Diabetic Angiopathy

Diabetic Angiopathy

Also called: Diabetic Vascular Disease

Summary

Angiopathy is any disease of the blood vessels or lymph vessels. When caused by diabetes, it may be referred to as diabetic angiopathy or diabetic vascular disease. Like most complications of diabetes, diabetic angiopathy is largely  due to hyperglycemia (high glucose levels).

People with diabetes who do not control their glucose (blood sugar) can develop vascular disease because high levels of glucose may damage blood vessels over time. This increases the risk of the vessels becoming clogged, blocking blood flow. When blood cannot carry oxygen and nutrients to cells throughout the body, the cells can become damaged or begin to die.

Too much glucose can exacerbate unhealthy cholesterol levels and contribute to atherosclerosis, a disease in which the arteries are hardened and narrowed by a gradual buildup of plaque on their inner walls.

A complication of type 1 diabetes, type 2 diabetes and other forms of diabetes, angiopathy can occur in any area of the body. Vascular problems in the heart, brain, limbs, eyes and kidneys are common in people with diabetes. Because of the potential danger of diabetic angiopathy to body systems, preventing or minimizing this damage is a key goal of diabetes management.

Strategies to help prevent angiopathy include:

  • Control of glucose
  • Control of high blood pressure (hypertension)
  • Improving cholesterol levels
  • Monitoring protein levels in urine (proteinuria)
  • Eye tests, including a dilated pupil exam
  • Foot care
  • Regular exercise
  • Good diet
  • Achieving and maintaining a healthy weight
  • Limiting alcohol
  • Notsmoking
  • Aspirin therapy if recommended by a physician

About diabetic angiopathy

Angiopathy is any disease of the blood vessels or lymphvessels. When caused by diabetes, it may be referred to as diabetic angiopathy or diabetic vascular disease.

A complication of type 1 diabetes, type 2 diabetes and other forms of diabetes, diabetic angiopathy is the process that strongly links diabetic individuals to an increased risk of cardiovascular diseases, including heart attack and stroke – the leading causes of death for people with diabetes. Heart disease occurs earlier, is two to four times more common, and is more often fatal in people with diabetes than nondiabetics.

Angiopathy can also affect the rest of the body. Poor circulationis related to higher risk of limb infections and amputation, vision problems and blindness, and kidney disease and kidney failure. People who keep their glucose (blood sugar), cholesterol and blood pressure levels close to normal may prevent or minimize the development of these complications.

Like most other diabetes complications, vascular disease is largely the result of high glucose (hyperglycemia). Increased glucose can exacerbate unhealthy cholesterol levels. Cholesterol is a fatty substance that can stick to blood vessel walls, narrowing the opening through which blood can flow. Unhealthy levels of cholesterol increase the risk of atherosclerosis, a disease in which the arteries are hardened and narrowed by the gradual buildup of plaque on the inner walls.

During circulation, the heart pumps blood through the body to deliver oxygen and nutrients that cells need and take away waste products that can harm cells. When blood flow through these vessels is lessened, cells do not receive the oxygen and nutrients they need. Over time, these body cells can become damaged or die.

Diabetes can upset the balance of HDL (“good”) and LDL (“bad”) cholesterol. Diabetic patients tend to have LDL particles that stick to arteries and damage arterial walls more easily. When glucose latches onto LDL, it remains in the bloodstream longer and may lead to plaque. People with diabetes also tend to have low HDL and high triglyceride levels, which increase the risk of heart and artery disease.

Scientists in 2006 reported showing for the first time that insulin is needed for the creation of blood vessels. They found that this glucose-controlling hormone is what alerts heart cells when to make more VEGF (vascular endothelial growth factor). VEGF stimulates production of blood vessels, such as when new arteries are needed because of coronary artery disease. This response appears to be impaired in people with insulin resistance. The next step in this line of research is to improve treatments for diabetic vascular conditions by enhancing the actions of VEGF and insulin in the heart.

