In this article we will talk about such a disease as diabetic angiopathy, and find out how dangerous this disease is. In addition, we will study its main symptoms, possible complications, and, in addition, find out how the diagnosis is carried out along with the treatment and prevention of the disease.
Which specialist should I contact?
Against the background of diabetic angiopathy, all kinds of painful changes in the vessels occur in the body, which are caused by high sugar levels. According to the ICD, the disease is encrypted E10.5 - insulin-dependent diabetes mellitus with peripheral circulatory disorders, E 11.5 - insulin-independent diabetes mellitus with peripheral circulatory disorders.
This disease is very dangerous due to disruption of the organs supplied with blood through diseased vessels.
Given that diabetes is not completely curable, angiopathy also cannot be guaranteed to be avoided and cured. However, under the condition of correct and continuous treatment of diabetes, the risk of angiopathy and various associatedher violations of the activities of organs is significantly reduced.
Treatment, and, in addition, the observation of diabetic patients is carried out by a specialized doctor, who is a diabetologist. In the event that such a specialist is not in the clinic, then an endocrinologist treats such patients. In the presence of a pronounced diabetic angiopathy of the lower extremities, it is possible that an angiologist, who is a vascular doctor, will need to consult.
In the event that angiopathy leads to disruption of the work of various organs, the help of doctors of other specializations may be needed. For example, an ophthalmologist is needed for eye damage, a nephrologist for kidney disorders, and a cardiologist for cardiac disorders.
Causes for the development of pathology
Changes in blood vessels are constantly provoked by increased sugar levels. Against this background, glucose from the blood penetrates into the structure of the endothelium, which is the inner lining of the vessel. This can provoke the accumulation of sorbitol and fructose in the endothelium, as well as water, which leads to edema and an increase in the permeability of the vascular walls. Because of this process, an aneurysm is formed - a pathological expansion of blood vessels. Against this background, frequent hemorrhages are possible.
In addition, other very important functions of the cells of the vascular membrane are violated. They stop producing an endothelial relaxing factor that regulates vascular tone, which, if necessary, can relieve their spasm. This intensifies the formation of blood clots, which leads to narrowing of the gaps or complete blockage.
With the development of a structural disorder of the endothelium, the risk of atherosclerotic plaque deposition increases, which also leads to narrowing of the lumen or absolute blockage. Thus, such a pathology as diabetic angiopathy (ICD code E10.5 and E11.5) leads to the formation of the following conditions:
- The appearance of an aneurysm - a pathological expansion of blood vessels that prevents normal and he althy blood circulation.
- Presence of hemorrhages from small vessels.
- Increased blood pressure due to vasospasm, which occurs as a result of impaired production of endothelial factor.
- Clot formation.
- Development of atherosclerosis.
- Slowdown of blood circulation due to vascular spasms, their aneurysms, narrowing of the lumen due to thrombotic or atherosclerotic mass.
Views
Depending on the degree of the affected vessels, the following two types of this disease are distinguished:
- Development of microangiopathy. This damages the capillaries. Affected small vessels are located in the skin (especially the skin of the lower extremities suffer), and, in addition, in the retina, in the kidneys and in the brain. This type is characterized by the formation of an aneurysm in the capillaries, while their spasms and hemorrhage from them can be observed.
- Arteries suffer from macroangiopathy. With this type of disease, atherosclerosis is formed in the body and the risk of thrombosis is significantly increased. The arteries of the whole organism, including the coronary arteries, are damaged, which leads to cardiacfailure, myocardial infarction is not excluded.
Sometimes microangiopathy and macroangiopathy are combined with each other.
Impact of disease on human organs
Diabetic angiopathy (ICD code E11.5 and E 10.5) results in the following diseases in the body:
- Development of retinopathy - a pathological change in the retina due to insufficient blood supply and small hemorrhage into it.
- The formation of nephropathy, which is a disorder of the normal functioning of the kidneys.
- The occurrence of encephalopathy, against which the brain is damaged.
- The development of coronary heart disease due to various disorders occurring in the coronary vessels.
- Diabetic foot syndrome due to circulatory failure in the legs.
