Diabetic Microvascular Damage

Part of controlling diabetes is understanding the possible complications that comes from not keeping the blood sugars in check.  These complications all arise from damage to blood vessels due to elevated blood sugar levels.  Every organ system in the body can be affected.  Broadly speaking these complications are divided into two groups: macrovascular ones (large vessel) and microvascular ones (small vessel).  This week I'll be discussing the small vessel damage.

Microvascular Effects:
These changes have been shown to be closely linked with diabetic control.  Those who keep their hemoglobin A1C levels below 7.0%, do not for the most part develop these problems.  Let me discuss them in more detail.

Neuropathy: This is caused from damage to nerve fibers due to the diseased blood vessels that supply them.  The result is decreased feeling in the feet and poor wound healing.  A small pebble in the shoe which would be immediately taken out in a person with normal feeling may fester in a diabetic and cause a sore.  These sores can enlarge and get deeper.  If severe enough, infection can begin first in the skin (cellulitis) and later it may even reach the bones (osteomyelitis).  Bone infection is nearly impossible to cure with medications alone and can lead to amputation.  This often starts in the toes, continues in the forefoot and can lead to amputation above and below the knee.  Those with diabetes should inspect their feet each and every night prior to going to bed.  A tiny sore can be cured if caught early, evading the dreaded complications listed above.  Once a year, your physician should check the feeling in your foot using a simple filament test shown above.


Nephropathy: This is kidney damage.  In the United States diabetes is the number one reason for hemodialysis. Not only is hemodialysis inconvenient, it will greatly affect one's quality of life.  The chance of dying is five times higher in those who are on dialysis compared to those who are not.  Early diabetic kidney damage can be found by screening for protein in the urine.  In addition to keeping the blood sugars down, there are medications (ACE inhibitors and ARB's) that have been shown to slow the progression of diabetic kidney damage.  The urine should be checked at least once a year with your physician.

Retinopathy: The membrane in the back of the eye that allows us to absorb light and is responsible for vision is called the retina.  Blood vessel damage causes this important membrane to become thin and degenerate.  What is the number one cause for blindness in our country?  You guessed it, diabetes.  There are early changes that can be seen in the eye by an ophthalmologist.  Each diabetic should see an eye doctor once a year to be checked.  If damage is found, laser surgery can slow down this destructive process.  In the absence of good blood sugar control, though, it is usually a losing battle.


Arthropathy: This is a less well known complication of diabetes.  It is the slow destruction of the joints, often in the feet.  The delicate arch collapses and becomes deformed.  Together with neuropathy, dangerous pressure points develop that lead to ulcers and sores.  Specialized shoes can help off load these pressure points.  Once again, good blood sugar control will completely prevent this problems.