Diabetes Vascular and Neural Damages

Diabetes and its complications

Diabetes can lead to cardiovascular damage in a number of ways. These processes do not develop independently, as each may accelerate or worsen the others. This means that when people with diabetes develop for example a heart attack or stroke, the prognosis is worse than for people without diabetes because of the vicious cycle caused by the combined vascular abnormalities associated with diabetes.
There are a number of types of this condition and a range of reasons for people to develop it. It can be a serious cause of concern, as damage to the blood vessels can lead to consequences ranging from stroke to loss of a limb.
All types of diabetes can lead to diseases within the heart and circulatory system. In many people with diabetes these different factors co-exist resulting in progressive damage to the heart and blood vessels. The two main processes which lead to cardiovascular disease are atherosclerosis and hypertension.

Macroangiopathy

Since atherosclerosis damages the medium and large blood vessels, the term macroangiopathy is often used to indicate its presence in people with diabetes.
Macroangiopathy is a disease of the large blood vessels in which fat and blood clots build up and stick to the vessel walls, blocking the flow of blood. Types of macroangiopathy include coronary artery disease (macroangiopathy in the heart), cerebrovascular disease (macroangiopathy in the brain), and peripheral vascular disease (macroangiopathy that affects, for example, vessels in the legs).

Microangiopathy

As well as atherosclerosis and hypertension there are other damaging effects which are specific to diabetes: microangiopathy.
Microangiopathy is a disease of the capillaries (very small blood vessels), in which the capillary walls become so thick and weak that they bleed, leak protein, and slow the flow of blood.
One of the most infamous forms can be found in patients with poorly controlled diabetes. In these patients, the walls of the blood vessels become damaged and start to leak proteins, and the flow of blood is impeded. Slowing the flow of blood can result in reduced oxygenation to the tissue supplied by the involved blood vessels. This, in turn, can result in necrosis. For example, the tissues in the foot may die and become damaged, potentially leading to amputation because once the tissue dies, it cannot be revived.
Diabetes predisposes to the development of microangiopathy in many areas, including the eye.
Capillaries throughout the body are affected, but damage to the microcirculation of the eyes, kidneys and nerves is responsible for the major clinical manifestations - retinopathy, nephropathy, neuropathy and the diabetic foot.
Microangiopathy can also occur in the central nervous system, leading to strokes. The brain especially is vulnerable to interruptions in its oxygen supply, and if the blood flow to the brain is disrupted or slowed, brain cells can die. Depending on the area of the brain involved, the patient can develop an array of symptoms.

Neuropathy

Diabetes can affect different components of the nervous system. Damage to one component of the nervous system which provides a nerve supply to the internal organs of the body, including the heart and blood vessels is known as neuropathy. Damage to the nervous system can follow microangiopathy involving the small vessels which supply blood to the nerves themselves.
Loss of the nerve supply to small blood vessels can also impair the regulation of blood flow. This is an important contributory factor to the development of diabetic foot ulcers

Diabetes Complication Treatment

A lumbar sympathetic block is an injection of local anesthetic into or around the sympathetic nerves. This may in turn reduce pain, swelling, color, sweating and other unusual changes in the lower extremity and may improve mobility. Certain patients with neuropathy or peripheral vascular disease may also benefit from lumbar sympathetic blocks.
The lumbar sympathetic block is performed under sterile conditions. The skin on back is cleaned with antiseptic solution and the skin is then numbed with a local anesthetic. Then X-ray is used to guide the needle or needles into the proper position along the outside of the spine. If this is okay, the injection takes place gradually over several minutes. The physician will use the X-ray to evaluate the spread of the injected medication. When a sufficient area is covered, the injection will be over. When done, the needle is removed and a band aid is applied.
Immediately after the injection, you may feel your lower extremity getting warm. Unless there are complications, you should be able to return to your work the next day.

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