It is very important to carry out preventive examinations by an ophthalmologist, since certain changes in the eye vessels are the easiest to diagnose. In the case of disorders in the vessels of the eyes, various disorders in other organs can be suspected. In the case of timely diagnosis at the initial stage, unpleasant symptoms can be avoided. Next, consider what symptoms accompany this disease.
Characteristic symptoms
Depending on which arteries and capillaries of which of the organs are affected to a greater extent, diabetic angiopathy is accompanied by various symptoms.
Signs of retinopathy
Retinal vessel damage onthe initial stage can be completely asymptomatic. In this regard, if a person has diabetes, he must at least once a year undergo an examination by an ophthalmologist and carry out an examination of the fundus. As the vascular disorder increases, symptoms that disturb the patient develop:
- The main sign is reduced vision.
- Vitreous bleeding may cause dark spots, flashes in the eyes or sparks.
- In case of retinal edema, there may be a feeling of a veil before the eyes.
It must be said that the lack of necessary treatment can lead a person to blindness. In the event that treatment is not started in a timely manner, when vision is significantly reduced, it will no longer be possible to restore it. One can only prevent vision loss with blindness.
Symptoms of Diabetic Nephropathy
Its occurrence is due not only to a pathological change in the vessels of the kidneys, but also to the negative impact on them of excessive glucose content. In the case of an increase in blood sugar above 10 mmol per liter, glucose is excreted from the body with urine. And this, in turn, gives an additional and serious burden on the kidneys.
Nephropathy is detected in a person usually fifteen years after the diagnosis of diabetes mellitus. With improper treatment of diabetes, an even earlier occurrence of a renal disorder is possible. Nephropathy can manifest itself with the following symptoms:
- The presence of frequent and profuse urination in a person.
- Presence of constantthirst.
- The presence of puffiness. The earliest sign is swelling around the eyes, which is most pronounced in the morning. The tendency to edema can lead to disruption of the abdominal organs. And because of the swelling of the pericardial membrane, a heart disorder is possible.
- High blood pressure.
- Presence of signs of intoxication with ammonia and urea due to the fact that their excretion by the kidneys is significantly impaired. At the same time, patients have reduced working capacity along with weakness in the body, drowsiness, nausea and vomiting, and there are also dizziness. In severe kidney disorders, when the concentration of ammonia in the brain increases greatly, convulsions occur.
How can diabetic encephalopathy manifest itself?
It develops due to microcirculation disorders in the brain and due to damage to its cells due to insufficient blood supply. Encephalopathy progresses slowly, usually over decades.
At the initial stage, there is a decrease in efficiency and increased fatigue during intellectual work. Then headaches are added, which are difficult to remove with medications. There is a violation of night sleep, which entails daytime sleepiness. At the middle and severe stages, doctors note cerebral and focal symptoms in patients.
For example, forgetfulness along with absent-mindedness, slow thinking and a violation of its logic should be attributed to general cerebral signs. Also observeddifficulty concentrating.
As for focal symptoms, in this case there is a violation of coordination, unsteadiness of gait occurs and different pupil sizes are noted. At the same time, a person does not have the opportunity to reduce his pupils to each other, that is, he is not able to look at his nose. In addition, the patient has a disorder of reflexes.
With diabetic encephalopathy, the risk of stroke is significantly increased. At a severe stage, encephalopathy can lead to a complete loss of a person's ability to work and self-service.
Symptomatics of the presence of coronary artery disease
In the presence of insufficient supply of oxygen to the myocardium, angina pectoris develops in the body, and then heart failure. At the same time, the risks of a heart attack increase.
Angina pectoris manifests itself as attacks of painful omissions behind the sternum, which are given to the left arm, and, in addition, to the shoulder, part of the neck, shoulder blade and lower jaw. Pain can occur during physical or emotional stress and last up to ten minutes. In the presence of severe damage to the coronary vessels, pain begins to appear at rest. This stage of angina indicates that, if left untreated, an early myocardial infarction is possible. Signs of heart failure include:
- Presence of arrhythmias in which there is a disorder of the heart rhythm. They are accompanied by subjective sensations of interruption in the work of the heart. It may also feel like it freezes, thumps hard, or even jumps out. Also likelydizziness along with fainting during attacks of arrhythmia.
