Microvascular Remodeling

The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and

This article goes in detail about the complications of Type 2 Diabetes, on how hyperglycemia damages the vascular system leading to microvascular disease and macrovascular disease. The complications of microvascular disease are diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. On the other hand, with macrovascular disease includes Cardio Vascular Disease (CVD), such as Atherosclerosis. Furthermore, the article gives recommendations of treating Type 2 Diabetes and the prevention of its health related complications with medication, screening, diet, and exercise.

Several possible mechanisms have been explained regarding diabetes induced neurodegeneration. Diabetes mellitus and the accompanying hyperglycemia is a chronic endogenous stressor that is accompanied with increased oxidative stress in brain, particularly the hippocampus, by accelerating free radical generation. These radicals contribute to increased neuronal degeneration by inducing oxidation to proteins, DNA alterations and lipids oxidation in cell membranes .

Even with the improvements in diabetes control and patient care, Type 2 diabetes is associated with a higher risk of death than the general population. For the current modelling analysis, the relative risk (RR) of death was estimated to be 2.45 for patients with DME and this was estimated based on the results from two studies. Mulnier et al. reported a RR of 1.93 (95%:CI: 1.89 to 1.97) for diabetic patients when compared to the general population.23 In the second study, Hirai et al., determined that the RR of death in diabetic patients with clinically significant macular edema was 1.27 (95%CI: 1.01 to 1.61).24 By combining the two estimates, the overall RR of mortality used in the model was 2.45 (i.e. 1.93 x 1.27).

Type 2 diabetes is becoming more and more common in children and teenagers because of the increase in obesity in young people” (Journal of the American Medical Association, 2011). As a result, there a many risk factors and health risks associated with type 2 diabetes. Risk factors include people with poorly managed blood glucose, overweight, family history, and poor diet. In people with diabetes kidney disease or kidney damage is a complication of diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin” (National Library of Medicine, 2014). Secondly, diabetic retinopathy is a condition which causes progressive damage to the retina, the light sensitive lining at the back of the eye. Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision” (American Optometric Association, 2014). Lastly, according to the U.S. Department of Health and Human Services, (2013) diabetic neuropathies are a family of nerve disorders which can occur overtime and develop nerve damage throughout the

Chronic elevated glucose in blood (hyperglycemia) with disturbances metabolism of protein, fat and carbohydrate resulting from disorder in insulin secretion, insulin action, or both. (1) Expected to increase diabetic patients by 2025 to approximately 300 million people in the worldwide (2) In ancient times it was difficult to identify diabetes as the ability of patients to heal weak, the researchers think the diabetes resulting from defect in the bladder and kidneys are the cause of diabetes. (6)

Diabetes is associated with an increased risk of developing primarily vascular complications that contribute to morbidity and mortality of diabetic patients. Poor glycaemic control leads to vascular complications that affect large (macrovascular), small (microvascular) vessels or both. Macrovascular complications include coronary heart disease, peripheral vascular disease and stroke. Microvascular complications contribute to diabetic neuropathy (nerve damage), nephropathy (kidney disease) and retinopathy (eye disease).

Age related macular degeneration (AMD) is the leading cause of blindness in people over the age of 50. Every ten years after the age of 50 the prevalence of this disease increases exponentially. Many different factors contribute to the development of AMD including genetic, environment, and metabolic functions. Aside from smoking, abnormal blood pressure, and an unhealthy diet low in fruits and vegetables, many more studies are concluding that similar inflammatory and oxidative processes seen in other age related diseases are also playing a key role in the development of AMD. This disease affects the central areas of the retina and choroid. In return central vision is impaired while peripheral vision is usually not lost. AMD is seen in two different forms, the earlier nonneovascular (dry) type and the more advanced neovascular (wet) type. Each form has its own specific pathology and unique characteristics that set them apart. Fatty, protein deposits called drusens may be the key risk factor in understanding dry AMD pathology, progression, and treatment. Once the more advanced wet AMD is diagnosed, pathology and treatment are targeted around the formation and destruction of abnormal blood vessels, characteristic of the wet AMD eye. The increasing prevalence of AMD has influenced more investigation into what factors can be modulated to prevent the onset or to stop the progression of AMD. This text will discuss the pathology of drusens and the role of inflammation and

