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Damage of vessels at a diabetes mellitus
June 22, 2012
Diabetes mellitus — a disease which arises as a result of absolute or relative insufficiency of insulin. At people who are ill a diabetes mellitus problems with cardiovascular system are shown long before that time when there are first symptoms of diabetes. The people having diabetes, especially the second type have higher risk to ache with cardiovascular diseases.
Reasons of diabetic damage of vessels
The fact that what more time of people suffers from a diabetes mellitus is taken for granted, especially the risk of damage of vessels is high. Increase of risk of display of diseases of vessels at diabetes is directly connected with the high arterial pressure, non-compliance with a rigid diet, smoking, lack of sufficient exercise stresses. At diabetes there is atherosclerosis as an effect of accumulation in walls of vessels of cholesterol more often. Over time there is a formation of cholesteric plaques which interfere with free transportation of oxygen to a cardiac muscle. If there is a separation of a cholesteric plaque, then as a result on this place there can be blood clot that becomes afterwards the reason of serious diseases — a stroke, gangrene as consequences of insufficient blood circulation in extremities.
Symptoms of diabetic damage of vessels
At people who are ill a diabetes mellitus in the presence of problems with vessels various symptoms can be observed. Damage of vessels at a diabetes mellitus can be expressed by problems with sight: the person sees everything indistinct, at him periodically flash before eyes of "front sight". Very often at the patient hypostases of extremities and the person are observed, standing there are ulcers, sensitivity, both hands, and legs is lost. Sometimes when walking the alternating lameness and pain in legs is shown. Besides, at the patient with defeats of vessels opacification and spumescence of urine can be observed, high arterial pressure is regularly shown, periodically there are pains in a breast.
The diabetic angiopatiya is a diabetic damage of vessels at which first of all the so-called capillaropathy is observed. This pathology is specific to a diabetes mellitus. In a human body at the level of capillaries there is a transportation of necessary substances in fabrics, and also the return transport from fabrics of waste products of cells. At damage of capillaries this process is slowed down what the organism in general suffers from.
At patients with a diabetes mellitus earlier, than at other people, atherosclerosis is shown. This illness proceeds at diabetics heavier, than at other patients. Atherosclerosis at diabetes can develop at people of both floors and at any age, at the same time it is very often combined with a mikroangiopatiya. Atherosclerosis affects heart arteries, vessels of a brain, an artery of upper and lower extremities.
The diabetic angiopatiya develops at the patient as an effect of bad treatment of a diabetes mellitus. It attracts disturbances in fatty and protein metabolism, strong and frequent differences of content of glucose in blood, considerable disturbances of hormonal balance. As a result, vessels suffer: oxygen providing fabrics becomes less active, there is a disturbance of a blood flow in small vessels.
Development of an angiopatiya happens as a result of autoimuny processes. In a human body autoimmune reactions develop as use effect for treatment of insulin of long action. Besides, extremely negative impact on progressing of an angiopatiya is made by the use by patients of alcohol and tobacco smoking.
Disease of vessels of legs at a diabetes mellitus
Regardless of how the diabetic illness of vessels is shown, at patients with a diabetes mellitus such symptoms as the alternating lameness, an ulceration of feet are very often observed. Afterwards the disease can provoke a gangrenosis. It agrees with medical statistics, at patients with a diabetes mellitus gangrene develops in 50 times more often than at healthy people. Most often gangrene at diabetes develops at women who are ill a diabetes mellitus.
As a rule, at the first stage of development of an angiopatiya of legs of the expressed changes and symptoms of a disease it is not observed. Existence of certain changes can be defined only in the course of research by methods of a takhoostsillografiya, a kapillyaroskopiya, a reografiya.
At the second stage of a course of a disease of vessels of legs which call functional at the person pain in distal departments is already periodically shown. Initially pain can disturb only at long walking. Later pain begins to be shown periodically also at rest, at the same time from time to time the patient has paresthesias, a burning sensation or a chill. At night spasms of legs can disturb.
In the course of survey of the patient at this stage the specialist notes that at it blanching and a cold snap of feet takes place. At a palpation the weakened pulsation on a back and back tibial artery is felt.
If the disease progresses, then gradually it passes into the third, organic stage. At this time at the person the Charcot's syndrome which actively progresses is already shown. After a while pain passes into a constant and does not weaken neither in the afternoon, nor at night. However if at the patient the phenomena of a diabetic mikroangiopatiya dominate, pain can be not so expressed. Therefore manifestation of heavy trophic changes can seem to the person sharp and sudden.
Skin standing also changes the structure: it becomes thinner and dry, is very easily injured. Initially pale skin gradually gets a crimson and cyanochroic shade. Weakening of a pulsation of a popliteal artery, and also arteries of the back of foot is noted. If it is listened, then is very weak. Sometimes on a thumb of foot or on other fingers, and also on a sole there are bubbles filled with serous and hemorrhagic liquid. Later the patient has trophic ulcers which do not heal long time.
