Retinal angiopathy of both eyes - what is it and how to treat it? diabetic angiopathy. Angiopathy of the vessels of the lower extremities, symptoms, diagnosis, treatment and prevention Glomerular filtration rate
It should be noted that retinal angiopathy does not occur as an independent disease. This is a symptom of another disease that causes a violation of the vessels of the eye. This changes the structure of the vascular wall. Usually angiopathy can exist for a long time. This disease leads to irreversible consequences.
Causes of angiopathy
Angiopathy can occur due to various diseases that affect the condition of the vessels. Also, the disease can occur at any age. Most often, angiopathy occurs after the age of 30 years.
Common diseases that cause angiopathy:
- Atherosclerosis;
- Scoliosis;
- Hypotonic angiopathy;
- Hypertonic disease;
- Diabetes.
- The disease can develop due to factors such as old age, bad habits, intoxication of the body, congenital anomalies in the development of blood vessels.
- Types of retinal angiopathy: traumatic, juvenile, hypertonic, hypotonic, diabetic. Today we will look at diabetic retinal angiopathy.
Diabetic angiopathy
Diabetes mellitus can be classified as a chronic disease. It occurs due to a violation of carbohydrate metabolism. At the same time, the process of assimilation of proteins and fats is also disturbed. Failures occur due to insufficient production of insulin by the pancreas. The disease progresses in a variety of ways.
Obvious signs of diabetes are constant hunger, excessive thirst, polyuria, blurred vision, neuralgia, pathological weakness.
Diabetic angiopathy of the eye occurs due to the lack of treatment for diabetes mellitus. In total, two types can be distinguished - macroangiopathy, microangiopathy. If this is macroangiopathy, then the large vessels of the eye are affected. And with microangiopathy, thinning of the capillary walls occurs. Blood circulation is disturbed. With the development of the disease, the walls of blood vessels are clogged. Changes impair blood microcirculation, this will lead to a lack of oxygen. Hemorrhages are observed, which greatly reduce the patient's vision.
Retinopathy with diabetes observed in 90% of patients. This is usually detected in the early stages of diabetes during the examination. At this time everything eye symptoms are not yet available. Decreased vision is already a late sign. May lead to blindness.
Diagnosis of angiopathy
This disease can be detected during examination by an ophthalmologist. The retina must be examined with a dilated pupil under a microscope. On examination, narrowing or dilation of blood vessels is detected. What else can be used to diagnose angiopathy?
- PC diagnostics;
- X-ray examination;
- Vascular ultrasound;
- Magnetic resonance imaging. It will allow you to assess the condition of the tissues of the eye.
Angiopathy of the retina in children
Angiopathy is associated with two serious diseases. In children, it can develop with endocrine pathology in diabetes. Although tuberculosis, rheumatism, kidney and blood disease, as well as inflammation of the disease of the organ of vision, can push for the development of this disease.
Diabetic angiopathy in a child can develop at a later date. The later diabetes is discovered, the more likely it is to develop the disease. In order for the disease not to progress, it is necessary to monitor the child's blood sugar. Children usually develop early vascular atherosclerosis. The child feels a decrease in vision and, at the same time, peripheral vision is also impaired.
Angiopathy during pregnancy
Angiopathy is very common during pregnancy. After all, during this period, the volume of circulating blood increases. Because of this, the blood vessels dilate evenly. Pregnancy becomes a trigger. With a mild degree of angiopathy, treatment is not needed. It usually goes away on its own after a couple of months.
Angiopathy can develop in pregnant women at a later date. If angiopathy was before conception in a woman, then while carrying the fetus, the disease can progress. This will lead to serious consequences. It is necessary to control the pressure and the main bottom. Doctors recommend taking antihypertensive drugs. If there is a threat to life, girls are advised to terminate the pregnancy.
Treatment of angiopathy
First of all, you need to start treating the underlying disease. The doctor will help normalize blood pressure, prescribe hypoglycemic drugs and give recommendations on diet. At effective treatment the underlying disease angiopathy will not progress. Treatment is carried out under the supervision of an ophthalmologist, therapist and endocrinologist. Use physiotherapy treatment and local.
Also, do not forget about diet therapy. Diet for diabetes is very important. From the diet should be excluded foods that are rich in carbohydrates. We replace animal fats with vegetable fats. Be sure to include fish, dairy products, fruits and vegetables in your diet.
Diabetic angiopathy is a collective term for a generalized ( throughout the body) damage in the first place, small vessels at diabetes. This damage consists in the thickening of the vessel wall and the violation of its permeability, resulting in a decrease in blood flow. The consequence of this are irreversible disorders in those organs that are supplied with blood by these vessels ( kidneys, heart, retina).
Statistics
Diabetic angiopathy is conventionally divided into microangiopathy and macroangiopathy. Microangiopathy is a lesion of small blood vessels ( retina, kidney), which occurs in more than 90 percent of cases. Most often ( in 80 - 90 percent of cases) affects the small vessels of the retina with the development of the so-called diabetic retinopathy. Every twentieth ( 5 percent) diabetic retinopathy is the cause of vision loss.
Damage to the small vessels of the kidneys diabetic nephropathy) occurs in 75 percent of cases. In 100 percent of cases, kidney damage in diabetes mellitus leads to disability of patients. Most often, diabetic nephropathy occurs in type 1 diabetes.
Damage to small vessels arterioles, capillaries) of the brain is one of the reasons for the development of diabetic encephalopathy. This complication occurs in 80 percent of patients with type 1 diabetes. The frequency of occurrence among all patients with diabetes mellitus varies from 5 to 75 percent.
Diabetic macroangiopathy is a lesion of large vessels ( heart arteries, lower extremities ) organism. In 70 percent of cases, damage to the vessels of the lower extremities is observed.
The defeat of the coronary arteries in diabetes mellitus occurs in 35 - 40 percent of cases. However, the relatively low incidence is compensated by the high incidence of lethal outcomes. According to various sources, every third person aged 30-50 years with diabetes dies from cardiovascular complications. In general, 75 percent of the deaths of diabetic patients are due to cardiovascular pathology.
Interesting Facts
The term "diabetes" means "pass through") was introduced by the ancient physician Areteus of Cappadocia. The very first mention of this pathology was found in the Eber papyrus, which was written 1500 years before our era. In this description, a recipe is found that is recommended to eliminate one of the symptoms of diabetes - frequent urination. Ancient doctors, experiencing difficulties in diagnosing this pathology, tasted urine. If it was sweetish, then it spoke of diabetes. In order to "remove urine that flows too often," the Eber papyrus contains recipes for several potions.
From the time of Paracelsus and Avicenna to the present, diabetes mellitus has been considered a fatal pathology, since more than 3.5 million people die from its complications every year.
Vascular Anatomy
The wall of blood vessels consists of several layers. These layers differ in composition depending on the caliber and type of vessels. The structure of the wall of blood vessels:
- the inner layer ( tunica intima);
- middle layer ( tunica media);
- outer layer ( tunica externa).
The inner layer
This layer consists of endothelial cells, therefore it is also called the vascular endothelium. Endothelial cells line the inner wall of blood vessels in one layer. The endothelium of the vessels faces the lumen of the vessel and therefore is constantly in contact with the circulating blood. This wall contains numerous blood coagulation factors, inflammatory factors and vascular permeability. It is in this layer that the products of the polyol metabolism of glucose accumulate in diabetes mellitus ( sorbitol, fructose).Also, this layer normally secretes endothelial relaxing factor. In the absence of this factor ( what is seen in diabetes), the endothelial lumen narrows and vascular resistance increases. Thus, due to the synthesis of various biological substances, the inner wall of blood vessels performs a number of important functions.
Functions of the endothelium:
- prevents the formation of blood clots in the vessels;
- regulates the permeability of the vascular wall;
- regulates blood pressure;
- performs a barrier function, prevents the penetration of foreign substances;
- participates in inflammatory reactions, synthesizing inflammatory mediators.
middle layer
The middle layer of the vascular wall is formed by muscle, collagen and elastic fibers. This layer gives shape to the vessels, and is also responsible for their tone. The thickness of the middle layer differs between arteries and veins. Due to the presence of muscle elements in the middle layer, arteries are able to contract, regulating blood flow to organs and tissues. Elastic fibers give the vessels elasticity.outer layer
This layer is formed by connective tissue, as well as collagen and elastin filaments. It protects blood vessels from sprains and ruptures. It also contains small vessels called "vasa vasorum" or "vessels of vessels". They nourish the outer and middle shell of the vessels.The main target in diabetes are small vessels - arterioles and capillaries, but large vessels - arteries - are also damaged.
Arterioles
These are small blood vessels that are a continuation of the arteries, and themselves, in turn, end in capillaries. Their diameter, on average, is 100 microns. Arterioles are made up of the same three layers as all blood vessels. However, there are some features in their structure. Thus, the inner endothelial and middle muscle layers are in contact with each other through small holes in the endothelium. Thanks to these holes, the muscle layer is in direct contact with the blood and immediately reacts to the presence of biologically active substances in it. In diabetic angiopathy, arterioles in the posterior region of the fundus are most susceptible to damage.capillaries
Capillaries are the thinnest blood vessels, which are located mainly in the skin, in the myocardium, in the kidneys, and in the retina of the eye. In diabetes mellitus, sclerosis of these capillaries is observed in the kidneys, which in the clinic is called nephroangiosclerosis. In diabetic angiopathy of the vessels of the eye, the capillaries are dilated, in some places microaneurysms are observed, and there is swelling between them.arteries
Diabetes can also affect large vessels - arteries. As a rule, this is accompanied by the development of atherosclerosis. At the same time, deposition of atherosclerotic plaques is observed on the inner wall of the artery ( made up of lipids, cholesterol). This is also accompanied by a decrease in the lumen of the arteries, followed by a decrease in blood flow in them. The blood in such vessels moves slowly, and in severe cases, there is a blockage of the vessel and a stop in the blood supply.The mechanism of vascular damage in diabetes mellitus
The basis of diabetic angiopathy is damage to the vascular wall ( Specifically, the endothelium), with a further violation of its function. As is well known, diabetes mellitus high level sugar ( glucose) in the blood or hyperglycemia. As a result of this diabetic hyperglycemia, glucose from the blood begins to intensively penetrate into the vessel wall. This leads to disruption of the structure of the endothelial wall and, consequently, to an increase in its permeability. Glucose metabolism products, namely sorbitol and fructose, accumulate in the wall of the blood vessel. They also attract liquid. As a result, the wall of the blood vessel swells and becomes thickened.Also, as a result of damage to the vascular wall, the coagulation process is activated ( thrombus formation), since the capillary endothelium is known to produce blood clotting factors. This fact further impairs blood circulation in the vessels. Due to a violation of the structure of the endothelium, it ceases to secrete the endothelial relaxing factor, which normally regulates the diameter of the vessels.
Thus, with angiopathy, the Virchow triad is observed - a change in the vascular wall, a violation of the coagulation system and a slowdown in blood flow.
Due to the above mechanisms, blood vessels, primarily small ones, narrow, their lumen decreases, and blood flow decreases until it stops. In the tissues that they supply blood, hypoxia is observed ( oxygen starvation), atrophy, and as a result of increased permeability and edema.
The lack of oxygen in the tissues activates the fibroblasts of the cell, which synthesize the connective tissue. Therefore, hypoxia is the cause of the development of vascular sclerosis. First of all, the smallest vessels - the capillaries of the kidneys - suffer.
As a result of sclerosis of these capillaries, kidney function is impaired and renal failure develops.
