How does diabetes harm the cardiovascular system?

It is estimated that about 5% of the adult population suffers from type 2 diabetes in the US. It is divided into two main types: type 1 and type 2 diabetes. The first is the result of the destruction of insulin-producing cells in the pancreas by an autoimmune process. The second is related to the phenomenon of tissue insulin resistance and an increase in insulin secretion (ie, hyperinsulinemia). However, with the duration of the disease, pancreatic islets are destroyed and insulin production is also affected in type 2 diabetes.

In both types of disease, blood glucose levels rise above normal levels. This condition negatively affects the functioning of the body through several mechanisms. Diabetes induces a prothrombotic, proinflammatory effect and causes vasoconstriction. All this increases the activity of the cells of the immune system and accelerates the formation of atherosclerosis.

It leads to many diseases of the cardiovascular system, such as:

coronary disease and heart attack, race, atherosclerosis of the arteries of the lower extremities.

People with diabetes are more likely to develop lipid metabolism disorders: the concentration of triglycerides and "bad" LDL cholesterol increases, and the level of "good" HDL cholesterol decreases. It also accelerates the development of atherosclerotic plaques and increases the risk of cardiovascular disease. Finally, the state of insulin resistance, that is, the reduced sensitivity of tissues to insulin, and the high levels of this hormone, called hyperinsulinemia, stimulate the formation of inflammatory and atherosclerotic plaques. In addition, they thicken the walls of the arteries and reduce their elasticity, which increases the risk of high blood pressure.

 

Diabetes affects the state of both the large arterial and venous vessels and the small vessels that supply blood to individual organs. That is why the complications of this disease are divided into macroangiopathic (ie large vessels) and microangiopathic (affecting small arterioles and capillaries).

Macroangiopathic complications include:

Coronary heart disease and heart attack: Studies show that the risk of dying from ischemic heart disease is three times higher in people with diabetes compared to people without diabetes;

stroke - the risk of stroke is also 2-3 times higher in diabetes; patients have severe atherosclerosis of the arteries of the neck and brain, which significantly increases the risk of stroke;

chronic lower extremity ischemia - the development of this condition is due to increased atherosclerosis of the leg arteries, reducing their blood supply; furthermore, diabetes inhibits the development of new vessels and collateral circulation; nerve damage and worsening of sensation are also important;

high blood pressure: insulin resistance and hyperinsulinemia increase blood pressure through various mechanisms, including water and sodium retention, hypertrophy of the arterial wall, and increased calcification; all this negatively affects the flexibility of the arteries and increases the risk of high blood pressure.

 

The above complications are mainly the result of intensified and accelerated atherosclerosis resulting from diabetes and accompanying obesity, as well as low physical activity.

 

Eye complications: In type 1 and 2 diabetes there are microcirculation disturbances in the retinal area of ​​the eye. This causes a condition called diabetic retinopathy. It has been found that after 15 years of type 1 diabetes, 98% of patients develop retinopathy and 5% of patients with type 2 diabetes develop retinopathy at the time of diagnosis. It manifests as a gradual deterioration in visual acuity and can also lead to sudden loss of vision in one eye.

Renal complications: are found in up to 50% of patients with type 2 diabetes. Their severity depends on the duration of the disease, the effectiveness of treatment, and high blood pressure. They usually remain asymptomatic for a long time, until chronic renal failure develops.

Diabetic neuropathy, including diabetic foot – The most common chronic complication of diabetes, affecting up to 90% of patients. It involves damage to peripheral nerves and impairment of their function, including loss. Symptoms are primarily related to sensitivity and include numbness and tingling in the hands and feet, painful muscle spasms, loss of the sense of touch, skin pain and temperature, muscle weakness, and skin ulceration. There are also problems with erection and urination [2].

Macro and microangiopathic complications are preventable. It is essential that diabetes is properly controlled so that blood glucose levels remain within the normal range. They serve this purpose:

•  Diabetes medications,
•  Regular use of insulin (especially in type 1 diabetes),
•  Taking care of a properly balanced diet,
•    Daily physical activity.

This allows you to reduce body weight and reduce obesity, which has a particularly negative effect on the body's carbohydrate balance. In a large clinical trial, glycemic control was measured by evaluating the value of glycosylated hemoglobin. It is a sensitive indicator of diabetes control in the last 3 months. The highest level of this compound in the blood was associated with an increased risk of various complications within the cardiovascular system [4].

Diabetes mellitus is a multidimensional chronic disease that affects almost the entire body. If left untreated, it can lead to many complications that are life and health threatening. That is why it is so important to use the right treatment and lead a healthy lifestyle.