Types and differences of diabetic angiopathy

Angiopathy can occur in any area of the body and is often referred to in terms of the body area it affects, such as:

Body AreaCondition
HeartCardiomyopathy, coronary artery disease
KidneysNephropathy
EyesRetinopathy
BrainCerebralamyloid angiopathy (CAA),
cerebrovascular disease
LimbsPeripheral arterial disease

There are two types of angiopathy:

  • Macroangiopathy. A disease in which fat and plaque build up in large blood vessels, stick to the vessel walls and block blood flow. Types of macroangiopathy include:
    • Coronary artery disease. Affects the muscles of the heart, resulting in an increased risk of heart attack.
    • Cerebrovascular disease. Damages the blood vessels serving the brain (carotid arteries), causing a higher risk of stroke.
    • Peripheral arterial disease (PAD). Occurs in arteries throughout the body, including the legs and arms, resulting in an increased risk of heart disease and stroke. Decreased blood flow to the legs and feet may also result in sores and infections that can lead to amputation.

  • Microangiopathy. Disease of the small blood vessels, which become thick and weak. Microangiopathy may cause bleeding, leakage of protein and impaired blood flow. Types of microangiopathy include:

    • Diabetic retinopathy. Affects the retina of the eye, causing vision problems and blindness.

      • Nonproliferative retinopathy. Blood vessels close off or weaken and leak blood, fluid and fat into the eye.  

      • Proliferative retinopathy. As retinopathy progresses and blood vessels close off, new blood vessels sprout in the retina. The new vessels are weak and can leak blood, blocking vision. The vessels can also cause scar tissue to grow, distorting the retina or pulling it out of place.
  • Diabetic nephropathy. Damages the blood vessels in the kidneys, causing useful proteins to be removed from the blood and lost in urine. Left untreated, nephropathy can lead to end-stage renal disease (ESRD), also known as chronic kidney failure.
  • Cerebral amyloid angiopathy (CAA). Occurs in the small blood vessels of the brain, causing a higher risk of dementia or stroke.

The signs and symptoms, diagnosis and treatment of angiopathy depend on the area of the body affected.

Prevention methods for angiopathy

Though blood vessel disease affects many patients with diabetes, there are strategies to help prevent and control it. These include:  

  • Controlling glucose (blood sugar). Keeping glucose close to a normal level can prevent the onset of or minimize angiopathy. A glycohemoglobin test (A1C test) measures a person’s average glucose level for the past few months. Along with regular glucose monitoring, having a glycohemoglobin test at least twice a year is a good way to determine if glucose levels are under control.
  • Controlling high blood pressure (hypertension). Keeping blood pressure under control can help minimize or prevent complications of diabetes. The target blood pressure for most people is below 120/80. High blood pressure can be controlled through self-monitoring, eating a heart-healthy low-salt diet, getting regular exercise and taking blood pressure drugs (antihypertensives) if prescribed.
  • Controlling cholesterol levels. A person’s total cholesterol level should be no more than 200 milligrams a deciliter (mg/dL) and no more than five times the HDL level. Diabetes can upset the balance of “good” HDL and “bad” LDL cholesterol.

People with diabetes tend to have LDL particles that stick to arterial walls and damage them more easily. When glucose latches onto LDL, it remains in the bloodstream longer and may lead to plaque. People with diabetes also tend to have low HDL and high triglyceride levels, which increase the risk of heart and artery disease. High triglycerides lead to increased production of LDL and deplete the production of HDL.

Regular exercise and a heart-healthy diet can reduce levels of total cholesterol, LDL cholesterol and triglycerides. If these strategies are unsuccessful, a physician may prescribe cholesterol-reducing drugs. Levels of HDL cholesterol may be increased by eating monounsaturated fat in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program. Adult patients should have a lipid profile completed annually to monitor cholesterol levels.