Sometimes, small vessels become clogged with blood clots, while others form small aneurysms ( protrusion of the vascular wall). The vessels themselves become fragile, brittle, which leads to frequent hemorrhages ( most often on the retina).
Diabetic macroangiopathy
For macroangiopathy ( damage to large vessels) is characterized by the addition of an atherosclerotic process. First of all, the coronary vessels, cerebral and vessels of the lower extremities are damaged. The atherosclerotic process in the vessels occurs due to a violation of lipid metabolism. Damage to blood vessels in atherosclerosis is manifested by the deposition of atherosclerotic plaques on their inner wall. Subsequently, this plaque is complicated by the growth of connective tissue in it, as well as calcification, which, in general, leads to blockage of the vessel.Symptoms of diabetic angiopathy
Symptoms of diabetic angiopathy depend on its type. Types of angiopathy differ in which vessels were damaged. Types of diabetic angiopathy:
- diabetic retinopathy ( damage to retinal vessels);
- diabetic nephropathy ( damage to the vessels of the kidneys);
- diabetic angiopathy with damage to the capillaries and coronary arteries of the heart;
- diabetic angiopathy of the lower extremities;
- diabetic encephalopathy ( cerebrovascular disease).
Symptoms of diabetic retinopathy
The structure of the eye
The eye consists of the eyeball, optic nerve and auxiliary elements ( muscles, eyelids). Of course eyeball consists of an outer shell ( cornea and sclera), middle - vascular and internal - retina. The retina or "retina" has its own capillary network, which is the target in diabetes. It is represented by arteries, arterioles, veins and capillaries. Symptoms of diabetic angiopathy are divided into clinical ( those presented by the patient) and ophthalmoscopic ( those that are detected during an ophthalmoscopic examination).
Clinical symptoms
Damage to the retinal vessels in diabetes mellitus is painless and almost asymptomatic in the initial stages. Symptoms appear only in the later stages, which is also explained by the late visit to the doctor.
Complaints that a patient with diabetic retinopathy makes:
- decreased visual acuity;
- dark spots before the eyes;
- sparks, flashes before the eyes;
- a veil or veil before the eyes.
If retinopathy is complicated by hemorrhages in vitreous body, then it is manifested by the presence of dark floating spots in front of the eyes. These spots may then disappear, but vision may be lost forever. Since the vitreous body is normally transparent, the presence of accumulations of blood in it ( due to ruptured blood vessels) and causes dark spots to appear in the field of view. If a person does not go to the doctor in time, then strands form between the vitreous body and the retina, which pull the retina, which leads to its detachment. Retinal detachment appears sharp decline vision ( to the point of blindness), the appearance of flashes and sparks before the eyes.
Also, diabetic retinopathy can occur with the development of retinal edema. In this case, the patient has a feeling of a veil before his eyes, loss of image clarity. A continuous veil before the eyes or a local cloud is the projection site of edema or exudates on the retina.
Ophthalmoscopic symptoms
These symptoms are detected during an ophthalmoscopic examination, which consists in visualizing the fundus with an ophthalmoscope and a lens. During this study, the doctor examines the vessels of the retina, the nerve. Symptoms of damage to the retinal vessels appear much earlier than complaints from the patient.
At the same time, narrowed arteries are visualized in the fundus, microaneurysms are detected in places. In the central zone or along the large veins, there are a few hemorrhages in the form of dots. Edema is localized along the course of the arteries or in the center of the macula. There are also multiple soft exudates on the retina ( accumulation of fluid). At the same time, the veins are dilated, filled with a large volume of blood, tortuous, and their contour is clearly defined.
Sometimes in a vitreous body numerous hemorrhages are visible. Subsequently, fibrous strands form between it and the retina. The optic nerve head is pierced by blood vessels ( optic nerve neovascularization). As a rule, these symptoms are accompanied by a sharp decrease in vision. Very often, only at this stage, patients who neglect planned medical examinations go to the doctor.
Symptoms of Diabetic Nephropathy
Diabetic nephropathy is damage to the blood vessels of the kidneys due to diabetes mellitus. further development kidney failure. The structure of the kidney
functional unit The kidney is the nephron, which consists of the glomerulus, capsule and tubules. The glomerulus is a collection of many capillaries through which the body's blood flows. From capillary blood all the waste products of the body are filtered into the tubules, and urine is also formed. If the capillary wall is damaged, this function is impaired.
Symptoms of diabetic nephropathy include complaints from the patient as well as early diagnostic signs. For a very long time, diabetic nephropathy is asymptomatic. Come to the fore general symptoms diabetes mellitus.
Common symptoms of diabetes:
- thirst;
- dry mouth;
- skin itching;
- frequent urination.
Vivid clinical manifestations of diabetic nephropathy appear 10-15 years after the diagnosis of diabetes mellitus. Prior to this, there are only laboratory signs of nephropathy. The main symptom is protein in the urine ( or proteinuria), which can be detected during a routine medical examination.
Normally, the amount of protein in daily urine should not exceed more than 30 mg. In the initial stages of nephropathy, the amount of protein in the urine per day ranges from 30 to 300 mg. In the later stages, when clinical symptoms, the protein concentration exceeds 300 mg per day.
The mechanism for the formation of this symptom is damage to the renal filter ( increases its permeability), as a result of which it passes first small, and then large protein molecules.
As the disease progresses, symptoms of renal failure begin to join the general and diagnostic symptoms.
Symptoms of nephropathy in diabetes mellitus:
- high blood pressure;
- common symptoms of intoxication - weakness, drowsiness, nausea.
Initially, edema is localized in the periorbital region ( around eyes), but as the disease progresses, they begin to form in body cavities ( abdominal, in the pericardial cavity). Edema in diabetic nephropathy is pale, warm, symmetrical, and appears in the morning.
The mechanism of edema formation is associated with the loss of proteins in the blood, which are excreted along with the urine. Normally, blood proteins create oncotic pressure, that is, they retain water within the vascular bed. However, with the loss of proteins, the fluid is no longer retained in the vessels and penetrates into the tissues. Despite the fact that patients with diabetic nephropathy lose weight, they look edematous outwardly, which is due to massive edema.
Increased arterial pressure
In later stages, patients with diabetic nephropathy have elevated blood pressure. High blood pressure is considered when the systolic pressure is greater than 140 mmHg and the diastolic pressure is greater than 90 mmHg.
The mechanism of increasing blood pressure consists of several pathogenetic links. First of all, it is the retention of water and salts in the body. Secondly, activation of the renin-angiotensin system. Renin is a biologically active substance produced by the kidneys, and which, through complex mechanism regulates blood pressure. Renin begins to be actively produced when the kidney tissue experiences oxygen starvation. As you know, the capillaries of the kidney in diabetes mellitus are sclerosed, as a result of which the kidney ceases to receive the necessary amount of blood, and with it oxygen. In response to hypoxia, an excess amount of renin begins to be produced. It, in turn, activates angiotensin II, which constricts blood vessels and stimulates the secretion of aldosterone. The last two points are key in the development of arterial hypertension.
Common symptoms of intoxication - weakness, drowsiness, nausea
Weakness, drowsiness and nausea are late symptoms of diabetic nephropathy. They develop as a result of the accumulation of toxic metabolic products in the body. Normal waste products of the body ( ammonia, urea) are excreted by the kidneys. However, with the defeat of the capillaries of the nephron, the excretory function of the kidney begins to suffer.
These substances are no longer excreted by the kidneys and accumulate in the body. The accumulation of urea in the body gives patients with diabetic nephropathy a specific smell. However, the most dangerous is the accumulation of toxic ammonia in the body. It easily penetrates the central nervous system and damages it.
Symptoms of hyperammonemia(increased concentration of ammonia):
- nausea;
- dizziness;
- drowsiness;
- seizures if the concentration of ammonia in the brain has reached 0.6 mmol.
Symptoms of diabetic angiopathy with damage to the capillaries and coronary arteries of the heart
The structure of the heart
The heart is a muscular organ, each cell of which must constantly receive oxygen and nutrients. This is provided by an extensive capillary network and coronary arteries of the heart. The heart has two coronary arteries - the right and left, which are affected by atherosclerosis in diabetes mellitus. This process is called diabetic macroangiopathy. Damage to the capillary network of the heart is called diabetic microangiopathy. Between the capillaries and muscle tissue there is an exchange of blood, and with it oxygen. Therefore, when they are damaged, the muscle tissue of the heart suffers.
In diabetes mellitus, small capillaries in the heart can be affected ( with the development of microangiopathy) and coronary arteries ( with the development of macroangiopathy). In both cases, symptoms of angina pectoris develop.
Symptoms of diabetic angiopathy of the heart vessels:
- pain syndrome;
- violation of the heart rhythm;
- signs of heart failure.
Pain is the dominant symptom in damage to the coronary vessels of the heart. The development of typical angina pectoris is characteristic. The pain is localized behind the sternum, less often in the epigastric region. As a rule, it has a compressive, less often pressing character. For angina, irradiation is typical ( return) pain in the left arm, shoulder, shoulder blade, jaw. The pain occurs paroxysmal and lasts 10-15 minutes.
The mechanism of pain is hypoxia of the heart. In diabetes mellitus, atherosclerotic phenomena are noted in the coronary vessels of the heart. At the same time, plaques and stripes are deposited on the vessels, which narrow their lumen. As a result, a much smaller volume of blood supplies the heart muscle. The heart begins to lack oxygen. Under conditions of oxygen starvation, anaerobic ( anoxic) the breakdown of glucose to form lactic acid. Lactic acid, being a strong irritant, irritates nerve endings heart, which is clinically expressed in pain syndrome.
Heart rhythm disorder
With damage to the small vessels of the heart and their sclerosis, changes specific to diabetes mellitus develop in the myocardium, which are called diabetic myocardial dystrophy. At the same time, not only damage to the capillary network is detected in the heart, but also changes in muscle fibers, proliferation of connective tissue, and microaneurysms. Due to dystrophic changes in the myocardium itself, there are various violations heart rhythm.
Heart rhythm disturbances:
- bradycardia - heart rate less than 50 beats per minute;
- tachycardia - a heart rate of more than 90 beats per minute;
- arrhythmias are disturbances in the normal sinus) heart rate;
- extrasystole - untimely contraction of the heart.
Signs of heart failure
Heart failure develops due to damage to both the heart muscle itself ( microangiopathy), and due to damage to the coronary arteries ( macroangiopathy). The main signs of heart failure are shortness of breath, coughing, and a drop in stroke volume.
As a result of damage to the heart muscle and its vessels, the heart loses its ability to fully contract and provide the body with blood. Falls stroke and minute volume of the heart. At the same time, stagnation is noted in the lungs venous blood which is the cause of shortness of breath. In the future, fluid accumulates in them, which causes coughing.
Damage to the heart vessels in diabetes mellitus can be isolated, but most often it is combined with damage to the kidneys, retina, and vessels of the lower extremities.
Diabetic angiopathy of the lower extremities
Symptoms of diabetic angiopathy of the lower extremities are due to both diabetes-specific changes and the atherosclerotic process in them. Symptoms of diabetic angiopathy of the lower extremities:
- feeling of numbness, coldness, goosebumps in the legs;
- pain, leg cramps and intermittent claudication;
- dystrophic changes in the skin of the extremities;
- trophic ulcers.
Feeling of numbness, coldness and goosebumps in the legs are the first symptoms of diabetic angiopathy of the lower extremities. They can appear in various areas - in the area of \u200b\u200bthe feet, lower leg, calf muscles.
