Microvascular complications of diabetes
02 January 2021 18:01
Glucose concentration vs flux
When the glucose enters your cells, the amount of glucose in your bloodstream falls. If you have
type 1 diabetes, your pancreas doesn't secrete insulin — which causes a build-up of glucose in your
bloodstream. Without insulin, the glucose can't get into your cells.
Difference in blood glucose concentration with variants in insulin dosing and dietary intake
After a meal there is a substantial change in blood glucose level depending on the insulin
administered and depending on the nutrient composition of foods.
The basal insulin and basal + bolus insulin administration were measured against insulin
concentration. The blood glucose concentration is much less when a bolus insulin is administered
than when only basal insulin is given.
Another measurement was done with the same amount of carbohydrate but different glycaemic
index in two different meals. Glucose levels varies depending on the nutrients composition of the
two foods.
The exposure to glucose can be measured as glycated haemoglobin (HbA 1C), this is long term glucose
exposure and related to lifespan of red blood cells.
This is the most common measure of long-term glucose exposure and it is linked to non-enzymatic
glycation of haemoglobin in red blood cells.
Neither HbA1C nor time in range describes glucose variability
Glycaemic variability (GV), which refers to swings in blood glucose levels, has a broader meaning
because it alludes to blood glucose oscillations that occur throughout the day, including
hypoglycaemic periods and postprandial increases, as well as blood glucose fluctuations that occur
at the same time on different days.
Complication of diabetes mellitus
• Hypoglycaemia
• Diabetic ketoacidosis
• Hyperosmolar (hyperglycaemic state)
Chronic complications can be divided up into microvascular and macrovascular.
Microvascular:
Diabetic retinopathy- sight loss
Diabetic nephropathy - kidney failure
Diabetic neuropathy - Autonomic dysfunction, Neuropathic pain, foot ulceration, lower limb
amputation
Macrovascular:
Coronary heart disease - myocardial infarction
Cerebrovascular disease - Stroke
Peripheral vascular disease - Claudication, lower limb amputation
Diabetes retinopathy:
Affects the retina of the eye which is the most metabolically active tissue of the body. It has a sparse
blood supply.
• Increased Polyol pathway ---> osmotic and oxidative stress
• Increased Hexosamine pathway ----> compromised protein function
• Methylglyoxal ----> Advanced Glycation end-products (AGEs)
• Inflammation, retina-blood barrier breakdown
• Retinal hypoxia
• Neovascularisation, vitreous haemorrhage
• Macular oedema (swelling of macula)
Microvascular complications Page 1
02 January 2021 18:01
Glucose concentration vs flux
When the glucose enters your cells, the amount of glucose in your bloodstream falls. If you have
type 1 diabetes, your pancreas doesn't secrete insulin — which causes a build-up of glucose in your
bloodstream. Without insulin, the glucose can't get into your cells.
Difference in blood glucose concentration with variants in insulin dosing and dietary intake
After a meal there is a substantial change in blood glucose level depending on the insulin
administered and depending on the nutrient composition of foods.
The basal insulin and basal + bolus insulin administration were measured against insulin
concentration. The blood glucose concentration is much less when a bolus insulin is administered
than when only basal insulin is given.
Another measurement was done with the same amount of carbohydrate but different glycaemic
index in two different meals. Glucose levels varies depending on the nutrients composition of the
two foods.
The exposure to glucose can be measured as glycated haemoglobin (HbA 1C), this is long term glucose
exposure and related to lifespan of red blood cells.
This is the most common measure of long-term glucose exposure and it is linked to non-enzymatic
glycation of haemoglobin in red blood cells.
Neither HbA1C nor time in range describes glucose variability
Glycaemic variability (GV), which refers to swings in blood glucose levels, has a broader meaning
because it alludes to blood glucose oscillations that occur throughout the day, including
hypoglycaemic periods and postprandial increases, as well as blood glucose fluctuations that occur
at the same time on different days.
Complication of diabetes mellitus
• Hypoglycaemia
• Diabetic ketoacidosis
• Hyperosmolar (hyperglycaemic state)
Chronic complications can be divided up into microvascular and macrovascular.
Microvascular:
Diabetic retinopathy- sight loss
Diabetic nephropathy - kidney failure
Diabetic neuropathy - Autonomic dysfunction, Neuropathic pain, foot ulceration, lower limb
amputation
Macrovascular:
Coronary heart disease - myocardial infarction
Cerebrovascular disease - Stroke
Peripheral vascular disease - Claudication, lower limb amputation
Diabetes retinopathy:
Affects the retina of the eye which is the most metabolically active tissue of the body. It has a sparse
blood supply.
• Increased Polyol pathway ---> osmotic and oxidative stress
• Increased Hexosamine pathway ----> compromised protein function
• Methylglyoxal ----> Advanced Glycation end-products (AGEs)
• Inflammation, retina-blood barrier breakdown
• Retinal hypoxia
• Neovascularisation, vitreous haemorrhage
• Macular oedema (swelling of macula)
Microvascular complications Page 1
