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 Diabetic Vascular Disease

1. Insulin

  • Structure.
  • Synthesis.
  • Mechanisms of action.
  • Insulin as a growth factor.

Diabetes mellitus and peripheral vascular disease

  • Macrovascular disease.
  • Microvascular disease.
  • The diabetic foot.

References

Katabchi AE, Duckworth WC, Stentz FB. Insulin synthesis, proinsulin and C-peptides. In: Rifkin H, Porte D Jr (eds). Diabetes Mellitus: Theory and Practice. 4th ed. New York : Elsevier, 1990:71-88.

This section provides the reader with some basic knowledge on the structure of human insulin and the conversion sequence of proinsulin to insulin. The significance of this knowledge for the clinical practice is also discussed.

Standl E. Hyperinsulinemia and atherosclerosis. Clin Invest Med 1995;18:261-266.

The high prevalence of macrovascular disease in non-insulin-dependent diabetes appears to be related to insulin levels and to the degree of hyperinsulinemia as measured in the blood of these patients. The various components of the Metabolic syndrome or Syndrome X are presented in this review along with the suggested therapeutic strategies in these patients.

Tooke JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes. J Diabetes Complications 2000;14:197-200.

This article reviews possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes. The key role of oxidative stress, endothelial function, and insulin resistance in this process is emphasized.

Schaper NC, Nabuurs-Franssen MH, Huijberts MS. Peripheral vascular disease and type 2 diabetes mellitus. Diabetes Metab Res Rev 2000;16 Suppl 1:S11-5.

In this review potential mechanisms for the high prevalence and altered distribution of peripheral vascular disease in patients with type 2 diabetes are explored. It is hypothesized that the metabolic abnormalities in the prediabetic phase predispose to a more distal and aggressive atherosclerosis. Once diabetes has developed this process is accelerated due to chronic hyperglycemia. Furthermore, endothelial damage, non-enzymatic glycosylation and polyneuropathy could lead to impaired vascular remodeling and collateral formation.

Shaw JE, Boulton AJ. The pathogenesis of diabetic foot problems: an overview. Diabetes 1997;46 Suppl 2:S58-61.

Diabetic peripheral neuropathy and peripheral vascular disease have been recognized as the most important etiologic factors of diabetic foot problems. The complex interplay between these abnormalities and a number of other contributory factors, such as altered foot pressures, limited joint mobility, glycemic control, ethnic background, and cardiovascular parameters is presented in this brief review article.

6. Akbari CM, LoGerfo FW. Microvascular Changes in the Diabetic Foot. in The Diabetic Foot (Veves A, Giurini J, LoGerfo FW eds.) Humana, Totowa , NJ , 2002, pp 99-112

This summarizes the complex interaction of neuropathy and vascular disease, including an explanation of the neuroinflammatory response and its role in the pathogenesis of ulceration.

Posted June 2010