Type 2 Diabetes

Diabetes Still Isn't Easy
Diabetes Still Isn't Easy

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Protecting Your Endothelium

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When we look at an organ of the body, like the stomach, we see something with borders and shape. But the skin is also an organ. It spreads all over the body to cover everything and protect us from the environment. The skin from the scalp to the soles of the feet functions as a single unit, with some exceptions for particular anatomic geography.

A similar organ without limits of geography is the endothelium, which lines of all the blood vessels, from the smallest capillaries to the very large arteries. The endothelium produces many chemicals that affect other tissues. When it is healthy, the endothelium provides a smooth lining so that excessive clotting doesn’t occur. Its cells allow certain things to pass through, especially in the capillaries.

As discussed in another blog, the arterial blood brings oxygen and nutrients to the capillaries where they pass through into the tissues. Similarly, waste products of digestion and carbon dioxide pass into the capillaries to be carried to the liver, lungs, and kidneys to be expelled from the body. When the endothelium is damaged because of other diseases or toxic material like those found in cigarettes, it can no longer avoid other problems like clotting. Smoking is a major factor in endothelial damage. Sixty years ago the very young soldiers who died during the Korean War were found to have blood vessels with abnormal endothelium, especially cholesterol plaques. Most were 18-20 years old. It's no coincidence that most people, if not everyone, smoked at that time.

Today we see similar changes in the young but less so from tobacco and more from obesity and early-onset Type 2 diabetes. The risk for this kind of damage involves close to half the populations of the US. This means that huge numbers of middle aged people will be suffering from heart attacks or strokes (or both) 20-30 years from now. It is important to keep in mind that if you find disease in one artery you will find it in all the arteries. Your job is to protect your endothelium by keeping a normal blood glucose, normal lipids, and normal blood pressure among many other things. Do not shy away from today’s medications that can help you do this.

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About the Author


MD, FACP

Dr. Bernstein is director of the diabetes management program at the Friedman Diabetes Institute.

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