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Diabetes Complications: Blood vessels & Hypertension

Blood Vessels

Diabetes affects blood vessels of all sizes. The affection of large vessels is called macrovascular disease e.g. coronary artery disease (disease of artery supplying heart) or cerebrovascular disease (disease of artery supplying brain) or peripheral vascular disease (disease of artery of lower limbs) while the disease of small blood vessels (microvascular disease) affects kidney and retina.

Arteries have inner, middle and an outer layer. Blood lipids, end products of glucose, free radicals, turbulent blood flow injure the inner layer of arteries. The lipids in the blood enter these areas of injury and various cells in blood get attached to these areas. Chemical substances released from these blood cells contract the blood vessels and attract more and more cells. The blood vessel is blocked by tiny blood clots. The middle layer of the vessel thickens and hardens, narrowing its lumen. The outer layer too, becomes hard and brittle. Blood has a natural capacity to dissolve small blood clots. This ability is reduced. A big clot may form in the lumen of the narrowed vessel. These changes occlude the vessel and obstruct blood flow, to a greater or lesser extent.

To some extent, this degenerative process in the arteries is a part of natural aging. High blood pressure, diabetes, consumption of tobacco in any form, central obesity, abnormal blood lipids contribute to this degenerative process. Diabetes worsens the effect of other associated risk factors. Male sex and positive family history of coronary artery disease in first-degree relatives are other risk factors of this process,

Hypertension (high blood pressure )

Hypertension is more common in both type 1 and type 2 diabetes and in impaired glucose tolerance than in general population. It is often associated with insulin resistance, abnormal blood lipids and central obesity. Blood pressure (BP) vises when kidneys are affected by diabetes. Hypertension worsens macro and microvascular disease of diabetes.

BP should be checked regularly in diabetics. It should be maintained at 130/85 mm or below. Hypertension is treated initially by weight reduction, restriction of saturated fats and sal! in the diet, limiting or omitting alcohol, regular exercise and stoppage of smoking. Drugs, often in combination, are given if these measures are ineffective. Selection of appropriate drugs is necessary, since some impair glucose tolerance mask early signals of hypoglycaemia, increase blood lipids reduce blood flow to lower limbs or cause erectile dysfunction.

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Diabetes Complications: Blood vessels & Hypertension