The mechanism of development of these symptoms is primarily due to insufficient blood supply to the tissues, as well as nerve damage. Cold, chilliness in the legs are due to poor blood circulation, especially during prolonged physical exertion. Goosebumps, burning sensation, numbness are caused by damage to peripheral nerves ( diabetic neuropathy), as well as vasospasm.
Pain, leg cramps, and intermittent claudication
Pain develops when the muscles of the legs begin to experience a lack of oxygen for a long time. This is due to a significant narrowing of the lumen of the blood vessel and a decrease in blood flow in them. Initially, the pain occurs when walking, which forces the person to stop. These transient pains are called intermittent lameness. It is accompanied by a feeling of tension, heaviness in the legs. After a forced stop, the pain goes away.
Leg cramps occur not only when walking, but also at rest, most often during sleep. They are caused by a low concentration of potassium in the body. Hypokalemia develops in diabetes mellitus due to frequent urination, as potassium is rapidly excreted in the urine.
Dystrophic changes in the skin of the extremities
In the early stages, the skin becomes pale, cold, and hair falls out on it. Sometimes the skin becomes bluish. Nails slow down their growth, deform, become thick and brittle.
Changes develop due to a long-term malnutrition of tissues, since the blood supplies the tissues not only with oxygen, but also with various nutrients. The tissue, not receiving the necessary substances, begins to atrophy. So, in people with diabetic angiopathy, subcutaneous fatty tissue most often atrophies.
Trophic ulcers
Trophic ulcers develop in decompensated forms of diabetes mellitus and are the final stage of diabetic angiopathy of the lower extremities. Their development is associated with reduced tissue resistance, general and local decrease in immunity. Most often they develop against the background of partial obliteration of the vessel.
The development of ulcers, as a rule, is preceded by some kind of trauma, chemical or mechanical, sometimes it can be an elementary scratch. Since the tissues are poorly supplied with blood and nutrition is disturbed in them, the injury does not heal for a long time. The site of injury swells, increases in size. Sometimes an infection joins it, which further slows down healing. The difference between trophic ulcers in diabetes mellitus is their painlessness. This is the reason for the late visit to the doctor, and sometimes the patients themselves do not notice their appearance for a long time.
Most often, ulcers are localized in the area of the foot, the lower third of the lower leg, in the area of \u200b\u200bold calluses. In decompensated forms of diabetes, trophic ulcers can turn into gangrene of the extremities.
diabetic foot
Diabetic foot is a complex of pathological changes in the foot that occur in the late stages of diabetes due to the progression of diabetic angiopathy. It includes trophic and bone-articular changes.
In a diabetic foot, there are deep ulcers reaching the tendons and bones.
In addition to trophic ulcers, diabetic foot is characterized by pathological changes in bones and joints. The development of diabetic osteoarthropathy ( Charcot's foot), which is manifested by dislocations and fractures of the bones of the foot. Subsequently, this leads to deformation of the foot. Also, a diabetic foot is accompanied by Menckeberg's syndrome, which consists in sclerosis and calcification of the vessels of the extremities against the background of advanced diabetes.
Symptoms of diabetic encephalopathy
Diabetic encephalopathy is manifested by disorders of memory and consciousness, as well as headache and weakness. The reason is a violation of microcirculation at the level of the brain. Due to damage to the vascular wall, lipid peroxidation processes are activated in it with the formation of free radicals, which have a damaging effect on brain cells. Symptoms of diabetic encephalopathy develop very slowly. It all starts with general weakness and increased fatigue. Patients are very often worried about headaches that do not respond to taking painkillers. Subsequently, sleep disorders join. Encephalopathy is characterized by sleep disturbance at night, and at the same time, daytime sleepiness.
Further, disorders of memory and attention develop - patients become forgetful and absent-minded. There is slow, rigid thinking, reduced ability to fixate. Focal symptoms are added to the cerebral symptoms.
Focal symptoms in diabetic angiopathy of cerebral vessels:
- disorder of coordination of movements;
- wobbly gait;
- anisocoria ( different pupil diameters);
- convergence disorder;
- pathological reflexes.
Diagnosis of diabetic angiopathy
Diagnosis of diabetic angiopathy is complex. Not only biological fluids are studied ( blood, urine) on glucose levels, but also target organs in diabetes mellitus ( kidneys, retina, heart, brain). Therefore, the diagnosis of diabetic angiopathy includes laboratory and instrumental studies. Laboratory methods for the study of diabetic angiopathy:
- determination of residual nitrogen in the blood;
- general urine analysis ( determination of glucose, protein and ketone bodies);
- determination of glomerular filtration rate;
- detection in the urine of b2-microglobulin;
- blood lipid profile.
Residual blood nitrogen
Residual nitrogen is an important indicator of kidney function. Normally, its content in the blood is 14 - 28 mmol / liter. An increased content of nitrogen in the blood indicates a violation of the excretory function of the kidneys.However, the most informative in the diagnosis of diabetic nephropathy is the determination of nitrogen-containing compounds, such as urea and creatinine.
Urea
In blood healthy people urea concentration ranges from 2.5 to 8.3 mmol/liter. With diabetic nephropathy, the concentration of urea increases significantly. The amount of urea directly depends on the stage of renal failure in diabetes mellitus. So, the concentration of urea more than 49 mmol / liter indicates massive damage to the kidneys. In patients with chronic renal failure due to diabetic nephropathy, the concentration of urea can reach 40 - 50 mmol / liter.
Creatinine
Like urea, creatinine concentration speaks to kidney function. Normally, its concentration in the blood in women is 55 - 100 µmol / liter, in men - from 62 to 115 µmol / liter. An increase in concentration above these values is one of the indicators of diabetic nephropathy. In the initial stages of diabetic nephropathy, the level of creatinine and urea is slightly increased, but in the last, nephrosclerotic stage, their concentrations increase sharply.
General urine analysis
AT general analysis urine changes characteristic of diabetic nephropathy appear somewhat earlier than an increased concentration of residual nitrogen in the blood. One of the first to appear is protein in the urine. In the initial stages of nephropathy, the protein concentration does not exceed 300 mg per day. After the concentration of protein in the urine exceeds 300 mg per day, the patient begins to develop edema.With an increase in the concentration of glucose in the blood above 10 mmol / liter, it begins to appear in the urine. The appearance of glucose in the urine indicates an increased permeability of the capillaries of the kidneys ( i.e. damage).
In the later stages of diabetic nephropathy, ketone bodies appear in the urine, which should not normally be contained.
Glomerular filtration rate
The glomerular filtration rate is the main parameter in determining the excretory function of the kidneys. This method allows you to assess the degree of diabetic nephropathy. In the early stages of nephropathy, there is an increase in glomerular filtration - above 140 ml per minute. However, with the progression of renal dysfunction, it decreases. At a glomerular filtration rate of 30-50 ml per minute, kidney function is still partially preserved. If the filtration decreases to 15 ml per minute, then this indicates decompensation of diabetic nephropathy.b2-microglobulin
Microglobulin b2 is a protein that is present on the surface of cells as an antigen. With damage to the vessels of the kidneys, when the permeability of the renal filter increases, microglobulin is excreted in the urine. Its appearance in the urine is a diagnostic sign of diabetic angionephropathy.Lipid spectrum of blood
This analysis examines blood components such as lipoproteins and cholesterol. With the development of diabetic macroangiopathy, low and very low density lipoproteins, as well as cholesterol, increase in the blood, but at the same time high density lipoproteins decrease. An increase in the concentration of low-density lipoproteins above 2.9 mmol / liter indicates a high risk of developing macroangiopathy. At the same time, a decrease in the concentration of high-density lipoproteins below 1 mmol/liter is regarded as a factor in the development of atherosclerosis in the vessels.Cholesterol levels vary from person to person. Ambiguous opinion on this subject and among experts. Some recommend not to exceed cholesterol levels above 7.5 mmol per liter. The generally accepted norm today is no more than 5.5 mmol per liter. An increase in cholesterol above 6 mmol is regarded as a risk of developing macroangiopathy.
Instrumental methods for the study of diabetic angiopathy:
- a comprehensive ophthalmic examination that includes direct ophthalmoscopy, gonioscopy, fundus examination, stereoscopic retinal photography, and optical coherence tomography ( OCT).
- electrocardiogram;
- echocardiography;
- coronary angiography;
- dopplerography of the lower extremities;
- arteriography of the lower extremities;
- ultrasound examination of the kidneys;
- dopplerography of the vessels of the kidneys;
- magnetic nuclear resonance of the brain.
Ophthalmic exam
Direct ophthalmoscopyThe method consists in examining the anterior structures of the eye using special instruments such as a slit lamp and an ophthalmoscope. Detection of abnormal vessels on the iris ( rubeosis) indicates the development of a severe form of diabetic retinopathy.
Gonioscopy
The gonioscopy method is based on the use of a special Goldman lens with mirrors, which allows you to examine the angle of the anterior chamber of the eye. This method is a helper. It is used only when rubeosis of the iris and increased intraocular pressure. Rubeosis of the iris is one of the complications of diabetic retinopathy, in which new vessels appear on the surface of the iris. New vessels are very thin and fragile, are located chaotically and often provoke hemorrhages, and also cause the development of glaucoma.
OCT
okt is pretty informative method in the diagnosis of diabetic maculopathy. With the help of coherence tomography, it is possible to determine the exact localization of edema, its shape and extent.
Stereoscopic photography of the retina using a special apparatus ( fundus chambers) allows you to explore the evolution of the disease in detail. Comparison of more recent photographs of the patient's retina with his previous images may reveal the appearance of new pathological vessels and edema, or their regression.
Fundus examination
Examination of the fundus is the main point in the diagnosis of diabetic retinopathy. It is carried out using an ophthalmoscope and a slit lamp and special lenses with high magnification. The examination is carried out after medical dilation of the pupil with atropine or tropicamide. The center of the retina is sequentially examined, visual disc, macular area and periphery of the retina.
Based on retinal changes, diabetic retinopathy is divided into several stages.
Stages of diabetic retinopathy:
- non-proliferative diabetic retinopathy ( first stage);
- preproliferative diabetic retinopathy ( second stage);
- proliferative diabetic retinopathy ( third stage).
- microaneurysms ( dilated vessels);
- hemorrhages ( small and medium, single and multiple);
- exudates ( accumulation of fluid with clear or blurred boundaries, of various sizes, white or yellowish color);
- macular edema various shapes and quantities ( diabetic maculopathy).
Ophthalmological picture at the most severe ( third) stage is supplemented by the appearance of new vessels on the optic disc and other areas of the retina. These vessels are very thin and often rupture, causing constant hemorrhage. Massive vitreous hemorrhage can lead to a sharp deterioration in vision and difficulty in examining the fundus. In such cases, an ultrasound examination of the eye is used to determine the integrity of the retina.
Electrocardiogram ( ECG)
This is a method in which the electric fields generated during the work of the heart are recorded. The result of this study is a graphic image called an electrocardiogram. With atherosclerotic lesions of the coronary arteries of the heart, signs of ischemia are visualized on it ( insufficient blood supply to the heart muscle). Such a sign on the electrocardiogram is a decrease or increase relative to the isoline segment S-T. The degree of increase or decrease in this segment depends on the degree of damage to the coronary arteries.With damage to the small capillary network of the heart ( i.e. microangiopathy) with the development of myocardial dystrophy, various rhythm disturbances are noted on the ECG. With tachycardia, a heart rate above 90 beats per minute is recorded; with extrasystole - extraordinary heart contractions are recorded on the ECG.
echocardiography
This is a method for studying morphological and functional changes in the heart using ultrasound. The method is indispensable in assessing the contractility of the heart. It determines the stroke and minute volume of the heart, changes in heart mass, and also allows you to see the work of the heart in real time.This method is used to assess damage to the heart muscle due to sclerosis of the capillaries of the heart. In this case, the minute volume of the heart falls below 4.5 - 5 liters, and the volume of blood that the heart ejects in one contraction ( stroke volume) below 50 - 70 ml.
