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Diabetes is one of the most common chronic illnesses today. It affects men and women alike, just like young and old. Though the symptoms of type 1 and type 2 are different, the potential long term complications are both the same.

Everyone wants to have a sweet…sweet life! Okay, at least most of us do! But for people suffering from diabetes mellitus, this is unfortunately not an option.

Diabetes Mellitus is a chronic metabolic disease characterized by elevated levels of glucose in the blood. As far as the causes of this detrimental disease are concerned, diabetes can result either from auto-immune destruction of the insulin secreting cells of the pancreas, or from acquired insulin resistance. Although the pathophysiology of the disease differs according to what type of diabetes one suffers from, most of the long term complications occur in both types, regardless of the etiology of the condition in a particular patient. The complications of diabetes mellitus are multi-systemic, due to the wide involvement of glucose metabolism in all body functions.

Cardiovascular diseases

Long standing diabetes mellitus puts the subject at risk of cardiovascular diseases, and this through several mechanisms.

First of all, with the impairment of glucose metabolism in the body, fatty acids metabolism takes over with a subsequent increase in free fatty acids (triglycerides) in the blood. Similarly, there is an increased level of LDL (Low Density Lipoproteins) particles in the blood and simultaneous decreased level of HDL (High Density Liporoteins) particles. This increases the risk of cholesterol plaques formation and thus hypertension and myocardial attacks.

Insulin resistance causes an increased accumulation of lipids in the liver and the smooth muscle. It is believed that the risk of macrovascular diseases (such as hypertension, atherosclerosis and all their complications) start to develop with the onset of insulin resistance, compared to the risk of microvascular diseases which develops with the onset of persistent hyperglycemia (this is based on the “ticking clock” hypothesis formulated by Stern in 1996 and Haffner and D'Agostino in 1999)

Diabetic vasculopathy and neuropathy

Of the two phenomena, diabetic vasculopathy is the first to occur. With continuously elevated cholesterol levels (secondary to high blood sugar), there is occlusion of the peripheral vessels (in the digits and toes), which result in decreased blood provision to the peripheral tissues. As a result, the muscles and the nerves of those tissues do not get enough nutrients to survive or even perform their function, and this results in nerve damage. This is essentially how diabetic vasculopathy develops into diabetic neuropathy.

Diabetic vasculopathy and neuropathy are the most common causes of non-traumatic amputations in hospital settings. The sad thing is, generally patients only discover that they are suffering from these complications after having suffered a non-healing wound or ulcer. Unfortunately at that stage, little to no viable tissue remains in the affected toe or finger (due to vascular compromise). With ischemic tissue necrosis, the medium becomes hospitable for bacterial overgrowth and concomitant infection. Because the tissue is not viable anymore and very unlikely to respond to antibiotic treatment, the only option to save the affected limb and prevent infection spread is amputation of the affected toe/digit.

However, with appropriate glycemic control from the start, the risk of developing vascular and neurologic complications is significantly decreased. 
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