The medical term “retinopathy” refers to damage to the retina that occurs against the background of general diseases of the body, such as hypertension, symptomatic hypertension, diabetes mellitus, and atherosclerosis. The danger of retinopathy is primarily due to acute occlusions of retinal vessels, which can occur during the course of the disease that caused it and require immediate medical attention. In the absence of timely, competent treatment, retinopathy often becomes the cause of retinal dystrophy, leading to atrophy of the optic nerve and the onset of irreversible blindness.
Causes of diabetic microangiopathy
As the disease progresses, the inner membrane of the artery thickens and atherosclerotic plaques form on it. Further hardening of the artery and necrosis lead to the formation of blood clots, which leads to impaired circulation in certain places.
The development of diabetic microangiopathy in diabetes mellitus is promoted by obesity, hyperglycemia, increased blood clotting, systemic inflammation and arterial hypertension. Smoking and occupational intoxication also increase the risk of developing atherosclerosis.
Preventive measures
You can protect yourself from such a disease - just listen to the following advice and follow them unquestioningly.
- The diet should include vegetables, fruits, fish and dairy products. We exclude fatty and fried foods. Salt is also an enemy, so it is necessary to reduce its amount.
- Bad habits are bad for your health. Alcohol and smoking are prohibited.
- The patient must monitor his mental state, avoid stress, depression, and be sure to follow the correct daily routine. At the request of the patient, the attending physician may prescribe sleeping pills or sedatives.
- If you have a sedentary lifestyle, you need to walk in the fresh air more often, engage in light sports: swimming, walking, physical therapy.
- Even if you don't have diabetes, it's a good idea to check your blood sugar levels daily.
Classification of microangiopathy
At the first stage of compensation of peripheral blood circulation, stiffness of movements occurs, especially in the morning, frequent fatigue, sweating of the feet and hands, and variable lameness.
The second stage of subcompensation is manifested by an acute perception of cold and a feeling of numbness in the feet, changes in the nail plates and pale skin also appear. There is hair loss in the lower leg area. Also at the second stage, variable claudication and regional systolic pressure may be observed.
The third stage is characterized by joint pain and muscle cramps, dry skin and plantar ischemia. There is hypostatic swelling of the feet and legs, poor mobility of the foot joints, and necrotic ulcers appear on the fingers.
The fourth stage is manifested by gangrene on the fingers and feet, the appearance of large necrotic areas of tissue on the lower leg.
In patients with diabetes mellitus, changes in the somatic nervous system are often detected, and already in the early stages changes in varying degrees of severity are possible.
With diabetic microangiopathy, there are often complaints of increased fatigue when walking, an acute perception of cold - paresthesia in the form of a burning sensation, a feeling of numbness in the legs and lower legs. Such symptoms often occur in diabetes mellitus during the period of decompensation during physical activity.
Paresthesias also appear at rest; they signal the development of organic vascular damage. When paresthesia appears in a certain area of the foot or leg and accompanying symptoms and pain, one can judge the degree of vascular changes.
Also, the area of localization and the nature of the pain can characterize the degree of vascular damage and the involvement of neighboring nerves.
Partial, mild pain in the area of the feet or legs in the absence of trophic disorders may indicate an initial angiospastic stage. Pronounced pain symptoms in the legs during prolonged walking or hypothermia, or with trophic disorders may indicate organic lesions and the initial stage of obliteration. Ischemic pain also indicates obliteration of areas of blood vessels; such pain is constant and stops only when the limbs warm up.
In diabetes mellitus, calf cramps are also common and occur not only when walking. Quite often, cramps appear at night due to increased excretion of potassium in the urine. In this situation, potassium salts are taken and the convulsions stop in a short time.
Clinical studies help determine the degree of trophic disorders and pulse changes. In the initial stage, characteristic signs of trophic disorders may not be observed. The earliest signs of diabetic microangiopathy are changes in the color and temperature of the skin, which becomes white and some areas are cold to the touch. With the appearance of organic changes in blood vessels, a pronounced pallor of the skin around the fingers and feet, with a bluish tint, is observed. Next, trophic changes begin to appear, the skin loses its former elasticity, becomes dry and flabby, and peeling of the skin begins. Hair on the lower extremities also begins to fall out and nail growth slows down significantly. The nail plate becomes deformed and becomes thick and crumbly.
Rapidly progressing vascular disease of the lower extremities can probably result in the development of ulcers and gangrene. The development and course of gangrene may differ and are determined by the form of vascular lesions.
Here are several types of gangrene development:
- atherosclerotic;
- complicating the development of diabetic microangiopathy;
- appeared with a combination of different vascular lesions;
- developing with obliterating endarteritis;
- developing during a purulent inflammatory process in patients with diabetes mellitus who do not suffer from vascular damage.
