmol/liter, for men – from 62 to 115 μmol/liter).
• Urine for protein, glucose, ketone bodies, b2-microglobulin (its presence in urine indicates kidney pathology). At the beginning of the disease, the protein content in the blood is approximately 300 mg in the daily urine norm, the percentage of sugar is 10 mmol / liter. At a late stage of the disease, the presence of ketone bodies can be recorded in the urine. The glomerular filtration rate indicates the extent to which the kidneys are affected - at an early stage of the disease, this figure is 140 ml per minute, with a severe course in the later stages - 15 ml per minute.
• Determination of the lipid spectrum of blood. In diabetic angiopathy, the level of lipoproteins and cholesterol (more than 6 mmol) increases.

Of the instrumental research methods recommended to confirm the diagnosis are:

• comprehensive examination by an ophthalmologist;
• conducting electrocardiography, echocardiography, coronary angiography;
• Dopplerography and arteriography of the legs are indicated;
• Conducting an ultrasound examination of the kidneys.

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Treatment diabetic angiopathy

Vascular lesions in metabolic pathologies require medical intervention. Treatment of diabetic angiopathy primarily involves treating the current disease - diabetes mellitus. In advanced cases, the most effective treatment is the treatment of complications. Thus, retinopathy is treated with photocoagulation - the growth of blood vessels is slowed down by point cauterization. This allows the patient to preserve vision for another 10-15 years. Also, parabulbar administration of drugs (corticosteroid drugs) is additionally indicated, and drugs that prevent vascular branching (Ranibizumab) are administered intraventrally.

In case of severe kidney damage, hemodialysis is recommended.

If circulatory problems lead to complications such as gangrene, then surgical treatment is indicated, specifically, the affected limb is amputated.

Treatment of diabetic angiopathy is based on normalizing blood sugar levels. At the second stage, medications that normalize blood flow, strengthen blood vessels and improve tissue trophism are relevant. It is important to remember that medications that lower sugar levels should be taken with constant monitoring of glucose levels, and liver enzymes should also be monitored. Along with drug treatment, diet therapy also plays an important role - adherence to a diet and eating regimen helps maintain blood sugar levels.

Treatment of diabetic angiopathy of the lower extremities

Three key areas of treatment of vascular pathologies in case of metabolic process deviations:

• restoration of normal metabolism;
• prescribing drugs that restore neurovascular regulation, strengthen vascular walls and normalize blood clotting;
• control counter-insular hormones and autoallergens to prevent their hyperproduction.

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

The main role in normalizing metabolic processes is given to medications that lower glucose levels. This category includes prolonged-release insulin preparations, oral medications, or combinations of the two types. In parallel, it is recommended to take vitamins of group B (B6, B12, B15), P, PP - to maintain liver function, normalize metabolic processes, strengthen blood vessels and improve blood flow.

In case of vascular pathologies, the use of anabolic steroids gives good results - they normalize protein metabolism and inhibit the activity of glucocorticoids. The next category is drugs that improve the permeability of the vascular wall, improve the resorption of hemorrhages and proteolytics. With complex use, the general condition improves, the sugar level stabilizes, and vascular manifestations of diabetes are reduced. In addition to drug treatment, electrophoresis with a solution of novocaine, heparin, massage, as well as a set of individually selected therapeutic physical exercises are prescribed.

In case of trophic ulcers, local treatment is used, in particular - antiseptic dressings, Vishnevsky ointment, insulin can be used, intravenous administration of blood substitutes is indicated. In some cases, arterial plastic surgery is performed (to restore blood flow to tissues).

In case of complications in the form of dry gangrene, conditions are created so that the affected area does not turn into a wet form. If necrotic lesions spread, pain increases or wet gangrene develops, then the only indication is amputation above the site of the lesion.

Prevention

It consists of following all medical prescriptions - taking medications that lower sugar levels, improve nerve conduction and blood flow, taking vitamin complexes, constantly monitoring sugar levels, and following a diet and eating regimen. Prevention of diabetic angiopathy is very important in the early stages of diabetes.

1. If there are already signs of angiopathy, it is very important to prevent the disease from progressing to a more serious stage. To do this, it is enough to periodically take a blood viscosity and coagulation test, which will provide information about its rheological properties. Determining the level of cholesterol in the blood will help to model the diet, which is no less important for maintaining healthy blood vessels.
2. Moderate physical activity according to an individually selected set of exercises will help to keep the body in good shape and improve blood flow. However, it is important to set loads commensurate with your strength, since overfatigue with angiopathy can end in an attack of angina, stroke or heart attack.
3. Of course, to prevent complications in other body systems, it is necessary to systematically visit not only a therapist, but also an ophthalmologist and endocrinologist, since patients with diabetes of the first and second types are at risk of developing severe vascular pathologies.

Prevention of diabetic angiopathy or its control at an early stage is an easier way than dealing with complex complications at an advanced stage.

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