Diabetes is one of the greatest challenges of our time. On the one hand because more and more people are affected by it, and on the other hand because it is a very complex metabolic disease in which not only blood sugar plays a decisive role. Long-term undetected elevated blood sugar levels can cause damage to the blood vessels and nerves. Early detection and treatment is therefore a challenge, which is not an easy task because most people with diabetes do not have any symptoms in the early phase of the disease and therefore do not seek medical help.
This makes it all the more important to provide information about the complications, which, if they occur, can mean major limitations for those affected, but also high costs for the general public. In principle, all late complications have one thing in common - they result from vascular damage. Depending on their localisation, a distinction is made between damage to large vessels (macroangiopathy) and damage to small vessels (microangiopathy).
Vascular disease (Angiopathy)
Microangiopathic late complication
Small and very small blood vessels are damaged mainly by elevated blood glucose levels over a longer period of time which leads to disorders in function and structure of the sensible endothelium. The endothelium gets thicker (sclerosis) and permeable which causes deposits of blood particles and proteins in the tissues disordering the function of the organs.
Micro capillaries in the retina of the eye are damaged. This late complication is the most common reason for blindness in the western part of the world. Please refer to Diabetic Retinopathy for further information.
Kidneys are important organs as maintaining the function of a filter for the human body but also as a regulator of the liquid balance including micro elements and influencing production of blood cells as well. If the kidneys are damaged due to poor metabolic control the filter effect is reduced. Please refer to Diabetic Nephropathy for further information.
This diabetic late complication results in a damage of the nerves. The reason for that is that nerve cells are under-nourished by blood vessels which are damaged due to the micro angiopathy. Strongly fluctuating blood glucose levels can also lead directly to damage of the nerve cells.
One distinguishes a peripheric neuropathy disordering mainly long strains of nerves of the legs or arms from autonomic neuropathy where mainly inner organs or regulation of sweat production at the feet are influenced. Please refer to Diabetic Neuropathy for further information.
Damage of big blood vessels like carotid artery, aorta, coronary vessels or big blood vessels of the feet are concluded under this definition. This damage occurs together with atherosclerosis which progresses quickly and aggressively at people with diabetes. It has to be taken into consideration that in common with type 2 diabetes beside high blood glucose levels also a qualitative and quantitative metabolic disorder and hypertension mainly occur.
The level of LDL cholesterol („the bad cholesterol“) is of high importance. LDL molecules of people with diabetes are particularly small and dense and can therefore easily penetrate in the walls of blood vessels, stay there and lead together with inflammation cells and calcium particles to so-called “Plaques”. These can lead to stenosis of the blood vessels. If they spontaneously burst by eliminating their content this could lead to an acute closure of the blood vessels by activating blood coagulation.
Due to localisation of this closure this can result in a heart attack, stroke or reduction in circulation of the leg. In order to prevent this development it is important to optimize diabetes control (HbA1c < 7.0%) but also to minimize all other risk factors of atherosclerosis. That means lowering of blood pressure < 130/80 mmHg, lowering of LDL cholesterol <100mg/dl and elevating HDL levels (good cholesterol) to > 40mg/dl for men and > 50mg/dl for women.
Another important factor is consumption of tobacco. Smoking and diabetes is a bad combination. Every person with diabetes should even reduce or better stop smoking. Medical regular checks (once a year) are a colour-coded Duplex Sonography of the brain vessels, the measurement of the circulation in the leg vessels and an EKG. Additionally people with hypertension should undergo an echocardiography and an ergometry.
Basic requirements for people with diabetes are regular medical checks and good control of blood glucose levels to prevent late complications. Essential are an HbA1c lower than 7%, self-monitoring of blood glucose, nicotine abstinence, well-balanced nutrition, activity and regular medical checks. Measures taken in time can help to avoid eventual late complications.