Diabetic Macrovascular Damage

Macrovascular disease is damage due to large blood vessels.  There are basically three types of disease that are caused from large blood vessel damage.  They are blockages in the legs (peripheral arterial disease), blockages to the brain (stroke), and blockages in the heart heart arteries (heart attack).  Whereas microvascular damage tends to cause damage that makes life miserable, macrovascular damage results in conditions that cause the majority of deaths in diabetic patients.

All three of these conditions share similar features.  Unlike microvascular disease, strict blood sugar control by itself has not been shown to greatly decrease the risk of having these conditions.  A multi thronged approach is essential.  Controlling high blood pressure is critical.  Having both diabetes and high blood pressure more than doubles the risk of these conditions.  As such, the blood pressure goals in a diabetic are lower than for others.  Ideally, the blood pressure should not exceed 130/80.

Similar to hypertension, elevated cholesterol levels are more dangerous in diabetics as well.  Upper limits for the LDL (bad cholesterol) levels are 100 mg/dl.  This is the same goal as for those patients who already have established disease in their coronary (heart) arteries.  In fact, the risk of a heart attack in a diabetic patient is the same as for a patient who already has established heart disease.

Lastly, avoidance of cigarette smoking is critical in any patient but even more so in diabetics.  In regards to peripheral arterial disease (PAD), the only patients we see with this disease who are not diabetic are smokers.  Those with both conditions are at especially great risk.  PAD, in combination with neuropathy (see Diabetic Microvascular Damage) makes it extremely difficult to heal wounds, leading to sores and ulcers.  This may even lead to gangrene requiring amputation.

I hope that your understanding of what can go wrong with diabetes will be a stimulus to act now to prevent diabetes from progressing.  Consider the consequences above.  If a person with tendencies towards diabetes progresses to the point that their Hgb A1C is above 7.0% and requires medication, it will triggers a cascade of additional medicines.  Even at the beginning, a patient is likely to require a medicine for diabetes, an aspirin a day to prevent heart attack, a blood pressure medication and a cholesterol lowering medication.  At a minimum that is four medications.  Many patients require two, three or even four medications for the diabetes alone, three to five medicines for blood pressure and sometimes two medicines for cholesterol.  That is a lot of pills.  Not only will that be extremely expensive, there are possible side effects with all of those.  Don't wait till your doctor tells you have diabetes to take your health seriously. We all should be "on a diabetic diet."  We should all be exercising.  Now is the time to act.