Diabetes vascular disease is characterized by endothelial dysfunction, a biologic abnormality that has been related to hyperglycemia, increased free fatty acid production, decreased bioavailability of endothelium-derived NO, formation of advanced glycation end products (AGE), altered lipoproteins, hypertension, and, as previously mentioned, insulin resistance.11 A decreased bioavailability of endothelium-derived NO, with subsequent impaired endo-thelium-dependent vasodilation, has been observed in diabetic individuals even before the development of detectable atherosclerosis. NO is a potent vasodilator and a key compound of the endothelium-medi-ated control mechanisms of vascular relaxation. In addition, it inhibits platelet activation, limits inflammation by reducing leukocyte adhesion to endothe-lium and migration into the vessel wall, and reduces vascular smooth muscle cell proliferation and migration. As a consequence, an intact NO metabolism in the vessel wall has a protective effect by inhibiting atherogenesis. The impaired vasodilation observed among diabetic individuals may also be caused by an increased production of vasoconstrictors, and particularly endothelin-1. Despite the evidence of increased endothelin-1, angiotensin II, and abnormal sympathetic nervous system activity, the mechanisms of vascular smooth muscle cell dysfunction and hypertension in diabetes remain elusive.11
The formation of AGE is the consequence of the oxidation of amino groups by glucose. Additional processes induced by augmented AGE production include subendothelial cellular proliferation and matrix expression, cytokine release, macrophage activation, and expression of adhesion molecules.14 Although the underlying mechanisms remain incompletely understood, it has been postulated that oxida-tive stress due to chronic hyperglycemia plays an important role in the etiology of diabetic complications. Hyperglycemia may induce the production of reactive oxygen species in the mitochondria, both directly via glucose metabolism and auto-oxidation and indirectly through the formation of AGE and binding of AGE receptors.
Was this article helpful?
All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.