Vascular damage from diabetes
Acute and chronic complications arise with diabetes.
Complications are caused by:
- damage to large blood vessels (diabetic macroangiopathy)
- damage to small vessels and nerves (diabetic microangiopathy and neuropathy).
When small vessels are affected – diabetic microangiopathy, there is damage to the kidneys, eyes or nerves. When large blood vessels are affected - diabetic macroangiopathy, it can cause stroke, heart attack or loss of circulation – the often mentioned ischemia of the lower extremities. If any part of the limb lacks circulation, it leads to the gradual death of its tissue – gangrene on the leg, which can also result in its amputation – which is understood as the surgical removal of bone in healthy tissue or another part of the body, or separation of a part of the body at a joint. However, this is as if the final stage that can be prevented with appropriately selected treatment. However, from experience, people come to the doctor at the last minute, when it is no longer possible to reverse this condition.
With microangiopathy, the vessels damaged are the smallest ones that bring blood to the inside of the tissues, where they form a network of capillaries. Their walls are thickened and weak, causing blood flow to slow down and haemorrhages often occur. The tissues are congested, poorly nourished and cell death occurs. The effect of long-term elevated blood sugar is felt primarily in cells where sugar transfer is occurs independently of the influence of insulin. The cells of the retina in the eye, the lens of the eye and the kidneys are very sensitive. Elevated blood sugar activates that sugar processing and damages proteins, increases oxidative stress, vascular permeability, the formation of substances that activate inflammation, increases the proportion of foreign matter between cells, while some cells that make up the lining of blood vessels die. Where the body does not have enough nutrition, small veins are formed, but they are incomplete and break very easily.
Damage to large vessels occurs with macroangiopathy. It causes accelerated hardening of blood vessels (sclerosis) and thickening of the wall along its entire length. Damage to large vessels (diabetic macroangiopathy) is basically an accelerated process of atherosclerosis of large vessels (hardening of the arteries). The vessels gradually narrow and close. This gives rise to diseases from poor circulation, an often-heard diagnosis – ischemic disease, to which the name of the organ is added. Most often, the heart is affected, which is manifested by chest pains (a feeling of pressure on the chest). However, pain is not always present, especially in diabetics; The condition is called silent non-circulation of blood – silent ischemia. This explains that the patient experiences a myocardial infarction and does not even know about it. Also, the vessels in the lower extremities can gradually narrow and ischemic disease of the lower extremities develops. It manifests itself in such a way that the patient feels pain in the calves when walking fast or leg pain, especially at night with relief felt after getting their legs out of bed. If the patient has such symptoms, they should tell the doctor. Another manifestation is the narrowing of the vessels in the neck. The most serious complication is the occlusion of blood vessels. If this happens on the heart vessels, it is a myocardial infarction. Myocardial infarction is a life-threatening condition. In diabetics, the risk is two to four times higher compared to the general population. The following example serves to make the risk clear. A diabetic without a heart attack has the same risk of having a heart muscle infarction as his person after a first heart attack has of having a second heart attack. The development of atherosclerosis in diabetics is much faster, changes manifest themselves earlier and have a more severe course than in non-diabetics. In Slovakia in 2011 there were 330 thousand diabetics, of which 22 thousand had experienced a myocardial infarction, 24 thousand had experienced a stroke, 8 thousand had “diabetic foot” and 4 thousand had an amputated lower limb. Complications arise at a younger age, tend to be more severe and have a worse prognosis.
HBOT works by increasing the amount of oxygen dissolved in blood plasma, which in turn increases the amount of oxygen delivered to tissues throughout the body. This is achieved by exposing patients to increased atmospheric pressure inside the hyperbaric chamber. When a patient inhales 100% oxygen at pressures higher than atmospheric pressure (usually 2.0-2.5 times atmospheric pressure), oxygen molecules dissolve into plasma and are transferred to the tissues that need them. This increases the amount of oxygen available to tissues that do not receive adequate amounts of oxygen, which is especially important in conditions such as angiopathy, where blood flow is impaired.
Increased oxygen supply also has other benefits, such as reducing inflammation and promoting the growth of new blood vessels (angiogenesis). Inflammation is a common sign of angiopathy, and reducing it can help relieve symptoms and prevent further damage to blood vessels. Angiogenesis, on the other hand, can help improve blood flow to the affected areas by creating new blood vessels that bypass damaged or blocked blood vessels.
HBOT is usually adminstered as a series of treatments, lasting between 60 and 120 minutes for each session. The number of treatments required depends on the severity of the condition being treated, but a typical course of treatment may include 20-50 sessions. The treatment is generally well tolerated, with few side effects. Some patients may experience ear pain or pressure changes, but these can usually be managed with techniques such as yawning or swallowing.
In conclusion, hyperbaric therapy is a promising therapy to treat angiopathy, a condition that affects many people around the world. By increasing the amount of oxygen delivered to tissues, reducing inflammation, and promoting angiogenesis, HBOT has the potential to improve outcomes and quality of life for patients with the condition.
In order for the treatment of complications of diabetes to be successful, it is necessary for there to be:
- Close cooperation with specialists (diabetologist, nephrologist, neurologist, ophthalmologist, otorhinolaryngologist, pedologist)
- Diabetes compensation and patient cooperation
- Maintaining sugar levels – a healthy lifestyle and diet