Coronary angiography
This is a method of examining the coronary arteries by injecting a contrast agent into them, followed by visualization on an x-ray or computed tomography. Coronary angiography is recognized as the gold standard in the diagnosis of coronary heart disease. This method allows you to determine the location of the atherosclerotic plaque, its prevalence, as well as the degree of narrowing. coronary artery. Assessing the degree of macroangiopathy, the doctor calculates the probability possible complications who are waiting for the patient.Dopplerography of the lower extremities
This is a method of ultrasonic examination of blood flow in the vessels, in this case in the vessels of the lower extremities. It allows you to identify the speed of blood flow in the vessels and determine where it is slowed down. The method also evaluates the condition of the veins, their patency and the operation of the valves.The method is mandatory for people with diabetic foot, trophic ulcers or gangrene of the lower extremities. He evaluates the extent of all injuries and further treatment tactics. If there is no complete blockage of the vessels, and blood circulation can be restored, then the decision is made in favor of conservative treatment. If, however, during Doppler sonography, complete occlusion of the vessels is detected, without the possibility of restoring blood circulation, then this speaks in favor of further surgical treatment.
Arteriography of the lower extremities
This is a method in which a contrast agent is injected into a blood vessel, which stains the lumen of the vessel. The passage of a substance through the vessels can be traced during X-ray or computed tomography.Unlike Doppler sonography, arteriography of the lower extremities does not assess the velocity of blood flow in the vessel, but the localization of damage in this vessel. In this case, not only the place is visualized, but also the extent of the damage, the size and even the shape of the atherosclerotic plaque.
The method is indispensable in the diagnosis of diabetic angiopathy of the lower extremities, as well as its complications ( thrombosis). However, its use is limited in people with kidney and heart failure.
Ultrasound examination of the kidneys
Ultrasound procedure allows you to assess the qualitative changes in the kidney - its size, the homogeneity of the parenchyma, the presence of fibrosis in it ( proliferation of connective tissue). This method is mandatory for patients with diabetic nephropathy. However, it visualizes those changes in the kidney that occur already against the background of renal failure. So, at the last and penultimate stages of diabetic nephropathy, the kidney parenchyma is replaced by connective tissue ( sclerosed), and the kidney itself decreases in volume.Diabetic nephropathy is characterized by diffuse and nodular nephrosclerosis. In the first case, the growths of connective tissue are visualized chaotically. In the second place of sclerosis are noted in the form of nodules. On ultrasound, these sites of sclerosis are seen as hyperechoic foci ( light structures are visible on the screen monitor).
Dopplerography of the vessels of the kidneys
This method makes it possible to assess the degree of circulatory disorders in the vessels of the kidneys. In the initial stages of diabetic nephropathy, blood circulation in the vessels increases, but over time it slows down. Dopplerography also gives an assessment of the state of the vessels, that is, it determines the places of sclerosis and deformation in them. In the initial stages of diabetic nephropathy, only narrowing of the vessels of the kidneys is noted, but later their sclerosis develops.Magnetic nuclear resonance of the brain
This is a method that examines the tissue of the brain, as well as its vascular network. With the development of diabetic encephalopathy, first of all, changes are noted from the side of the vessels of the brain in the form of hypoplasia of the arteries. Foci of "silent" infarcts due to vascular occlusion, microhemorrhages, signs of hypoperfusion of the cerebral cortex are also visualized.Treatment of diabetic angiopathy
Treatment of diabetic angiopathy primarily includes the elimination of the causes that led to its development. Maintaining glucose levels is essential in the treatment of diabetic angiopathy. In the background - these are drugs that improve blood circulation in the vessels and increase the resistance of capillaries. With the development of macroangiopathy, drugs are prescribed that reduce cholesterol levels. With damage to the vessels of the kidneys - drugs that eliminate edema ( diuretics) to lower blood pressure. In the treatment of diabetic retinopathy, drugs are used that improve the condition of the retina and metabolism in the vessels.
Drugs that lower blood sugar levels
| Name of the drug | Mechanism of action | Mode of application |
| Metformin
(trade names - Metfogamma, Siofor, Glycon) | Increases the absorption of glucose by tissues, thereby lowering its content in the blood | The initial dose is 500 - 1000 mg per day, that is, 1 - 2 tablets. Further, based on the level of glucose in the blood, the dose of the drug is increased. Maximum daily dose- 6 tablets ( 3000 mg) |
| Glibenclamide
(tradename– Maninil) | Increases the release of insulin by the pancreas, which has a hypoglycemic effect | The initial dose is one tablet per day ( 3.5 mg), after which the dose is increased to 2-3 tablets. The maximum daily dose is 3 tablets ( extremely rare - 4) at 3.5 mg. The dose is selected individually, based on the level of glucose in the blood. |
| Gliclazide
(trade name - Reklid, Diabeton) | Stimulates the production of insulin by the pancreas, and also improves blood properties ( reduces its viscosity, prevents the formation of blood clots) | Initial dose 1 tablet ( 80 mg) per day. Then the dose is doubled. The maximum daily dose is 320 mg, i.e. 4 tablets |
| Miglitol
(trade name Diastabol) | Inhibits an enzyme ( intestinal glycosidase), which breaks down carbohydrates to form glucose. As a result, blood sugar levels do not rise. | The starting dose is 150 mg per day ( 3 tablets of 50 mg or 1.5 of 100 mg). The dose is divided into 3 doses per day and taken immediately before meals. After a month, the dose is increased, based on individual tolerance. The maximum dose is 300 mg per day ( 6 tablets of 50 mg or 3 of 100 mg) |
| Glimepiride
(trade name Amaryl) | Stimulates the release of insulin from the pancreas | The initial dose of the drug is 1 mg per day ( one 1 mg tablet, or half a 2 mg tablet). The dose is increased every 2 weeks. Thus, at week 4 - 2 mg, at week 6 - 3 mg, at 8 - 4 mg. The maximum daily dose is 6 - 8 mg, but on average, it is 4 mg |
The intake of hypoglycemic agents should be carried out under constant monitoring of glucose in the blood and in the urine. It is also necessary to periodically monitor liver enzymes. Treatment with the above drugs should be carried out in parallel with the diet and other drugs.
Cholesterol-lowering drugs
| Name of the drug | Mechanism of action | Mode of application |
| Simvastatin
(trade name - Vasilip, Zokor, Aterostat) | Reduces total cholesterol in blood plasma, reduces the amount of low density lipoproteins and very low density lipoproteins | The initial dose is 10 mg, the maximum is 80 mg. The average dose is 20 mg ( one 20 mg tablet or two 10 mg tablets). The drug is taken once a day in the evening with a sufficient amount of water. |
| Lovastatin
(trade name - Lovasterol, Cardiostatin, Choletar) | Suppresses the formation of cholesterol in the liver, thereby reducing the level of total cholesterol in the blood | The initial dose is 20 mg per day, once with meals. With severe diabetic macroangiopathy, the dose is increased to 40 mg per day. |
| Atorvastatin
(trade names - Torvacard, Liptonorm) | Suppresses the synthesis of cholesterol. It also increases the resistance of the vascular wall | The initial dose is 10 mg per day. The average maintenance dose is 20 mg. In severe diabetic macroangiopathy, the dose is increased to 40 mg. |
These drugs are prescribed for diabetic macroangiopathy, that is, when there are atherosclerotic deposits on the vessels ( stripes, patches). They are prescribed both for the prevention and treatment of atherosclerosis. During treatment with statins, it is necessary to periodically check the level of transaminases ( enzymes) of the liver, as they have a toxic effect on the liver and muscles.
Drugs that lower blood pressure
| Name of the drug | Mechanism of action | Mode of application |
| Verapamil
(trade names Isoptin, Finoptin) | Blocks calcium channels, thereby dilating blood vessels, which leads to a decrease in blood pressure | The initial dose is 40 mg 3 times a day. If necessary, the dose is increased to 80-120 mg 3 times a day |
| Nifedipine
(trade names Kordipin, Korinfar) | Expands peripheral vessels, thereby reducing blood pressure, without exerting side effects on the heart | Initial dose - 10 mg ( one 10mg tablet or half of 20mg). If necessary, the dose is increased to 20 mg four times a day. |
| Lisinopril
(trade name Diroton) | Blocks the formation of angiotensin II, which increases blood pressure | The initial dose is 5 mg once a day. If there is no effect, then the dose is increased to 20 mg per day. |
| Lisinopril + Amlodipine
(trade name Equator) | The drug has a combined effect. Lisinopril dilates peripheral vessels, and amlodipine dilates the coronary vessels of the heart. | The daily dose is a tablet, regardless of the meal. This is the same maximum dose |
| Nebivolol
(trade names Binelol, Nebilet) | Blocks receptors located in the vessels and in the heart. This reduces blood pressure, and also produces an antiarrhythmic effect. | The initial dose is 5 mg once a day. Subsequently, the dose is increased to 10 mg per day ( 2 tablets). With renal failure - 2.5 mg |
The gold standard in the treatment of hypertension is monotherapy, that is, treatment with a single drug. As monotherapy, nifedipine, diroton or nebivolol are used. Subsequently, various combined schemes. The most commonly used are "nifedipine + diroton", "diroton + diuretic", "nifedipine + diroton + diuretic".
Drugs that eliminate edema ( diuretics)
| Name of the drug | Mechanism of action | Mode of application |
| Furosemide
(trade name - Lasix) | Causes a strong but short-lived diuretic effect | The initial dose is 20-40 mg once in the morning. If necessary, repeat the dose after 8 hours. The maximum daily dose is 2 grams |
| Acetazolamide
(trade name - Diakarb) | Has a mild diuretic effect | 250 mg each ( one tablet) twice a day for the first 5 days, then take a break of 2 days. Diakarba is combined with potassium preparations |
| Spironolactone
(trade names - Veroshpiron, Spironol, Urakton) | Produces a diuretic effect without removing potassium from the body | The average daily dose is 50-200 mg, which is equal to one to four tablets. |
With an isolated edematous syndrome, diuretics are prescribed separately. However, most often, they are combined with drugs that lower blood pressure, since diabetic nephropathy manifests itself and high blood pressure and edema.