- The appearance of shortness of breath. At first, it occurs during physical exertion, and in later stages it may also appear at rest.
- Occurrence of dry cough, not associated with otolaryngological diseases.
- Appearance of edema of the extremities. In severe stages, swelling of the abdomen or even lungs also occurs.
- Human exercise intolerance.
The development of angiopathy of the coronary vessels is dangerous for myocardial infarction, and, in addition, severe heart failure. Both complications can be fatal.
How does diabetic angiopathy of the lower extremities manifest itself (ICD E11.5 and E 10.5)?
Symptoms of cutaneous circulatory disorders
Microangiopathy primarily affects the skin on the legs. Therefore, in medicine there is a specific term, namely: diabetic foot syndrome. Or the term may sound even simpler: diabetic foot. It denotes a pathological change in the legs in the presence of diabetes. This syndrome, in addition to diabetic angiopathy of the vessels of the lower extremities, can also cause a disorder of the nervous system that occurs with diabetes. The angiopathic form of the diabetic foot is observed in 10% of patients who suffer from diabetes. Often, pathology is observed at the age of forty-five years. Symptoms of diabetic angiopathy of the lower extremities are as follows:
- Having pale skin along withslow nail growth and hair loss on the legs.
- Presence of rapid cooling of the feet along with chilliness.
- Thinning of the skin.
- At a later stage, ulcers form on the shins or feet.
Untreated ulcers can lead to gangrene, which can lead to limb amputation.
ICD-10 code E 11.5 - diabetic angiopathy of the lower extremities is divided into macro- and microangiopathy. The first one goes through several stages:
- At the initial stage, there are no serious abnormalities, but the normal functioning of the kidneys is difficult, there is arterial hypertension and proteinuria (proteins in the urine), a kidney biopsy is necessary for diagnosis.
- At the next stage, the skin on the legs becomes pale, the legs are cold, painless sores form.
- At the third stage of diabetic angiopathy of the vessels of the extremities, the ulcers become larger, soreness and discomfort appear.
- Fourth stage: necrosis appears in the middle of the ulcers, tissues die off, the area around the ulcers swells, the skin is hyperemic, osteomyelitis often occurs at this stage, as well as abscesses, abscesses and ulcers.
- Fifth stage - tissue continues to die.
- Sixth stage - foot necrosis occurs.
Treatment of diabetic angiopathy of the lower extremities will be discussed below.
Diagnosis of pathology
Diagnosis usually includes tests along with various procedures and consultations of different doctors. The attending physician for a detailed diagnosis of angiopathy can refer the patientto the following specialists:
- For a consultation with an ophthalmologist, that is, an ophthalmologist.
- To see a cardiologist.
- To a kidney specialist, that is, to a nephrologist, and if one is not available, then to a urologist, who is a specialist in the genitourinary system.
- To a neurologist who treats the nervous system, including the brain.
- For a consultation with an angiologist specializing in blood vessels.
Also, patients are prescribed blood tests for lipids, sugar, and so on. Certain doctors in the framework of the diagnosis of diabetic angiopathy (ICD E10.5 and E 11.5) can prescribe various procedures:
- Ophthalmoscopy is usually ordered by an ophthalmologist along with eye tomography.
- A cardiologist sends patients for an ECG, an ultrasound of the heart, as well as an examination of the coronary vessels.
- When diagnosing diabetic angiopathy, a nephrologist will most likely send you for an ultrasound scan of the kidneys, and, in addition, will require you to undergo vascular dopplerography, pass urine for sugar and beta-2-microglobulin. Blood tests for urea, creatinine and residual nitrogen may also be required.
- In this case, the neuropathologist sends patients for angiography of cerebral vessels and for an electroencephalogram.
- Angiologist appoints a duplex scan of the vessels of the extremities.
In the event that a person suffers from diabetes, then once a year he needs to undergo a preventive examination by all of the above doctors. So now let's find out whattreatment is being undertaken to combat the disease.
What is the treatment for diabetic angiopathy?
