Issue link: https://www.massageandbodyworkdigital.com/i/1509769
52 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 52 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 Cardiovascular System Complications When diabetes has advanced to the point where insulin production is limited and blood glucose is consistently above normal levels, we see a variety of impacts on the cardiovascular system. Hyperglycemia stimulates a system-wide inf lammatory response. In the absence of insulin to bring down blood sugar, this inf lammation can be severe enough to cause damage to many organs. Because another function of insulin is to carry lipids out of the bloodstream and into fat cells, a low level of insulin in the blood can lead to increased circulating triglycerides and a much-increased risk for atherosclerosis (the development of fatty plaques on the insides of blood vessels). Atherosclerosis is not rare or unique to diabetes, but a major difference in this situation is that it is not necessarily limited to the blood vessels closest to the heart. Most people who have atherosclerosis have it in the coronary or carotid arteries, or possibly in the aorta. But with diabetes, it can occur in all these places, plus distant arteries and arterioles, which leads to a peripheral artery disease. It can even affect the tiny vessels that supply our nerves, which can contribute to peripheral neuropathy in the muscles and other organs and retinopathy in the eyes. In the US, diabetes is the primary cause of new blindness in people aged 20–74. This eye damage can be related to a combination of poor circulation and atherosclerotic plaques, and may also be related to the accumulation of sugar in the lens of the eyes. It's in the nature of cardiovascular disease to be circular—that is, hypertension contributes to atherosclerosis, which contributes to hypertension, ad infinitum. In keeping with this pattern, the relationship between diabetes and cardiovascular system disease also includes the risk for hypertension, aneurysm, heart attack, and stroke. Diabetes is commonly listed as the seventh-leading cause of death in the US. Heart attack and stroke are higher on the list, but it's unclear how many of those cases might have been related to the presence of diabetes. In addition to raising the risk for cardiovascular disease, diabetes can also contribute to systemic edema, which is typically related to poor circulation and kidney damage. Kidney Damage Because renal function is a high priority, kidneys are on the receiving end of a lot of arterial force. They need that healthy pressure to push blood through the filters that are required to extract excess water and metabolic wastes that we excrete through urine. But kidneys are delicate, and the combination of constantly elevated physical pounding of blood (hypertension) plus high blood sugar and accompanying inf lammation can damage these organs. Diabetes accounts for about 45 percent of all cases of renal failure in this country. 1 At this moment, about 90,000 people are on the waiting list for a donor kidney, but only about 26,000 kidney transplants are performed every year. 2 And people who are lucky enough to receive a new kidney must commit to a lifetime of antirejection drugs, which means they become immunocompromised. Skin Complications As arteries carry blood further away from the heart, they get progressively smaller and blood pressure decreases. This is normal, but in the presence of uncontrolled diabetes, telescoping arteries and arterials can become additionally occluded by atherosclerotic plaque. This, combined with local sensory nerve damage and venous insufficiency, opens the door to long-lasting, difficult-to-treat ulcerations: open, nonhealing sores, usually on the feet. This happens most often in older diabetes patients, and about 25 percent of all diabetic ulcers eventually lead to an amputation. (Diabetes is the leading reason for nontraumatic amputations in the US.) 3 Nerve Damage Diabetes is especially damaging to the nervous system. Remember that nerves must also have a blood supply to function. When this blood supply is limited because of atherosclerosis, along with the presence of pro-inf lammatory chemicals in the bloodstream, this means that all the peripheral nerves of a person with diabetes are at risk for damage. Motor Function Reduced muscle function in people with diabetes can be a result of limited access to glucose and the inefficient production of ATP. Limited blood supply to motor neurons also means that people with advanced and poorly controlled diabetes are likely to have muscle atrophy, muscle weakness, and poor stamina. Each client who lives with this disease will have different consequences and manage their conditions with different strategies—that's why choices about massage therapy for clients with diabetes can't be rubber-stamped: There's no one solution that works.