Patients with type 2 diabetes are at risk of macrovascular and microvascular complications. Evidence has shown that an improvement in blood glucose control, as shown by a reduction in HbA1c levels, is associated with a reduction in microvascular complications (2,3,4).

Diabetic retinopathy is caused by blocked blood flow to the eye, causing ischemia or increased permeability of the blood vessels in the eye. Macular edema is caused by swelling in the eye due to the increased permeability, and both of these are common causes of vision loss of those with diabetes. Some factors that can be seen in the retina from a fundoscopic exam that can cause these issues (all of which were detected in our patient), are micro-aneurysms, intrarenal hemorrhages, and hard exudates. All three of these can disrupt the blood-retinal barrier, causing issues with blood flow and swelling. Additionally, lipids and proteins both play important roles in the eye, and if there is improper breakdown of these molecules, they can make deposits in the outer layer eye. The more deposits (hard exudates) a patient has, the larger affect it can have on their vision.

Age-related macular degeneration (AMD) is a common cause of irreversible blindness in the elderly. AMD is characterized by the progression from early to intermediate stages of the disease. The two major advanced forms are the geographic atrophy (GA) AMD and neovascular AMD. GA or “dry” AMD is characterized by loss of retinal pigment epithelium (RPE) cells and outer layers of the neurosensory retina as well as the choriocapillaris. Neovascular or "wet" AMD is characterized by the formation of choroidal neovascularization (CNV), the ingrowth of new blood vessels from the choriocapillaris through Bruch's membrane into the sub pigment epithelium or subretinal

An additional approach that studies have used to measure collateral circulation development is to measure the rate-pressure product in patients with coronary artery disease (CAD). Increases in rate-pressure product at the beginning of myocardial ischemia have been found and is potentially related to increased myocardial oxygen supply from collateral growth stimulation (Senti et al., 1998). After exercise training, coronary patients have also seen a 29% increase in coronary flow reserve in response to adenosine (Hambrecht et al., 1993). Patients with chronic CAD and impaired LV systolic function who exercised at 60% of peak oxygen uptake 3 times a week for 8 weeks saw a significant increase in mean collateral circulation score and improvements in wall

Diabetic ketoacidosis (DKA) DKA and hyperosmolar hyperglycemic syndrome (HHS) occurs in 20 % of the elderly who have not previously been diagnosed with diabetes. HHS is more often found in the elderly, being precipitated by an acute illness or drug therapy (Childs, Cypress, & Spollett, 2009). DKA and HHS, are both similar in the aspect for a decrease in the effective concentration of insulin in conjunction with the counter regulatory hormones glucagon, cortisol, growth hormone and epinephrine. However, DKA and HHS differed in the driving force, degree of insulin deficiency, serum glucose levels, pH, serum osmolality and duration of symptoms (Childs, Cypress, & Spollett, 2009).

Yokoyama H, Aoki T, Imahori M, Kuramitsu M. Subclinical ‎atherosclerosis is increased in type 2 diabetic patients with ‎microalbuminuria evaluated by intima-media thickness and pulse ‎wave velocity. Kidney International. 2004; 66(1):448–454. ‎

Diabetes Mellitus is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. It is a disease which is caused by the insufficient insulin secretion or decrease in the peripheral effects of insulin. It is a serious problem in terms of morbidity and mortality. The hyperglycemia is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. It’s associated with many complications which includes blindness of the eyes and amputations of the extremities. It is also associated with neuropathy, retinopathy, and cardiovascular diseases which lead to mortalities.