Monday, March 8, 2010

In diabetes mellitus the circulation is poor


in diabetes mellitus the circulation is poor.?
Name 2 things which contribute to the poor circulation. Thank you!!
Diabetes - 6 Answers
Random Answers, Critics, Comments, Opinions :
1 :
Smoking and your sugars been to low and to high
2 :
poor kidney function. cycle of constant thirst/urination. upsets balance of electolytes, etc. w/o sufficient fluid- blood pressure drops, and blood flow to extremities suffer. causing neuropathy.
3 :
Poor nutritional habits contribute to poor circulation in Diabetes as does low blood glucose levels. Also after time small blood vessels become damaged and can be dangerous. Fluid retention is a factor in poor circulation also in Diabetes patients. The major cause is damage to the circulatory system.
4 :
I participate in this forum as time permits as I feel that a physician is a public servant. This is a dangerous forum in which to ask serious questions about your personal health. Your question sounds more like a homework project. None of the three answers to your question so far have much validity to them. Cardiovascular complications are the most important consequence of diabetes. There are two types of diabetes - type 1 and type 2 - and both suffer from the same potential cardiovascular problems. There are two types of cardiovascular problems which we refer to as micro (such as circulation to the retina) and macro (such as circulation to the heart). Diabetes increases the risk of both micro and macro vascular problems. Two 'landmark' trials - one on type 1 diabetics - and the other on type 2 diabetics - were undertaken to determine whether or not 'intensive' versus a more relaxed approach to the treatment of diabetes would reduce the incidence of either micro or macro vascular complications. Both trials concluded that this was the case and physicians - myself included - began to push for very 'low' glucose goals. Unfortunately - a number of subsequent trials have questioned whether or not intensive control was actually helpful - and there was some evidence that it might actually be harmful. Thus physicians at this point must make their own decision on a patient by patient basis on how aggressive to be. Your question asks how diabetes leads to poor circulation and the answer is exceedingly complex - in addition - the arterial damage caused by diabetes remains incompletely understood. In the case of micro vascular disease it appears that hyperglycemia (elevated glucose) increases angiogenesis - the production of new blood vessels - which bleed and may lead to blindness (in the case of the retina of the eye). The interesting point here - however - is that such damage seems to take place in diabetics who are 'controlled' meaning that they do not have episodes of hyperglycemia. Therefore there must be other factors at work which we have not yet elucidated. In the case of macro vascular disease more is known but more is also not known. Diabetes causes endothelial (the cells which line arteries) dysfunction. Such dysfunction increases vascular spasm, increases the deposition of LDL cholesterol in the intima (the middle muscle layer) of the artery, increases proliferation of smooth muscle cells (which narrow the artery), and increases inflammation - which causes additional damage to the arterial wall. Elevated levels of insulin have been noted to increase plaques (which narrow arteries) and this is true whether the insulin is injected by a type 1 diabetic or whether it represents the over-production of insulin (to compensate for insulin resistance) in a type 2 diabetic. Diabetes also influences rheology (blood flow) shifting from laminar (smooth) to turbulent blood flow especially at areas of bifurcation (where arteries branch off). Turbulent blood flow causes molecules that are normally in the center of the blood flow instead to be 'thrown against' the endothelial cell. Following this there is an increase in adhesion molecules which attract thrombocytes (platelets) which contribute to blood clotting and further narrowing of arteries. Diabetics apparently again related to insulin levels and non-laminar blood flow also exhibit erythrocyte (red blood cell) shear forces meaning that injury occurs to the endothelial cells lining the artery. There are additional factors that I will not bore you with and I will remind you that these factors only explain part of the micro and macro vascular complications of diabetes. In summary diabetes, level of diabetic control, and insulin levels create a number of problems which not only increase atherosclerosis (narrowing of the arteries caused by plaque) but also vascular spasm and the formation of blood clots. A diabetic with no known coronary artery disease has the same risk of suffering a heart attack over a ten year period as a non-diabetic who has already suffered a heart attack (and therefore has known and significant disease of the coronary arteries). Most diabetics die not directly from their glucose level but rather from cardiovascular events such as heart attacks and strokes. If you wish additional or more specific information please email me at johnerussomd@jhu.edu - thank you. I wish you the very best of health and may God Bless.
5 :
I have to agree with the answerer who says he/she is a doctor that the question is far to complex for a simple answer. I for instance, suffer from a number of medical issues, cancer, DVT, neuropathy - all present prior to my diagnosis of type 1 diabetes. That said, perhaps if doctors were more forthcoming with explanations to their patients the information shared in these peer to peer exchanges of information would be more accurate. I think a lot of us here get comfort in the sharing of experiences and also there are a lot of "askers" who see no easy way to access a doctor. And, it is seldom that you will find a doctor with the time to spend on Y/A.
6 :
http://search.yahoo.com/search?p=peripheral+neuropathy&ygmasrchbtn=web+search&fr=ush-ans






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Posted by Diabetes Melitus at 9:14 AM