Drugs that improve blood circulation and increase the resistance of the vascular wall
| Name of the drug | Mechanism of action | Mode of application |
| Pentoxifylline
(trade names - Trental, Agapurin) | Expands blood vessels, improves microcirculation ( circulation in small vessels) in tissues, increases the resistance of the endothelium | One to four 100 mg tablets per day or one 400 mg tablet. In injections, one ampoule 2 times a day intramuscularly |
| Bilobil
(trade names - Ginkgo Biloba, Memoplant, Vitrum Memory) | Improves cerebral circulation, prevents lipid peroxidation and stimulates metabolism in the nervous tissue | One to two capsules three times a day |
| Rutozid
(trade names Venoruton, Rutin) | Reduces capillary permeability, thereby preventing the development of edema. Strengthens the vascular wall | The dose of the drug is set individually. In diabetic retinopathy and atherosclerosis, the average daily dose is 3 capsules 2-3 times a day |
| A nicotinic acid (trade name Niacin) | The drug has a combined effect. Expands blood vessels, improves blood circulation in them, and also reduces blood cholesterol levels | The average daily dose is from 300 to 600 mg. The dose must be divided into 3 doses and taken with food |
| Troxerutin
(trade name Troxevasin) | Eliminates inflammation in the vascular wall, prevents lipid peroxidation, and eliminates edema | 300 - 600 mg each ( one or two tablets) per day for a month. Then they switch to maintenance therapy - 300 mg per day |
Drugs that improve blood circulation ( angioprotectors), are prescribed for both diabetic macroangiopathy and microangiopathy. With damage to the cerebral vessels ( encephalopathy) bilobil, niacin are prescribed; with diabetic angiopathy of the lower extremities, heart vessels - venoruton, trental. Treatment with angioprotectors is carried out under the control of a complete blood count.
Drugs that prevent blood clots
| Name of the drug | Mechanism of action | Mode of application |
| Sulodexide
(trade namesVessel Due F, Angioflux) | Prevents the formation of blood clots, especially in small vessels ( particularly in retinal vessels) | Intramuscularly, one ampoule of 600 LE for 15 days, then switch to ampoules of 250 LE |
| Aspirin
(for people suffering from stomach pathology, gastro-resistant aspirin is recommended, which dissolves in the intestineAspenter) | Reduces blood viscosity, thereby improving its circulation in the vessels. Prevents the formation of blood clots | For the prevention of complications of diabetic angiopathy 325 mg per day or one 100 mg tablet every three days |
| Wobenzym | Reduces blood viscosity and prevents platelet aggregation | 3 tablets three times a day for 1-2 months |
When treating with these drugs, it is necessary to periodically monitor the coagulogram, which includes such parameters as prothrombin and thrombin time, platelet count.
Drugs that improve metabolic processes and increase tissue resistance
| Name of the drug | Mechanism of action | Mode of application |
| Solcoseryl
(injections) | Improves blood circulation in the vessels, prevents the development of sclerosis in the vessels | Intramuscularly 1 - 2 ampoules ( 2 - 4 ml) within a month |
| Trifosadenine
(ATP) | Expands blood vessels, improves metabolism in the vascular wall | Intramuscularly, 1 ml ( one ampoule) once a day for the first 15 days, then twice a day. Duration of treatment - 30 injections |
| Vitamin C
(vitamin C) | It has a pronounced antioxidant effect, increases the use of glucose by the body, thereby reducing its concentration in the blood | Intramuscularly 1 ml or intravenously 5 ml daily |
| Pyridoxine
(vitamin B6) | Stimulates metabolism, especially in nerve cells | Intramuscularly 50 - 100 mg ( one - two ampoules) every other day within a month |
| Tocopherol
(vitamin E) | It has a powerful antioxidant effect, also prevents the development of oxygen starvation | Inside 100 - 200 ( one or two capsules) mg for 3-4 weeks |
In severe stages of diabetic retinopathy effective way treatment is laser photocoagulation ( cauterization). This method consists in point cauterization of blood vessels to stop their growth. Under the action of the laser, the blood in the vessels warms up and coagulates, and the vessels then overgrow fibrous tissue. Thus, 70 percent is effective in the second stage of retinopathy and 50 percent in the third stage. The method allows you to save vision for another 10-15 years.
Also, in the treatment of retinopathy, parabulbar and intravitreal ( into the vitreous) the introduction of drugs that improve the condition of the retina. Corticosteroids are administered parabulbarically, and an inhibitor of vascular growth factor is administered intravitreally. The latter includes the drug ranibizumab ( or lucentis), which has been used in ophthalmology since 2012. It prevents the development of new vessels and macular degeneration, which is the main cause of blindness in diabetic retinopathy. The course of treatment with this drug is two years and includes 5 injections per year.
With the development of extensive trophic ulcers on the lower extremities or gangrene, the limb is amputated above the level of the lesion. In the severe stage of diabetic nephropathy, hemodialysis is prescribed.
Treatment of diabetic angiopathy with folk remedies
Traditional medicine for the treatment of diabetic angiopathy:- infusions;
- medicinal fees;
- baths;
- compresses.
Types of effects that medicinal plants have:
- general strengthening effect - ginseng, eleutherococcus, zamaniha, leuzea.
- hormone-like and insulin-like action - clover, dandelion, nettle, elecampane;
- metabolic action - knotweed, blueberries, linden flowers, St. John's wort;
- action that reduces the need for insulin - blackberry, pear, dogwood, pomegranate, chicory;
- immunostimulating effect - mountain ash, lingonberry, wild rose;
- sugar-lowering effect - horsetail, cornflower ( flowers), Birch ( leaves and buds);
- insulin-stimulating action - mountain arnica leaves, ginger root, corn stigmas.
Basic rules of herbal medicine:
- if there are symptoms of intolerance to the drug ( rash, itching, fever, chills), the drug should be stopped;
- plants for the preparation of recipes should be purchased at pharmacies. Purchases from individuals should be kept to a minimum, especially if a rare plant is required, appearance which is unknown to the patient;
- when purchasing plants in a pharmacy, be sure to check the expiration date;
- at home, you should follow the recommendations for storing herbs ( time, conditions and so on);
- self-collection of medicinal plants is possible if the rules of this process are known.
Teas
Tea is made from medicinal plants and is replaced with coffee, green and black tea. Beneficial features drinks are stored for a short time. So cook tea drink should be taken daily and stored in the refrigerator.Chamomile tea
Chamomile tea has a pronounced hypoglycemic effect. Also, the drink has an antimicrobial and anti-inflammatory effect. It should be taken into account the fact that a drink based on chamomile is an effective anticoagulant. Therefore, people with increased blood clotting should refrain from drinking this tea. To make tea, you need to take two teaspoons of dry chamomile ( 15 grams) and pour boiling water ( 250 milliliters). Leave the composition to brew for half an hour, then strain and drink chilled or warm.
Lime tea
Linden blossom tea reduces sugar levels, so it is recommended in the treatment of diabetic angiopathy. Also, a lime drink increases the body's immunity and prevents the development of complications. You need to prepare tea from dried plants, which should be purchased at a pharmacy. When self-collecting, trees growing near highways, industrial facilities should be avoided.
To steam one liter of tea, you need to combine a liter of boiling water ( 4 glasses) and four heaping tablespoons of dry plants. Keep the composition on fire for five to ten minutes, avoiding seething. You can take linden tea without restrictions for a month, then you need a break for two to three weeks.
Blueberry leaf tea
Blueberry leaves contain neomyrtillin, a substance that lowers blood sugar. To prepare a drink, you need to take a tablespoon of fresh, finely chopped leaves, pour two glasses of boiling water ( 500 milliliters) and keep for five minutes on low heat. It is necessary to drink this tea drink fifteen minutes before eating, using the prepared amount of the drink within one day.
Blueberries can be used to make a drink that is also high in useful substances. You should take twenty-five grams fresh berries (one heaping tablespoon), combine with a glass of water ( 250 milliliters) and keep on fire for fifteen minutes, without bringing to a strong boil. Ten minutes before meals, drink two tablespoons ( 35 milliliters) infusion several times a day.
sage tea
Sage activates the action of insulin in the body, removes toxins and strengthens the immune system. It is necessary to pour dry sage leaves into a thermos ( one to two tablespoons), pour a glass of boiling water ( 250 milliliters) and leave to infuse for an hour. The drink should be consumed two to three times a day, 50 grams each ( one fifth of a glass). During pregnancy, breastfeeding and hypotension, tea and other sage-based recipes should be discarded.
Lilac tea
Lilac tea normalizes blood glucose levels. In early spring, lilac buds are used, in late spring - flowers, and in summer you can make a drink from the green leaves of this plant. You need to brew tea in a thermos. A tablespoon of buds or lilac flowers should be poured with one liter of boiling water. You need to take such a drink three times a day before meals, 85 milliliters ( one third of a glass).
infusions
Regularly taken infusions based on medicinal plants stimulate the production of insulin, normalize metabolic processes and strengthen the immune system. Row medicinal herbs acts as sugar-lowering drugs, improving the functioning of the pancreas and normalizing carbohydrate metabolism.Bean leaf infusion
The composition of the bean leaves includes the substance arginine, which has an effect on the body similar to insulin. To prepare the infusion, you need a handful of bean wings ( 100g) place in a thermos. Add one liter of boiling water and leave for several hours. Strained and chilled infusion should be taken half an hour before meals. Using bean shells as the main component, you can prepare an infusion with more a wide range impact.
Ingredients for preparing the infusion:
- bean flakes - five tablespoons ( 100g);
- St. John's wort - two tablespoons ( 40 grams);
- rosehip - two tablespoons ( 50 grams);
- field horsetail - two tablespoons ( 40 grams);
- flax seeds - teaspoon 10 grams).
A tablespoon of the mixture of the above ingredients should be steamed daily in a thermos with one glass of boiling water ( 250 milliliters). You need to drink in small portions during the day, and prepare a fresh infusion the next morning. Horsetail has a cleansing effect on the body, ridding it of toxins. John's wort has antimicrobial and antiseptic action. Flax seeds restore the functionality of the pancreas, which produce insulin.
Dandelion Root Infusion
Dandelion roots contain the substance inulin, which is a plant analog of insulin. Dandelion roots also contain fructose, which is absorbed by the body faster than glucose. A sufficient amount of inulin and fructose is also found in chicory and Jerusalem artichoke.
To prepare the infusion, pour two tablespoons of dry or fresh roots into a thermos. Pour a liter of boiled hot water ( 4 glasses) and leave overnight. You need to drink a drink during the day, taking the remedy ten to fifteen minutes before meals.
Medicinal fees
Gathering #1Plants for the preparation of the collection:
- arnica ( flowers and leaves);
- hawthorn;
- elecampane root;
- nettle leaves - half the norm;
- blueberry leaves - half the norm.
Collection number 2
The infusion on this collection of herbs should be taken within one week, after which a pause is necessary. You need to use a decoction of one third of a glass ( 65 milliliters) ten minutes before meals.
Ingredients for preparing the collection:
- flax seeds - ten grams;
- elecampane root - 20 grams;
- nettle leaves - 30 grams;
- field horsetail - 30 grams.
Baths
Bathing with medicinal plants helps to reduce the likelihood of developing diabetic complications. Treatment with herbal baths prevents damage to the peripheral nerves, which eliminates the risk of developing diabetic foot.Regardless of the composition of the herbal tea used to prepare the bath, after water procedures, the following rules must be observed:
- exclude physical activity within two hours after the bath;
- avoid eating cold food or drinks after the procedure;
- exclude the use of harmful and toxic products within 24 hours after the bath.
Pour 50 grams of dry couch grass root with boiling water ( one or two liters) and keep on fire for ten to fifteen minutes. Pour the decoction into a bath filled with water, the temperature of which does not exceed 35 degrees. The duration of the procedure is no more than fifteen minutes. The course of taking baths is every day for two weeks, after which a week-long break is necessary.
Bath from the roots of the white step
Fill 50 grams of the plant with water ( two to three glasses) and insist for several ( two three) hours. Next, put the infusion on the fire and soak on low heat for twenty minutes. Strain the decoction and add to a bath of water ( 35 - 37 degrees). This water procedure should be carried out before going to bed for ten to twelve days.