At the same time damage of ileal and femoral arteries is shown in more exceptional cases. Such pathology is the certificate that at the patient extremely severe form of obliterating atherosclerosis developed.
Gangrene which can develop both owing to obliterating atherosclerosis, and as complication of a diabetic mikroangiopatiya becomes very dangerous complication of diseases of vessels as a result. Gangrene complicates a current of a serous and hemorrhagic bubble or a trophic ulcer. The gangrenosis often begins with that place where earlier there was a crack a callosity or other wound. The gangrenosis can occur differently. At "Sukhoi" to gangrene necrotic masses is gradually mummified and torn away. At "wet" gangrene at the patient very heavy general symptoms are shown, and the septic state actively develops.
Diabetic damage of vessels at different people can proceed absolutely differently. In certain cases process develops gradually, for many years, sometimes decades. But sometimes at patients with a diabetes mellitus the current diabetic macro - and mikroangiopatiya progresses extremely quickly, and gangrene can develop in that case almost immediately. Features of process directly depend on what character of a current of a diabetes mellitus is observed at the patient.
Diagnosis of an illness of vessels at a diabetes mellitus
In the course of establishment of the diagnosis the specialist, first of all, conducts survey of the patient to learn about his complaints, history and features of development of a diabetes mellitus, illness symptoms. It is very important to doctor to define whether periodic jumps of arterial pressure take place at the patient, whether the patient smokes. After that careful inspection in the course of which the doctor defines localization of the symptoms disturbing the patient is performed, finds out, how often they give trouble.
To confirm a diabetes mellitus, in the course of diagnosis without fail it is necessary to define amount of sugar in blood, using for this purpose a certain scheme about which the doctor-endocrinologist will tell. Also in the course of a laboratory blood analysis the level of cholesterol and other lipids is defined. If the doctor suspects that at the patient work of kidneys is broken, to him carry out also the analysis of urine for definition of availability of protein in it.
To define a condition of vessels of the lower extremities and their function, complex researches which include several tests assuming an exercise stress, and also duplex ultrasonography of vessels are applied. To estimate cardiac performance, to the patient the electrocardiogram, and also the stress test assuming carrying out an ECG in the course of the increasing loading is carried out. Ultrasonography research allows to estimate blood-grooves a condition of vessels.
For identification of damage of vessels of a retina (retinopathy) special researches — – only the specialist ophthalmologist has to carry out an oftalmoskopiya or the fluorescent angiogram.
Treatment of diabetic damage of vessels
Treatment of diseases of vessels at diabetes assumes ensuring control over the level of arterial pressure, and also continued support of normal level of sugar in blood. It is for this purpose extremely important to keep to the diet recommended by the attending physician and also constantly to accept correctly picked up medicamentous drugs.
Regular administration of drugs which reduce glucose level or insulin is obligatory for diabetics. Beta adrenoblockers, inhibitors of an angiotensin-converting enzyme, blockers of calcium channels, and also drugs-diuretics are applied to lowering of arterial pressure at diabetes. It is possible to reduce the content of cholesterol in blood by means of statines.
If the patient has a risk of formation of blood clots, then to it medicines which, reduce the level of interaction of thrombocytes can be appointed. It can be Aspirin, Plaviks.
If on skin of legs ulcers were formed, then they should be processed surgically. For prevention of emergence of new ulcers and distribution of an infection to the patient reception of antibiotics is appointed. Lack of adequate treatment as a result can lead to further infection, gangrene and amputation. For the prevention of amputation angioplasty, stenting, shunting is carried out. The treatment method is individually appointed by the vascular surgeon.
At a retinopathy special operation with use of the laser is sometimes performed. With its help carry out excision of pathological vessels which provoke vision disorders at patients with a diabetes mellitus.
Prevention of diabetic damage of vessels
Patients with a diabetes mellitus have to pay to prevention of diseases of vessels special attention. It is necessary to try to change own way of life as much as possible. It is especially important to make it if the disease of vessels is already diagnosed at an early stage.
Not to allow emergence of ulcers, every day the person has to examine legs very carefully. At a strong xeroderma it is necessary to apply lanolin - the containing means. It is important not to allow traumatizing skin of legs, to adhere to a diet, not to pass time of reception of those drugs which were appointed by the doctor for complex therapy.
Major factor of prevention of diabetic damage of vessels is maintenance of normal content of sugar in blood.
Besides, a sick diabetes mellitus it is extremely important to leave off smoking, reduce completely in a diet quantity of fat and salty dishes, not to allow increase in weight, and also to watch indicators of arterial pressure and content in cholesterol blood. Perhaps, the doctor will recommend to take aspirin which promotes prevention of emergence of blood clots.
Not less important for the prevention of a disease of vessels of legs every day to walk not less than 45 minutes, to wear only convenient shoes.
Section: Diseases of vessels