Such development can occur with low tissue resistance. Diabetic gangrene is divided into dry and wet types. The dry type occurs spontaneously and is accompanied by a hemorrhagic blister on the finger, formed due to mechanical or thermal injury. Swelling appears and tissue nutrition is disrupted. The onset of gangrene may lie in the area of callus or keratinization, which also reduces blood circulation in tissues and compression of adjacent small vessels occurs.
Wet gangrene will most often develop with obliterating atherosclerosis and endarteritis.
Therapy
Treatment includes a number of activities. One of the main ones is to stabilize blood pressure and bring it to normal. In addition, the composition of the blood is analyzed, how thick and viscous it is, and cholesterol levels.
Based on these data, the doctor prescribes drugs that will not only eliminate the symptoms of hypertensive macroangiopathy, but also cure the main causes of the disease:
- For this purpose, complex treatment often includes anticoagulants that thin the blood.
- Another group of drugs that are introduced into treatment are antispasmodics. They allow you to remove excess tone in the vessels, expanding and relieving pain.
- Angioprotectors help strengthen the walls of blood vessels and eliminate cracks in them.
- In the presence of diabetes mellitus, therapeutic measures must include measures to stabilize insulin levels.
In addition to special pharmaceuticals, some non-traditional methods can be used in treatment, for example, magnetic therapy, mud therapy, and play-reflexotherapy.
The patient must also adhere to a strict diet: it is necessary to completely exclude fatty foods, fried, spicy and salty foods. These products not only increase blood cholesterol levels, but also negatively affect blood pressure and disrupt metabolism.
Symptoms of diabetic macroangiopathy
With atherosclerosis of the coronary arteries, coronary heart disease appears in acute or chronic forms. Diabetic microangiopathy is often diagnosed together with aneurysms and arrhythmia, heart failure. Patients with diabetes die from heart attacks twice as often as patients without diabetes.
Atherosclerosis of the cerebral arteries is often accompanied by chronic cerebral ischemia.
Diabetic microangiopathy is characterized by numb feet, lameness in gait, swelling of the limbs, pain in the muscles of the thighs and buttocks during physical activity. A sharp disruption of blood flow causes critical ischemia, with the development of which comes necrosis of the foot and leg. Gangrene also occurs against the background of skin damage due to cracked feet or fungal infection. In more minor disturbances of blood flow, a chronic trophic ulcer develops.
Prevention and prognosis
The prognosis for ocular angiopathy depends entirely on the course of hypertension. Patients who manage to maintain normal blood pressure readings for a long time are not at risk of blindness. Patients facing aggressive forms of hypertension need to prepare for a serious decrease in visual acuity.
There are no specific preventive measures for this disease, because hypertension is often a hereditary disease. To avoid complete loss of vision, people prone to high blood pressure should regularly measure this indicator and take medications prescribed by their doctor. Twice a year they need to be examined by an ophthalmologist, and if signs of angiopathy are detected, follow additional instructions.
Diagnosis of diabetic macroangiopathy
Diagnosis of diabetic microangiopathy helps to identify the stage of damage to coronary, cerebral, and peripheral vessels. The determination will also involve an endocrinologist, diabetologist, cardiologist, neurologist and cardiac and vascular surgeon.
Diagnostics of diabetic angiopathy takes place in two directions, in the first, the research method is aimed at assessing the general condition of the patient, the second is aimed at determining the degree of damage to the vessels of the limb and performing reconstructive surgery to save the limb.
A research method assessing the patient’s general condition helps determine the severity of diabetes mellitus, pathological changes in the heart and kidneys. During outpatient diagnosis, blood tests, electrocardiography, and X-rays of the affected foot are used. Purulent discharge from the foot wound is also taken for analysis to determine the microflora. Blood pressure is measured in the tibial arteries.
A biochemical blood test is performed to determine glucose and cholesterol levels. The cardiovascular system is examined using ECG, myocardial perfusion scintigraphy and computed tomography angiography.
Our advantages
"Moscow Eye Clinic" offers comprehensive diagnostics and effective treatment of eye diseases. Modern equipment and the high professional level of specialists working in the clinic eliminate diagnostic errors.
Based on the results of the examination, each visitor will be given recommendations on choosing the most effective methods of treating the eye pathologies identified in them.
Treatment of diabetic macroangiopathy
During treatment, the progression of dangerous vascular complications that threaten the patient with disability or death slows down. Therapy for diabetic macroangiopathy is aimed at correcting the syndrome of hyperglycemia and arterial hypertension.
To replenish carbohydrate metabolism, patients undergo insulin therapy with monitoring of blood glucose levels. Correction of carbohydrate metabolism occurs through the administration of lipid-lowering drugs and a diet limiting animal fats.
