What kind of complications?

Diabetes can potentially lead to long term complications

These are classically divided into macrovascular complications affecting the large blood vessels causing heart disease, stroke and peripheral vascular disease (affecting the legs and feet) and microvascular complications affecting the small blood vessels in the eyes, kidneys and nerves.

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Large blood vessel complications

The heart is supplied by blood vessels known as the coronary arteries. Coronary artery disease is caused by a build-up of fatty substances like cholesterol. These fatty lumps collect in the blood vessels (also known as arteries) which are the tubes that carry blood around the body.

The fatty lumps cause thickening of the walls and narrowing of the vessels. This means that less blood and therefore less oxygen can get through. The process is called atherosclerosis, commonly referred to as ‘hardening’ of the arteries. Prolonged high blood glucose levels and high blood pressure also contribute to narrowing of the blood vessels

Depending on the site of the narrowing it can affect the following:

• The heart causing conditions such as angina or heart attacks
• The brain causing conditions such as strokes or transient ischaemic attacks (commonly known as mini-strokes)
• The feet and legs causing conditions such as peripheral vascular disease (compromising the blood supply to the feet) or intermittent claudication (pain in the legs on walking)

UK guidelines recommend that all people >40 years have routine cardiovascular assessments. If you already have cardiovascular disease or diabetes then you are already in the high-risk group.

Small blood vessel complications

The 3 common complications affecting small blood vessels (known as microvascular complications) are:

• Neuropathy (nerve disease – often causing foot complications)
• Retinopathy (eye disease)
• Nephropathy (kidney disease)

We will discuss these microvascular complications in more detail in the topics to follow.