Normal and Therapeutic Nutrition

Normal and Therapeutic Nutrition 3(2+1)

Lesson 30:Diabetes – Dietary management

Chronic complications

Vascular disease (Figure)

Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy).
The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:

• Diabetic retinopathy - growth of friable and poor-quality new blood vessels in the retina lead to severe vision loss. (figure)


• Diabetic neuropathy - abnormal and decreased sensation, starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot. (figure)


• Diabetic nephropathy - damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis. Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world. (figure)


• Diabetic cardiomyopathy - damage to the heart, leading to diastolic dysfunction and eventually heart failure.

Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:

• Coronary artery disease, leading to angina or myocardial infarction (“heart attack”)
• Stroke(mainly the ischemic type)