Bath with Jerusalem artichoke
To prepare a bath with Jerusalem artichoke, prepare one and a half kilograms of a mixture of tops, flowers, tubers ( fresh or dry). Pour the Jerusalem artichoke with one bucket of boiling water ( ten liters) and put on a small fire. After ten to fifteen minutes of a slight boil, remove from heat and leave to infuse for twenty minutes. Strain the decoction and add it to a bath of water ( 35 - 40 degrees). Take a bath with Jerusalem artichoke should be once every two days for two to three weeks.
Bath with clover
Take 50 grams of dry meadow clover and pour one liter ( 4 glasses) hot water. After two hours of infusion, add to the bath, the water temperature of which should not exceed 37 degrees. It is necessary to do the procedures before going to bed for two weeks. The duration of the bath is from ten to fifteen minutes.
Compresses
To accelerate the healing process of foot wounds in diabetic angiopathy ethnoscience offers compresses and dressings based on medicinal plants and oils.herbal dressings
To prepare a compress, you need to grind the ingredient included in the recipe and apply to ulcers. The mass is fixed with a gauze bandage. Before applying the composition, the feet must be washed with warm water. After removing the bandage, the feet should be rinsed and put on clean cotton socks. The frequency of herbal compresses is two to three times a day.
Components for compresses:
- crushed and whole fresh calendula leaves;
- crushed leaves and almost heart-shaped linden;
- dried nettle leaves ground into dust.
Oil based compresses medicinal herbs and other useful components have a healing effect on trophic ulcers, soften the skin and reduce pain.
Honey compress ingredients:
- refined vegetable oil - 200 grams;
- pine or spruce resin - 50 grams ( resin should be purchased at a pharmacy or specialized stores);
- beeswax - 25 grams.
Prevention of diabetic angiopathy
Preventive measures to prevent diabetic angiopathy:
- constant monitoring of sugar and other blood parameters;
- systematic visits to an ophthalmologist, endocrinologist, family doctor;
- maintaining a proper diet;
- active lifestyle;
- compliance with the rules of body hygiene;
- rejection bad habits.
Blood sugar control
For persons at risk, it is necessary to systematically take blood tests for sugar content. This should be done in accordance with a special schedule, which the therapist will help to draw up. People who are obese or who have close relatives with diabetes should check their sugar levels several times a week. Today on sale there are special devices that facilitate the task of self-checking the amount of sugar in the blood. Timely response to an increase in blood sugar will help prevent the development of complications.After the diagnosis of diabetes mellitus, prevention is aimed at preventing complications. The level of cholesterol in the blood is an indicator that must be monitored, since its increase provokes vascular pathology and tissue destruction. When the sugar level rises above 10 mmol / liter, it passes through the kidney filter and appears in the urine. Therefore, it is recommended not to allow an increase in fasting glucose above 6.5 mmol / liter. At the same time, sharp rises and falls in glucose levels should not be allowed, since it is fluctuations in glycemia that damage blood vessels.
Parameters to be followed in diabetic angiopathy:
- fasting glucose: 6.1 - 6.5 mmol / liter;
- glucose two hours after eating: 7.9 - 9 mmol / liter;
- glycosylated hemoglobin: 6.5 - 7.0 percent of total hemoglobin;
- cholesterol: 5.2 - 6.0 mmol / liter;
- blood pressure: no more than 140/90 mmHg.
Parameters to be followed in case of diabetic angiopathy complicated ischemic disease heart, as well as frequent hypoglycemic conditions:
- fasting glucose: 7.8 - 8.25 mmol / liter;
- glycosylated hemoglobin: 7 - 9 percent;
- fluctuations in glycemia within a day no more than 10 - 11 mmol / liter.
Visiting doctors
In order to prevent the likelihood of developing angiopathy, one should be observed by an endocrinologist and conduct a systematic duplex ultrasound examination. When pain in the lower leg or foot, the appearance of trophic ulcers on the extremities or necrosis of the skin, it is necessary to conduct an ultrasound scan of the arteries of the lower extremities as soon as possible. Diabetic eye problems appear before visual impairment is diagnosed. In order to prevent angiopathy, you need to visit an ophthalmologist twice a year.Diet
Persons at risk to prevent angiopathy should control the quantity and quality of food consumed. Food should be fractional, food should be taken five times a day in small portions, avoiding feelings of hunger or satiety. The amount of easily digestible carbohydrates consumed should be reduced to a minimum. This category of products includes sugar, baked goods and White bread, sweets, honey. The absence of sugar can be compensated by sweeteners and a moderate amount of fresh vegetables and fruits. Consumption of bananas, grapes and other fruits with high content sugar should be kept to a minimum.Nutrition rules for the prevention of diabetic angiopathy:
- exclude the use of fried and smoked foods;
- increase the amount of onion you eat baked or boiled);
- increase the amount of raw vegetables and fruits consumed;
- the diet should be dominated by steamed, baked or boiled foods;
- fatty meats ( lamb, pork) should be replaced with lean ones ( chicken, turkey, veal);
- when cooking poultry, the skin should be removed from the meat;
- canned food and nutritional supplements should be minimized;
- to improve the process of digestion of fats in food, it is necessary to add spices ( except hot pepper).
Food products for the prevention of diabetic angiopathy:
- wholemeal flour products;
- rice, buckwheat and barley groats, oatmeal;
- oat, wheat, rice, rye bran;
- potatoes and other high fiber foods.
Products that stimulate the pancreas:
- sauerkraut;
- blueberry;
- green bean;
- spinach;
- celery.
Maintaining a healthy water balance is one of the important preventive measures in the development of diabetic complications. A sufficient amount of water stimulates the production of insulin and its absorption by the body. To provide the cells with the necessary amount of moisture, you need to drink about two liters of fluid per day ( eight glasses). Give preference to mineral non-carbonated water, unsweetened herbal and fruit teas. For the prevention of diabetic angiopathy, it is useful to take pomegranate juice, fresh cucumber, plum juice.
Fluid intake should be limited in renal failure, arterial hypertension.
Body hygiene
Prevention of angiopathy involves careful body hygiene. Insufficient tissue regeneration and the likelihood of infections can cause a wide range of complications. Therefore, in the event of cuts and abrasions, the surface of the wounds should be treated in a timely manner with antiseptic agents. It is worth minimizing interaction with risk factors. So, for example, a razor can be replaced with an electric razor.Feet care
Foot care plays an important role in the prevention of diabetic angiopathy. Keep your feet clean and follow all the rules for caring for them. If the skin of the legs is dry, it is necessary to use moisturizing creams, which include urea. Shoes should be comfortable and not outrageous. discomfort (rubbing, squeezing). Preference should be given to leather shoes with insoles made of natural materials. Choose shoes with a wide toe and low heels. Avoid wearing socks made of synthetic materials. Make sure that your feet are not exposed to hypothermia or overheating. Avoid abrasions, bruises, cuts. Timely treatment corns and calluses, the use of antiseptics and a systematic examination of the feet will help to avoid complications in diabetes.Rules for foot care in diabetic angiopathy of the lower extremities:
- every evening, the feet should be washed with warm water with potassium permanganate and baby soap;
- after water procedures, the legs should be wet with a towel, apply a bactericidal cream and grease the skin between the fingers with alcohol;
- trim your toenails once a week at a right angle;
- exclude procedures for steaming and softening the skin of the legs;
- do not keep your feet near a fire, fireplace or other heating devices;
- do not try on new shoes on bare feet;
- do not use someone else's shoes, socks, foot towels;
- in public places ( hotel, swimming pool, sauna) use disposable shoes.
Physical exercise
To preventive measures in the fight against diabetes and its complications include sports and moderate physical activity.Kinds physical activity with diabetes:
- walks in parks, squares;
- visiting the pool;
- a ride on the bicycle;
- walking up stairs instead of the elevator;
- reduction of routes using transport in favor of walking;
- hiking in the forest.
Bad habits
Prevention of diabetic complications involves avoiding the use of alcoholic beverages. Alcohol affects the liver, resulting in insufficient amounts of glucose entering the bloodstream. Also, alcohol increases the effect of the use of insulin and sugar-lowering drugs. All this can drastically lower blood sugar levels and provoke hypoglycemia. Smoking aggravates the course of diabetes and accelerates the development of diabetic complications. Therefore, for the preventive purposes of preventing angiopathy, smoking should be abandoned. It is also worth limiting stressful and depressive situations, since nervous exhaustion can also cause the development of a large number of diabetic complications.Diabetic angiopathy is a vascular lesion that is a complication of long-term diabetes mellitus. The disease does not depend on gender. The most vulnerable age is after 50 years. Most often, a violation of blood flow is observed in the vessels of the lower extremities, kidneys and retina. Symmetric changes are characteristic on both sides.
AT International classification diseases (ICD 10) for diabetic angiopathy, there are 5 coding options, depending on the form of diabetes. All codes indicate a mandatory violation of peripheral circulation:
- E10.5 - with insulin-dependent diabetes;
- E11.5 - with an insulin-independent form of the disease;
- E12.5 - if diabetes mellitus is associated with malnutrition;
- E13.5 - with other known forms of diabetes;
- E14.5 - if the causes of diabetes are not established.
Some statistics
Systemic damage to the vascular bed in patients with diabetes mellitus leads to cerebral angiopathy (encephalopathy). The frequency of this complication is from 5 to 75%, depending on the form of the disease.
In 35 - 40% of patients of working age, angiopathy is found in the vessels of the heart. It is one of the main causes of death among diabetic patients from ischemic complications (up to 75% of cases).
The mechanism of development of pathology
In the development of the pathology of the vascular bed in diabetes mellitus, importance is attached to disorders of fat and carbohydrate metabolism in the patient's body.
- The basis of the effect on the vessels is uncompensated glycemia (high blood glucose). It leads to the accumulation of toxins, acid residues, directly affects the wall of blood vessels.
- Increased formation of low density lipoproteins causes their accumulation in the vascular wall, the growth of muscle cells.
- Oxidative reactions of fats contribute to the appearance of free radicals, which have a pronounced destructive effect on the inner lining of blood vessels (endothelium).
- Blocking the synthesis of prostacyclin, which dilates blood vessels and prevents thrombosis, leads to the opposite pathological effect.
- Changes in the peripheral nervous system first, they violate the regulation of the tone of small and medium-sized vessels (in a reversible stage), then persistent irreversible changes occur, in which the walls of the capillaries do not respond to nerve impulses.
- The result is narrowing of small arterial vessels at the precapillary level. In them, the pressure rises sharply, not enough blood enters the capillaries to supply the tissues with oxygen.
- On the other hand, there is paralysis of collateral vessels (shunts), which are located between the arteries and veins. They are most developed on the legs to provide increased blood supply. Diabetic angiopathy leads to a reset arterial blood saturated with oxygen into neighboring veins. So oxygen "sneaks" without reaching the tissues.
All subsequent changes are caused by chronic tissue hypoxia.
Anatomical changes in the vessels
In diabetes mellitus, two types of angiopathy may develop:
- Macroangiopathy affects vessels of medium caliber and small arterioles. The most convenient conditions are created in the arteries for the formation of atherosclerotic plaques with calcification.
- Microangiopathy characterized by impaired blood circulation at the level of the smallest vessels (capillaries) of both arterial and venous type. The growth of the cells of the inner membrane and the loss of adaptive regulation lead to a complete blockage of the lumen and the cessation of blood flow through the capillaries into the tissues.
In patients, both types are most often mixed. Isolation into forms of circulatory disorders is important for the treatment and diagnosis of the stage of the disease. In addition, the combination of diabetes with obliterating atherosclerosis is not excluded.
