As we discussed last week, diabetes is a prominent health issue, not just in the UK but across the globe. Cases are set to increase over the coming years and, consequently, health organisations are busy trying to raise awareness and promote healthier lifestyle choices in an effort to stem this estimated rise.
Diabetes is a condition many may not realise they have, due to the fact that it often causes no obviously discernible symptoms. The long-term effects of the illness however, are much more significant and numerous; vascular disease being notable among them.
Vascular disease is the name given to a range of conditions which affect the circulatory system. This system comprises the network of veins and arteries connecting essential organs which moves blood and oxygen around the body, and the lymphatic system, which filters out damaged cells and plays a crucial role in the body’s immune response.
Because the vascular system is responsible for so many human functions, there are several conditions which come under the vascular disease umbrella; including peripheral arterial disease (PAD), atherosclerosis, Raynaud’s, deep vein thrombosis and lymphedema. Vascular disease can also lead to heart problems, and stroke.
Following on from our post last week, and looking ahead to Vascular Disease Awareness Month this September, we got in touch with the organisers of this campaign, the Circulation Foundation, to discuss further the connection between diabetes and vascular health. They were kind enough to put us in touch with one their consultants, Kevin Varty MD, Consultant Vascular Surgeon and Honorary Secretary of the Vascular Society.
How does diabetes cause vascular disease?
Diabetes affects insulin production and the way our bodies process it, which causes blood sugar to be high.
So how does this affect the vascular system?
In two ways, as Kevin explains:
‘The higher levels of sugar in the body tissues leads to changes in proteins. These are the building blocks of the body at the molecular level. This change can have a wide range of effects on the body. In the arteries, thickening and hardening of the wall results.’
‘The nerves are also affected and they do not function properly. Some of these nerves control the distribution of blood flow in the body, and this is another reason for diabetic patients developing vascular disease.’
Type 1 and type 2
Chronic cases of diabetes mellitus fall into two main categories:
- type 1 is caused by an autoimmune response, where the immune system attacks cells in the pancreas, rendering it unable to produce insulin;
- whereas type 2 will come about over time as a result of one or more risk factors. 90 percent of diabetes cases in the UK are thought to be type 2.
But does the type of diabetes someone has have a bearing on their risk of developing vascular disease? Is one type more likely to lead to circulatory complications than another?
‘1 in 3 diabetic patients over the age of 50 have some evidence of peripheral arterial disease.’ Kevin tells us. ‘The same applies to type 1 and type 2. There are proportionately more type 2 diabetics and they have an older age profile. We therefore see more type 2 patients with vascular disease.’
‘The risk of arterial problems increases over time, many will present with problems after 5-10 years.’
Kevin goes on to explain that the presence of other conditions or lifestyle habits influences the likelihood of vascular disease developing too:
‘There is an interaction with other risk factors such as high lipid levels (cholesterol, fat), diet, weight, smoking and exercise. Good diabetic control and managing these other factors is important to minimise the risk of developing vascular problems over time.’
Which vascular conditions are diabetes patients more at risk from?
Because consistently high blood sugar has the capacity to damage any part of the vascular network, pretty much any condition related to the vascular system is a risk in those with diabetes.
‘The effects on the arterial system are widespread.’ Kevin explains. ‘Coronary artery disease (the cause of heart attacks), brain arterial involvement with strokes, kidney artery disease leading to high blood pressure and kidney failure, and leg artery disease increasing the risk of foot ulcers and amputation are all common.’
‘Again this depends on duration of diabetes and the presence of other risk factors mentioned above.’
As we’ve touched upon, a quite dangerous aspect of diabetes is the fact that it isn’t always easy to spot. During the early stages of the condition, patients may notice that they become more thirsty and need to go to the toilet to urinate more often; but these aren’t exactly standout signs of an illness.
So what about signs of vascular disease? Are they any more noticeable during their onset than those of diabetes?
An example is peripheral arterial disease, which according to the Circulation Foundation only causes symptoms (which may be pain in the calf, thigh or buttocks, or resting pain in the feet) in about a quarter of cases.
However, people who have been diagnosed with diabetes will be closely monitored for the development of conditions such as this one.
‘Patients in the UK will have an annual diabetic review with their doctor or nurse.’ Kevin tells us. ‘This looks for signs of arterial disease. It is difficult for patients to know if they are developing arterial disease at an early stage. Clearly if they have any significant symptoms, they should report them to their doctor.’
Keeping risk to a minimum
For those who have received a diabetes diagnosis, managing the condition is crucial in preventing vascular disease from developing. In this, it’s lifestyle which plays the biggest role.
‘The patient can do a lot to help themselves and this is very important.’ Kevin explains. ‘They will obviously be trying to get their diabetes under control as much as possible. In addition however, lifestyle management through diet, regular exercise, weight control, and avoiding or stopping smoking are all key elements in reducing the risk of vascular disease.’
But as Kevin goes on to say, sticking with your designated treatment plan is vital too:
‘Following the advice and medications given by their doctor or nurse may also be important. For example controlling cholesterol levels with statin drugs, controlling blood pressure with medication may be required. Blood thinning drugs such as aspirin or clopidogrel may also be required.’
You can find more on the Circulation Foundation website on the relationship between diabetes and vascular disease, as well as information on Vascular Disease Awareness Month and how you can get involved.