4) DIABETES AND HEART DISEASE
b) "Small Blood Vessel" versus "Large Blood Vessel" Disease
"Small blood vessel disease" (microvascular disease) is where deposits form in the small diameter (under one eight of an inch) blood vessels and capillaries of the body. The body, if given half a chance, can actually regenerate some of these vessels by changing the size of surrounding blood vessels or regenerating small vessels. The body does this by the formation of what are known as "collaterals" or new small diameter arteries into areas being starved of oxygen by plugged arteries. This is why "small blood vessel disease" can actually be reversed a sizable amount if a strict regime is followed by the person with diabetes. Unfortunately the formation of even small collaterals does proceed much slower in a person with diabetes as compared to a "normal" person, so a person with type 2 diabetes needs to be very strict in controlling the blood sugar in order to avoid "quality of life" issues.
"Small blood vessel disease" can severely damage the kidneys, the eyes and the nerves. "Small blood vessel disease" is almost always controlled by preventing high blood sugar. High blood sugar can result in small blood vessel disease in the kidneys resulting in kidney failure requiring dialysis or kidney transplant. High blood sugar can give neuropathy resulting in lack of feeling in the extremities and a host of symptoms such as impotency. High blood sugar appears to affect the small blood vessels of the brain and reduce the cognitive function and contribute to Alzheimer's disease. And the effects on the small blood vessels of the eyes of high blood sugar are the leading cause of blindness in the USA. So "small blood vessel disease" can severely affect the "quality of life", but it typically doesn't kill. "Large blood vessel disease" kills.
"Large blood vessel disease" (macrovascular disease or "heart disease") is twofold: where lipid, fat and calcium deposits form in the larger major blood vessels in the body shutting these large blood vessels down, and where the major blood vessels in the body become thickened and stiff. The body cannot completely and satisfactorily regenerate these large vessels, the collaterals that develop typically can only supply part of the required amount of blood flow, especially with diabetes.
A person with type 2 diabetes may think all is well if they have no major health problems because they have observed a diet which prevents high blood sugars (i.e. they have prevented "small blood vessel disease"). But they have been avoiding avoiding exercise, avoiding weight loss, and avoiding blood lipid control (i.e. they haven't been avoiding "large blood vessel disease"). Unexpectedly the person with type 2 diabetes will get a stroke, peripheral arterial disease or a heart attack. The damage may be pretty much irreversible at that point. Anyone with "large blood vessel disease" is in big trouble. As the medical profession puts it "the long term prognosis is not good". So if a person with diabetes is going to wait till they have serious "large blood vessel disease" health problems before they start actively controlling both the diabetes and the heart disease that always accompanies diabetes, they are fooling themselves, and it probably won't work.
Weight loss, exercise and blood lipid control are the three keys to controlling "large blood vessel disease". For a multitude of reasons and through a multitude of pathways too large to describe here, individuals with type 2 diabetes have about three times the risk of getting this "large blood vessel disease". And it is a killer.
Current Chapter: 4) DIABETES AND HEART DISEASE
a) Introduction
b) Small Blood Vessel versus Large Blood Vessel Disease
c) Large Blood Vessel Mechanisms
d) Blood Lipid Chemistry
e) Diabetes and "Heart Failure"
f) Peripheral Arterial Disease (PAD)
g) Blood Proteins, Diabetes and Heart Disease
h) Genetic Risk Factors for Diabetes and Heart Disease
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