Clinical manifestations of angiopathy of the legs
Symptoms of diabetic angiopathy are related to the type of disorders.
Macroangiopathy is characterized by:
- cold feet, constantly freezing legs;
- pain in the muscles of the legs when walking (intermittent claudication), passing after stopping;
- in a severe stage of the disease, pain at rest, especially at night;
- convulsions in calf muscles associated with increased excretion of potassium in the urine;
- forced position - for relief, the patient sits at night, tries to warm his legs, rubs them;
- on examination, the doctor notes a characteristic small rash on the skin of the foot and lower leg;
- in the severe stage, there is no pulsation in the arteries of the foot;
- trophic ulcers appear with necrosis in the center, gangrene develops when the wound becomes infected.
Patients try to rub their feet with warming ointments
Signs of microangiopathy:
- numbness of the foot, a feeling of "goosebumps", burning sensations both during exercise and at rest;
- dry skin on the legs;
- thickening of nails;
- small rash on the legs;
- preserved pulsation of the arteries of the foot.
The condition worsens with hypothermia of the legs, decompensation of diabetes, short walking.
The level of vascular obliteration is indicated by the place of numbness (foot, lower leg, thigh), changes in the skin. In determining the stage of the disease, it is important to notice signs of diabetic neuropathy and changes in the configuration of the legs in time. The disappearance of fatty tissue on the legs ("shrinkage") and thighs indicates tissue atrophy.
Formed in the late stages of diabetes. It includes, in addition to angiopathy of the vessels of the legs, changes in nervous regulation metabolic processes in the bones and joints of the foot. Trophic ulcers become deep, reach the tendons and bone tissue. There are dislocations and fractures in the foot, its shape changes.
Clinical manifestations of retinal angiopathy
For diabetes, the occurrence of angiopathy in only one part of the body is not typical. Usually, the lesion is systemic in nature and, simultaneously with the lower extremities, circulatory disorders in the vessels of the eyes and kidneys can be detected.
Diabetic angiopathy of the retina (retinopathy) manifests itself in the early stages of the disease. It has a typical mechanism of development by the type of microangiopathy.
If the patient has no complaints, the ophthalmologist can see changes in the fundus. They are present in 90% of patients. The risk of complete blindness in diabetes is 25 times more pronounced than in its absence.
Questioning patients allows you to identify the following symptoms:
- dark spots or dots, sparks of light appear and disappear before the eyes;
- concerned about cramps or pain in the eyeball;
- with overwork, there is a throbbing pain in the eyes;
- frequent headaches.
Reduced vision occurs already with severe vascular damage.
Clinical manifestations of angiopathy of the kidneys
Diabetic damage to the kidney vessels is called nephropathy. The disease develops as microangiopathy in the main working structure - capillary glomeruli. Symptoms are associated with a violation of their ability to filter the blood, cleansing from slag substances. Pathology occurs in 70% of patients with diabetes.
Main clinical manifestations:
- Edema - first formed around the eyes in the morning, symmetrical on both sides, then fluid accumulates in abdominal cavity, between the pleura, in the pericardial sac. The reason is the loss of protein (protein molecules do not linger, but pass through the wall of blood vessels into the urine).
- Hypertension - an increase in blood pressure occurs due to fluid and salt retention, increased production of renin in response to oxygen deficiency in the kidney tissue. The result is the activation of the hormone aldosterone. Such hypertension is referred to as symptomatic, it is not associated with true hypertension.
- Intoxication is the latest manifestation. It occurs due to the accumulation of tissue decay products that are normally excreted in the urine. Patients complain of constant weakness, nausea, drowsiness. With a sufficiently high accumulation of ammonia compounds, brain damage occurs, which manifests itself in vomiting, dizziness, convulsions, loss of consciousness.
The severity of angiopathy depends on the primary lesion of the organ:
- with progressive changes in the vessels of the legs without treatment, inevitable gangrene occurs, starting from the foot and above;
- retinal angiopathy leads to visual impairment up to complete blindness;
- nephropathy eventually causes kidney failure, uremic coma.
Diagnostics
Damage to the vascular bed and its consequences can occur not only in diabetes mellitus, but this disease is one of the main causes and provokes the development of atherosclerosis, hypertension, acute myocardial infarction, and heart failure.
In the case of confirmed diabetes, patients are examined for early detection of complications during medical examination. Necessarily patients are examined by a surgeon, an oculist, urine tests are prescribed.
Laboratory diagnostics provides for monitoring of residual blood nitrogen (creatinine, urea), fat composition (lipoprotein fractions, cholesterol), glomerular filtration rate of the kidneys, the presence of b2-microglobulin in the urine, as well as the determination in the general analysis of urine, in addition to glucose, protein, the level of ketone bodies.
The pathological mechanism involves the breakdown of the regulatory function of nerve cells
Hardware methods:
- A complete examination by an ophthalmologist includes ophthalmoscopy, examination of the fundus, if necessary, stereoscopic photography of retinal vessels;
- ECG and ultrasound of the heart can diagnose hypertension;
- dopplerography of the vessels of the legs checks the patency, detects thrombosis;
- angiography of the arteries of the lower extremities using a contrast agent injected into the femoral artery, allows you to determine the degree of patency of the vessel;
- Ultrasound of the kidneys indicates a violation of the shape, structure (replacement with scar tissue);
- dopplerography of the vessels of the kidneys shows the patency of the tubules;
- MRI ( magnetic resonance imaging) makes it possible to check the structure of organ tissues in layers.
When symptoms of angiopathy of the coronary and cerebral vessels appear, special methods for studying blood circulation are added.
According to the state of the vascular pattern of the eye, the doctor judges other systemic lesions
Treatment
Treatment of diabetic angiopathy requires, first of all, the correction of blood glucose levels with the help of diet and hypoglycemic agents. The constant intake of drugs and their dose are controlled by the endocrinologist.
Mandatory course of treatment medicines different actions:
- drugs that affect the level of low-density lipoprotein (Atorvastatin, Rosuvastatin, Lovastatin);
- drugs that lower blood pressure;
- diuretics to remove fluid;
- drugs that strengthen the wall of blood vessels that promote expansion (Ascorutin, Troxevasin, Trental, nicotinic acid);
- means that prevent the formation of blood clots (Aspirin group under the control of a coagulogram);
- metabolic activators to improve metabolic processes in tissues (vitamins C, E, the entire group B, Solcoseryl).
Other treatments
Laser photocoagulation is used to treat diabetic retinal angiopathy. Cauterization of the retinal vessels allows you to save vision from 50 to 70% of patients (depending on the stage of the disease).
The introduction of corticosteroids and drugs that suppress the growth of blood vessels (Ranibizumab) into the eyeball is used, 5 injections per year.
With trophic ulcers on the legs, the attachment of gangrene requires amputation of the limb at a level above tissue damage.
Diabetic angiopathy of the kidneys is treated by hemodialysis, which allows you to temporarily cleanse the body of toxins.
Usage folk remedies with this serious pathology is not the main treatment. The passion of patients with decoctions, poultices and baths leads to neglected cases that require surgical treatment. The use of any advertised means should be agreed with the endocrinologist.
Diabetic angiopathy of the retina is a dependent disease. As the name implies, the disease is a consequence of the development of diabetes mellitus in the body, one of its complications.
Eye angiopathy is the occurrence of disturbances in the functioning of the blood vessels of the organ of vision and a change in the structure of the vascular wall of the eye. Pathological changes in the vascular wall of the eye lead to the fact that a person loses his sight.
Very often, patients develop retinal angiopathy in both eyes.
Loss of vision occurs due to irreversible processes in the eye, which are:
- necrotic changes in the retina of the eyeball;
- thinning of the retina;
- retinal break;
- detachment of the photosensitive layer.
All these consequences of the development of eye angiopathy are combined under the general name of retinopathy.
The deterioration of vision occurs due to the deterioration of the retina, which, in turn, occurs as a result of a deterioration in the blood supply to the light-sensitive layer of the organ of vision.
When a complete retinal detachment occurs, blindness occurs. Developing retinal angiopathy in both eyes can lead to total loss vision.
Reasons for the development of retinal angiopathy
Angiopathy is a consequence of the development of any disease that affects the condition vascular system organism.
Additionally, the disease can develop due to the progression of osteochondrosis of the cervical spine in the body. The cause of the appearance of disorders in the choroid of the eyeball can be autoimmune vasculitis - inflammatory lesions of the vascular system and blood diseases.
Changes in the vascular system of the fundus may indirectly indicate the degree of damage to the vascular system of the whole organism. Most often, eye angiopathy appears for the following reasons:
- hypertension of any origin;
- diabetes;
- atherosclerosis;
- hypotonic angiopathy - angiopathy that occurs with low blood pressure;
- scoliosis;
- injury - traumatic angiopathy.
In addition to the causes contributing to the progression of the disease, there is a whole range of predisposing factors that affect the progression of the disease, such factors are:
- smoking;
- human exposure to harmful environmental factors, such as production emissions;
- various types of intoxication of the body;
- the presence of congenital anomalies in the development of blood vessels;
- advanced age.
In medicine, several varieties of angiopathy are known.
Types of angiopathy, its symptoms
Sugar level
The first signs of the development of disorders are the appearance of flies before the eyes, the appearance of darkening in the eyes, the periodic appearance of dark spots or dots before the eyes, a feeling of pain in the eyes, pain in the eyeballs may appear. Very often, a sick person feels headache and pulsation in the eyeballs after work requiring eye strain. In the future, there is a violation of the functioning of the organs of vision, and the primary symptoms become persistent.
Depending on the type of underlying disease that caused the progression of the pathology of the vascular system, the following types of angiopathy are distinguished:
- diabetic angiopathy;
- hypertonic;
- hypotonic;
- traumatic;
- Eales' disease or juvenile angiopathy.
The main manifestation of the development of the disorder is the lesion of the choroid, which is detected during the examination with a special apparatus in the ophthalmological office.
Depending on the causes that led to the occurrence of the violation, it can manifest itself during examination in the form of a narrowing or expansion of the vessels that feed the tissues of the eyeball.
The development of angiopathy can occur at any age, but people over the age of 30 are most often affected by this disease.
Characteristics of diabetic, hypo- and hypertensive angiopathy
With the development of diabetes mellitus in the body, not only small vessels are affected, which causes the appearance of microangiopathy, but also large blood vessels that feed the eyeball.
With the defeat of large blood vessels in the body, the development of macroangiopathy is observed. When macroangiopathy occurs, large-diameter blood vessels are affected not only in the structure of the eye, but also in other organs. The defeat of large vessels throughout the body leads to disability.
High blood pressure affects the vascular wall, leading to its destruction
The progression of diabetes mellitus leads to the appearance of hypertension in the body. The development of hypertension and diabetes mellitus provokes the appearance of a complex complication, the cause of which is both diabetes mellitus and hypertension. This complication is called diabetic-hypertensive angiopathy.
A complication that develops under the influence of hypertension is called hypertensive angiopathy.
Increased pressure in the vascular system acts on the vascular wall, destroying its inner layer. This leads to wall compaction and fibrosis. The vessels of the retina begin to compress when crossing, which leads to a violation of blood circulation. The resulting violations lead to the creation of conditions conducive to the formation of blood clots and hemorrhages. An increase in blood pressure leads to rupture of some blood vessels. Tortuosity of the fundus vessels is a characteristic sign of the development of hypertensive angiopathy.
