There are several reasons why the risk of vascular diseases, such as heart attack, stroke, and diseases of the vessels in the limbs (peripheral vascular
disease), is increased in both
types of diabetes. The
weight gain
and lack of exercise common in people with type
2
diabetes lead
to other
conditions such
as abnormal cholesterol levels and high blood pressure,
which are potent causes of vascular
disease. If all of these
risk factors are not
treated effectively, the
probability of
vascular disease remains high.
High blood sugar over months and years leads to a chemi- cal
reaction of the sugar in the blood vessels, damag-
ing
them structurally. Perhaps most importantly, we now know that diabetes
and obesity can be described
as irritants to
the body tissues, meaning
that the body becomes generally inflamed.
We know that this is so because we can measure high
levels of com- pounds that indicate inflammation in the blood of
many people with diabetes.
It turns out
that this inflammation, when
maintained
over time, extends
to the
lining of
the blood
vessels, which
attracts inflammatory cells out of the bloodstream. Choles-
terol also takes
on an
inflamed form, enters
the lining of the
blood vessels,
and attracts still more inflammatory cells from the bloodstream, setting the stage for serious damage.
Other contributors
to vascular disease include the fact that high
blood
pressure
results from
nephropathy, which
further damages blood vessels. This further
damages the kidney and blood pressure rises still fur- ther, setting up a vicious
cycle. Even short periods of high glucose, such as may occur after meals in people with diabetes and even prediabetes, can cause
prob- lems with the function of blood vessels, making them more sticky, inflamed, and less able to relax. Whether these repeated briefer
periods of
high blood
sugar combine over time to cause permanent vascular dam- age is not known. However, it is known that the risk of vascular disease is
already high in
people with prediabetes.
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