Gestational Diabetes Article

DIABETES AND CIRCULATORY PROBLEMS

People with diabetes, especially those with type 2 diabetes, are two to fi ve times more likely to have problems with circulation to the heart, the legs, and the head when compared to individuals without diabetes. This is because diabetes predisposes a person to a condition called atherosclerosis. If you imagine a blood vessel as a water or drainage pipe, then atherosclerosis is buildup in the pipe narrowing the channel and impairing the fl ow. In the case of the blood vessel the buildup, called plaque, consists of a core of infl ammatory cells, cholesterol, and lipids with a fi brous cap of smooth muscle cells (see Figure 3-1). The plaque can narrow the blood vessel, impairing blood fl ow. Occasionally the fi brous cap can rupture, and when this happens a blood clot forms, causing an acute blockage of the blood vessel. If the acute blockage happens in one of the blood vessels to the heart, it results in a heart attack. If it occurs in one of the blood vessels supplying brain tissue, it results in a stroke.

What is it about diabetes that predisposes a person to atherosclerosis? First, having high glucose levels for long periods can injure the cells lining the blood vessels, initiating the plaque buildup. Second, the high blood pressure and the elevated lipids frequently present in people with diabetes are known risk factors for plaque buildup. There are also other less well understood factors such as blood clotting factors and platelet function that are also altered in people with diabetes.

Even though people with type 1 diabetes generally do not have high blood pressure and high cholesterol problems, they can develop heart disease after many years. This is especially likely to occur if they have diabetic kidney disease.