In a state of neglect, patients develop hemorrhages in the eyeball, there is clouding of the retina and destructive pathological changes in the tissues of the retina.
Hypotonic angiopathy progresses if a person has low blood pressure in the body. The decrease in pressure reduces the rate of blood flow, which in turn contributes to the formation of blood clots. This complication is characterized by branching of the vessels and a pronounced expansion of the arteries. Additionally, the examination reveals pulsation of the veins, in some cases the pulsation is so strong that a person begins to feel it in the eye.
A person develops dizziness, pain in the head area and meteorological dependence.
Characteristics of traumatic and juvenile angiopathy
Traumatic angiopathy occurs when compression occurs chest, cranium, abdominal region or in case of damage to the cervical spine. Damage to the vascular layer occurs as a result of a sharp increase in pressure and squeezing of blood vessels at the level of the cervical region. characteristic feature This type of complication is the appearance of hemorrhages in the tissues of the retina and a strong narrowing of the fundus capillaries. With the development of this complication, there is a sharp drop in vision, which can not always be restored in the future.
Juvenile angiopathy is a complication that has a poorly understood etiology. The development of complications occurs against the background of an inflammatory process progressing in the walls of the vascular system. The nature of the appearance of inflammation is unclear. When this pathology occurs, the appearance of hemorrhages in the retina and vitreous body of the eye is observed.
Juvenile angiopathy is the least favorable type of complication. In the process of progression, proliferation of connective tissue and detachment of the retina can be observed.
This situation leads to the progression of glaucoma and cataracts in the body.
Method for diagnosing and treating angiopathy
A complication in the form of angiopathy is detected during an examination of the fundus in the ophthalmologist's office.
An ophthalmologist examines the patient's fundus with a dilated pupil using a special microscope. During the examination, the ophthalmologist detects the presence of narrowing and dilation of blood vessels, the presence of hemorrhages and the position of the macula.
Assigned if necessary additional examinations. For the diagnosis of the disease are used:
- Ultrasound of the vessels of the organs of vision with duplex and Doppler scanning of the vessels of the retina makes it possible to determine the speed of blood flow and assess the state of the wall of blood vessels.
- X-ray examination using a contrast agent allows you to assess the patency of the vascular system and the speed of blood flow through the vessels.
- Computer diagnostics.
- Magnetic resonance imaging is used to assess the condition of the soft tissues of the organ of vision.
Treatment of the disease must begin at the very early stage development. This approach will avoid the appearance of a whole range of complications, among which the main ones are the following:
- loss of vision, which may be complete or partial;
- atrophy of the optic nerve;
- significant narrowing of the field of view.
Angiopathy is a disease that requires an integrated approach to treatment. In the process of choosing a treatment regimen, it is required to consult with several doctors, the main specialists among them are:
- cardiologist;
- therapist;
- neuropathologist;
- ophthalmologist.
The choice of treatment regimen is carried out by the attending physicians, taking into account the individual approach, the form of the disease and taking into account the characteristics of the patient's body.
Prevention of the development of the disease
When a hypertensive form of the disease is detected, first of all, the blood pressure indicator should be normalized and maintained at the same level.
When diabetic form of angiopathy is detected, first of all, attention should be paid to the diet. The menu of a person suffering from diabetes should contain foods with a minimum sugar content, these are different.
In the course of the medical procedures Do not forget about moderate physical activity, which helps to strengthen circulatory system and the body as a whole, and also help to improve the absorption of sugar by the muscular system. In the process of treatment, medical, physiotherapeutic and folk methods are used.
The main methods of prevention are measures aimed at maintaining the body in a normal functional state. For this purpose, people with high blood pressure should be regularly examined by cardiologists, and in the presence of diabetes in the body, it is necessary to regularly monitor blood sugar levels and regularly consult with an endocrinologist. Patients should lead a healthy lifestyle, give up bad habits and follow a diet developed by nutritionists.
Patients with diabetes should strictly follow a low-carbohydrate diet.
The doctor will tell in the video in this article how diabetes and eye angiopathy are related.
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Angiopathy of the retinal vessels is serious complication diabetes mellitus.
After 20 years from the onset of diabetes, a pathological change in the retinal vessels is observed in almost every patient.
The disease is chronic and characterized by slow progression.
Therefore, control of blood glucose levels and timely detection of changes in the fundus help to delay the onset of the disease.
Causes
It's easy to guess that The cause of retinopathy in this case is diabetes mellitus..
However, there are a number of factors that aggravate the course of the process and accelerate it:
- Smoking;
- alcohol abuse;
- Failure to comply with medical recommendations regarding medication;
- Fat metabolism disorders (atherosclerosis);
- Burdened heredity;
- Visiting an ophthalmologist less than once a year.
Mechanism of development of diabetic retinal angiopathy
First mechanism. In diabetes mellitus, a high concentration of glucose (more than 5.5 mmol / l) is determined in the blood. As a result, glucose begins to penetrate the vascular wall and accumulate on the endothelium (the layer that lines the inner surface of the blood vessel).
Over time, due to increased permeability, glucose metabolism products - fructose and sorbitol, which tend to attract fluid, begin to be deposited on the vessels.
As a result, the vessels swell and thicken. The endothelium is damaged and a cascade of reactions is triggered, leading to an inflammatory process.
The second important mechanism for the development of retinal angiopathy- this is the activation of thrombus formation, which develops in response to the inflammatory process.
This slows down blood flow and leads to the formation of blood clots, which cause retinal hemorrhages.
These mechanisms constrict blood vessels and slow down blood flow. The retina does not receive enough nutrients.
Oxygen starvation sets in, which further damages the endothelium and increases swelling.
Types of angiopathy
Single signs of the disease appear in patients with diabetes mellitus approximately 3 years after diagnosis. And after 20 years, they are observed in almost all patients to one degree or another. According to the course of the disease, it is divided as follows:
- Benign (developing slowly);
- Malignant (progressing quickly).
According to clinical and morphological features, the disease is divided into types:
- Preangioretinopathy. it initial stage a disease characterized by uneven or mild diffuse dilatation of the retinal veins. At the same time, their diameter is set to 2 or 3 times the diameter of the arteries (normally, this figure should not be more than 1.5). In this case, vision problems are not observed;
- Simple diabetic angioretinopathy. At this stage, changes in the fundus occur. Retinal veins dilate and twist, petechial hemorrhages and microaneurysms appear. In this case, visual acuity is maintained only during daylight hours, and the sensation of color is disturbed;
- Propreliferative. A large number of petechial hemorrhages and aneurysms, soft and hard exudates, widespread diffuse edema appear in the retina. Visual acuity is impaired;
- Proliferative. It is distinguished by a massive proliferation of retinal vessels, vascular thrombosis, extensive hemorrhages and wrinkling of the retina. There are adhesions between the retina and the vitreous body. In this case, the patient's vision is sharply reduced, blindness is possible.
Symptoms and manifestations of the disease
The main symptom that causes an appeal to an ophthalmologist is decreased visual acuity.
The patient complains that he cannot see well small objects at a certain distance. Gradually, metamorphopsia appears - a distortion of the contours of objects.
If the disease is complicated by hemorrhage into the vitreous cavity, then dark floating circles or spots appear in the field of view. Over time, the spots go away, but vision is not restored.
If you do not consult a doctor in a timely manner, adhesions will occur between the retina and the vitreous body, which can provoke.
The first sign of a retinal detachment may be flashes of light or sparks in front of the eyes.
In some cases, angiopathy is accompanied by swelling of the retina and it seems to the person that he is looking through a dense translucent veil.
Diagnosis of retinal angiopathy by diabetic type
Diagnosis of diabetic retinal angiopathy usually does not cause difficulties and is based on the history of the disease (that is, the presence of diabetes in a person), as well as on the data of instrumental studies:
An ophthalmologist can easily detect areas of vasoconstriction, pinpoint hemorrhages and other signs of angiopathy in the fundus.
Besides, some patients have reduced color perception, impaired dark adaptation and contrast sensitivity.
Treatment of diabetic retinal angiopathy
The basis of the treatment of retinal angiopathy is the correction of diabetes mellitus and bringing blood glucose into the normal range (3.5 - 5.5 mmol / l). Constant maintenance of sugar at this level allows you to restrain the development of complications for quite a long time.
As for the treatment of retinal angiopathy, it is symptomatic. Preparations that protect the vascular wall are used, as well as agents that have an antioxidant and reparative effect: trental, actovegin, solcoseryl, divascan, and others.
In a number of countries, surgery and laser therapy are used to treat retinal antihyopathy.
Surgical intervention
In the presence of non-proliferative diabetic angiopathy of moderate and severe degree, laser coagulation to prevent vision loss.
The operation is performed within 20 minutes under local anesthesia. A lens is placed on the diseased eye to focus the rays on the fundus of the eye.
The essence of the operation is that the retina is attached to the tissues to create strong adhesions that do not allow it to peel off.
In the prolepirative stage of the disease, laser coagulation is ineffective. In order to help the patient maintain vision, a vitrectomy is performed.
This is a surgical intervention in which the vitreous body is partially or completely removed, and with it scars, blood or tissues that cause retinal tension.
The removed vitreous is replaced with artificial polymers and saline. These substances, after expansion, press the retina of the eye, so that it is held in its normal position. This prevents the appearance of new hemorrhages and pathological proliferation of blood vessels.
Diet for sickness
Four meals a day are recommended, which makes it possible to avoid sharp fluctuations in glucose throughout the day. For each patient, the need for fats, carbohydrates and proteins is individually signed.
Eating should be fractional, at least 5 times a day. Do not allow feelings of hunger or overeating. It is necessary to reduce the amount of easily digestible carbohydrates to a minimum:
Nutrition rules:
- Fatty meats such as pork or lamb should be replaced with chicken, turkey, rabbit, while cooking them without skin and fat;
- Fried foods, smoked meats, pickles should be excluded from the diet. Steamed or boiled food should prevail;
- Raw fruits and vegetables need to be increased;
- In order to improve the process of digestion of fats, spices should be added to food (an exception is hot pepper);
- Chocolate and sweets should be replaced with marshmallows, marshmallows, marmalade.
Diabetic retinal angiopathy in children
Diabetic angiopathy develops in children in the later stages of the disease. If you do not start the process and start treatment on time, then the progression of the disease can be avoided for a long period. It will not be possible to completely get rid of the disease, because it is a complication of diabetes.
Examination reveals tortuosity and dilation of the veins, as well as small hemorrhages and swelling of the retina. Symptoms of the disease:
For the treatment of the disease in children, the following methods are used:
- Prescribe drugs that help improve blood circulation in the retina, such as Solcoseryl, Actovegin and vitamin complexes;
- Physiotherapy procedures;
- Reflexology;
- Color therapy;
- magnetic therapy.
If one of the parents has congenital diabetes mellitus, then very careful monitoring of the child's blood sugar level is necessary.
Prevention
It is almost impossible to completely avoid angiopathy in diabetes mellitus, but when the following recommendations are followed, the disease develops slowly:
- It is necessary to lead a healthy lifestyle and avoid psycho-emotional stress;
- You need to monitor nutrition and stick to a diet low in salt, protein and carbohydrates;
- Long walks in the fresh air and moderate physical activity are recommended;
- It is worth completely getting rid of bad habits;
- Patients with arterial hypertension special attention should be paid to the treatment of this disease, since it leads to the rapid progression of angiopathy;
- It is necessary to follow all the recommendations of the doctor and take the prescribed drugs, regularly measure the level of sugar in the blood and keep it under control.
