Vasculitis in diabetics

#KYJ - Vasculitis

Nurse M asks "can you do a blog on vasculitis and why it's a diabetic complication?"

So here we go...

Vessel disease and in particular, vasculitis has recently been found to be associated with fibromyalgia and related Neuralgia (nerve pain).

Literally, vasculitis means inflammation of the blood vessels.  It is just one of a myriad of Autoimmune disorders.

Think of it as rheumatoid arthritis inside blood vessels.   Some medical co-morbidities are often prerequisite. Perhaps the most well known is  Diabetes.

Diabetes is commonly associated with both microvascular (small vessel) and macrovascular  (large vessel) complications. Vessel hardening (sclerosis), endothelial injury from viscous blood, and fatty plaques (atheroma) all contribute to the vessel inflammation that is vasculitis.

Hypertension, frequently present in diabetics, accelerates the onset of vasculitis. Over the past 10-15 years, we have developed a good understanding of the underlying chemical changes in diabetic blood vessels. 

What we know, is that vasculitis is immune, mechanical (BP) and metabolic; and that these factors interact to stimulate the release of cytokines (cell communication proteins) and growth factors in branches of small blood vessels.  Eyes, kidneys, and hands/feet.

In diabetics a common factor is byproducts of glycated proteins in diabetic blood.  You better know of these proteins as HbA1C. The higher their HbA1C is, the more vasculitis and subsequent effects.

Two important substances over secreted in diabetics, is seen in the glomerulus, and the retina vessels. 

In the kidney, "transforming growth factor-beta" has been observed to be prosclerotic (causing hardening) in  renal arterioles.  This fuels and exacerbates the Renin-Angiotensin response which pushes up BP.

In the retina, vascular endothelial growth factor and its receptor, vascular endothelial growth factor R-2 are increased.  Gobbledygook I know, but these cytokines cause new blood vessel growth (angiogenesis). 

Ultimately, the cell changes caused by these cytokines stimulates inflammation- Vasculitis.

Now here is the clincher, inflammation inside blood vessels, traps the smallest cholesterol carrier proteins called LowDensity Lipoproteins (LDLs).  This is in essence, the formation of cholesterol deposits in arteries (atheromas), narrowing and hardening the vessels (atherosclerosis).

DM and cardiovascular disease are inextricably linked.

So the next time the diabetic you are looking after complains of fatigue and flu like aches, it may very well be vasculitis, and is contributing to kidney failure, blindness, small peripheral vascular disease (ulcers and slow healing), and a massive increase in risk of MI and CVA.

Keep those HbA1C levels in check, monitor vision, renal function and manage hypertension aggressively.

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