Treatment Methods
This pathology, in the event that it has already led to organ disorders, unfortunately, cannot be completely cured. Therapy is aimed at alleviating the symptoms, and, in addition, at stopping the development of the disease and preventing complications. Depending on the result of tests and diagnostic measures, as well as on the symptoms that bother a person, different groups of medications can be prescribed:
- To lower cholesterol and treat atherosclerosis, Atorvastatin is prescribed along with Lovastatin and Simvastatin.
- To reduce pressure, drugs are prescribed in the form of Lisinopril, Corinfar and Verapamil.
- Means for strengthening capillaries and improving microcirculation are often "Bilobil" along with "Cavinton", "Rutin" and "Troxerutin".
- Often, such patients are prescribed diuretics to eliminate edema, which are drugs in the form of Spironolactone, Diakarba and Furosemide.
- For the prevention of blood clots, "Aspirin" with "Sulodexide" is prescribed.
- To improve material metabolism in tissues, doctors mainly prescribe vitamins C, E and B6.
In addition, the treatment program for diabetic angiopathy includes medications for the treatment of the underlying disease, which is diabetes. For treatment, drugs that lower sugar are prescribed, we are talking about Metformin, Diastabol, Diabeton, Glimepiride, and so on.next.
Next, we will learn how the prevention of diabetic vascular angiopathy is carried out.
Prevention
It should be emphasized that the development of such a disease as diabetic angiopathy (ICD 10 E11.5 and E10.5) can always be avoided.
- To do this, you must follow all the recommendations of the attending physician regarding the treatment of diabetes. You need to take all the necessary medicines on time, following the prescribed diet.
- You should completely give up bad habits, and, in addition, try to walk in the fresh air as much as possible.
- It is important to be very careful about the hygiene of your feet and not wear tight, and at the same time uncomfortable shoes.
- You need to get a glucometer that will help you constantly monitor your blood sugar levels. In this case, the indicators in a person on an empty stomach should be from 6.1 to 6.5 mmol per liter. And two hours after eating, they should show a value of 7.9 to 9 mmol / liter.
- You need to measure your blood pressure daily. At the same time, it is required to ensure that it does not rise above 140/90 millimeters of mercury.
- If you have abnormal blood sugar levels or high blood pressure, you should immediately contact your doctor.
- Every year it is necessary to undergo preventive examinations by an ophthalmologist, and, in addition, by a urologist and a cardiologist.
Treatment of diabetic angiopathy of the lower extremities is carried out using:
- Antibiotics (for infected ulcers).
- Statins (to lower cholesterol).
- Metabolic drugs (improving tissue energy supply, "Mildronate", "Trimetazidine").
- Blood thinners.
- Angioprotectors (reducing swelling of blood vessels, normalizing metabolism).
- Decongestants (diuretics).
- Antioxidants and B vitamins.
Diabetic angiopathy of the extremities is very dangerous and can cause complications.
Prognosis of pathology
In the event that this disease is detected at its initial stage, the prognosis will be relatively favorable. With proper treatment, this disease will not progress further. But in the absence of proper treatment, a disease such as diabetic angiopathy, the ICD code E11.5, can take a threatening form in just five to ten years and lead to extremely serious consequences:
- Gangrene can develop in the skin of the lower extremities due to disorders of the circulatory processes in the skin of the lower extremities. Against the background of the treatment of this problem in the hospital, a limb can be amputated. But in the event that even with gangrene you do not turn to a doctor, death will soon occur due to intoxication of the body.
- Coronary artery disease can lead to a heart attack or stroke, and unfortunately the survival rate is low.
- Disorder of the eye vessels in just five to seven years can lead to absolute blindness.
- Failure of blood circulation in the vessels of the kidneys causes insufficiency of this organ, which is incompatible with life.
- Disturbance of blood circulation in the cerebral vessels leads to severe impairment of brain function, in which patients become disabled. It is also not excluded that in this case a stroke may occur.
In the event that all medical recommendations regarding treatment are followed, such terrible complications can always be avoided, or at least delayed for several decades. Thus, one should not neglect one's he alth and ignore certain symptoms that are a kind of signal for action on the part of the body. And you should, when the slightest alarming signs appear, consult a doctor for advice and subsequent treatment if necessary.
We reviewed diabetic angiopathy (ICD code 10 E11.5 and E 10.5).