  • Quitting smoking or not starting to smoke. Along with its many other hazards to health, smoking raises blood pressure and damages the heart and circulatory system by gradually narrowing blood vessels. It is a major risk factor for peripheral arterial disease (PAD).
  • Monitoring protein levels in urine. In the early stages of kidney disease (nephropathy) small amounts of protein leak into urine (microalbuminuria). As time goes by, more protein is leaked into the urine (proteinuria), leading to an increased risk of end-stage renal disease (ESRD), or chronic kidney failure. In patients with diabetes for more than five years, the American Diabetes Association recommends microalbuminuria testing every year.
  • Eye exams. The retina and other structures of the eye can be severely damaged before a patient notices a change in vision or has any other symptoms. To detect diabetic retinopathy, glaucoma, cataracts and other diseases, it is important to have a dilated pupil examination at least once a year by an ophthalmologist.
  • Foot care. PAD occurs when blood vessels in the legs become narrowed or blocked by fatty deposits. Decreased blood flow can lead to sores and infections on the legs and feet. When ulcers do not heal, amputation may become necessary. Proper foot care can help prevent complications and amputation. Ways to care for feet include:

    • Schedule a complete foot examination at least annually.
    • Inspect feet daily for red spots, cuts, swelling and blisters. A physician should be contacted for these foot problems, as well as for ingrown toenails and changes in foot color, shape or sensitivity.
    • Corns and calluses should be trimmed by a physician.
    • Wash feet daily and dry them carefully.
    • Rub a thin coat of lotion on the top and bottom of feet, but not between the toes.
    • Wear comfortable shoes and socks and never walk barefoot.
    • Protect the feet from extreme heat and cold.
    • Keep the blood flowing to the feet. Elevate them when sitting. Wiggle the toes and move the ankles up and down for five minutes two or three times a day. Do not cross your legs.
  • Regular exercise. Exercise is an excellent tool to keep blood pressure down and reduce cholesterol levels. Physical activity can help delay or prevent cardiovascular disease. During exercise, muscles use glucose for energy, lowering sugar levels in the body. Emotionally, it can reduce levels of stress and depression.
  • Eating nutritious foods. For most people, a healthy diet is high in fruits, vegetables, fiber and whole grains and low in saturated fat, trans fat, salt and sugar.
  • Achieving and maintaining a healthy weight. Being overweight or obese is a major risk factor for a host of serious health conditions, including diabetes, coronary artery disease, high blood pressure, heart attack and stroke. Losing weight also lowers insulin resistance.
  • Watching intake of alcohol. Alcohol affects the clearance of fat from the liver, increases the risks of low blood glucose (hypoglycemia), high blood pressure, neuropathy and retinopathy. It also raises levels of triglycerides in the blood. However, modest consumption of alcohol can benefit the heart and may reduce the risk of diabetes. Patients are advised to ask their physician about how much alcohol they should drink, if any.
  • Taking aspirin. Studies have shown that taking a low-dose aspirin every day improves blood flow and lowers the risk of heart attack and stroke. However, aspirin can also damage the kidneys and stomach and cause other problems. A physician should be consulted before starting aspirin therapy.

Questions for your doctor on angiopathy

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about diabetic angiopathy:

  1. How does diabetes affect my blood vessels?
  2. Do I have diabetic angiopathy, or am I at risk? Which type or types?
  3. What diagnostic tests might I need to undergo, and what do they involve?
  4. What do my test results show?
  5. Does having diabetic angiopathy mean I also have atherosclerosis, peripheral arterial disease, coronary artery disease or cerebrovascular disease?
  6. What are the best ways to treat my diabetic angiopathy?
  7. If exercise, diet, quitting smoking and other changes are not enough, what medications or other treatments might I need?
  8. How does angiopathy affect my risk of heart disease, kidney disease, eye disease and other complications?
  9. What tests should I have to monitor my condition, and how often?
  10. Can I prevent diabetic angiopathy?
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