[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Endocrine system](https://durgical.com/en/general-pathology/areas/endocrine/) › Diabetes: chronic lesions # Diabetes: chronic lesions - Lesion Long-standing diabetes leaves recognisable marks in vessels, kidneys, eyes and nerves. These cause heart attacks, kidney failure, blindness and amputations. Updated Nov 12, 2026 ## Key points - Macrovascular: accelerated atherosclerosis; myocardial infarction is the commonest cause of death. - Hyaline arteriolosclerosis: homogeneous pink thickening of arteriolar walls; in the kidney both afferent and efferent arterioles. - Microangiopathy: diffuse thickening of capillary basement membranes, yet more leaky to plasma proteins. - Kidney: glomerular basement membrane thickening, diffuse mesangial sclerosis, nodular glomerulosclerosis (Kimmelstiel-Wilson), papillary necrosis, pyelonephritis. - Eye: non-proliferative retinopathy (microaneurysms, haemorrhages, exudates, oedema), proliferative retinopathy (neovascularisation), cataract, glaucoma. - Nerve: distal symmetric sensory neuropathy, autonomic neuropathy, mononeuropathies. ## What it is The morphology of chronic diabetes is the morphology of its vessels. Large arteries develop accelerated atherosclerosis; small arterioles show hyaline arteriolosclerosis; capillaries everywhere develop thick basement membranes but become leaky. These changes, together with neuropathy and impaired healing, explain myocardial infarction, stroke, renal failure, blindness and the diabetic foot. ## Structure - Pancreas: smaller islets with insulitis (type 1) or amyloid (type 2); beta-cell hyperplasia in infants of diabetic mothers. - Arteries: early, severe, often calcified atherosclerosis, including distal leg arteries. - Arterioles: hyaline (PAS-positive) wall thickening with narrowed lumen. - Glomeruli: PAS-positive mesangial nodules with peripheral capillary loops; capsular drops and fibrin caps. - Retina: microaneurysms, dot-blot haemorrhages, cotton-wool spots (microinfarcts), new fragile vessels. - Nerve: axonal degeneration with segmental demyelination; vasa nervorum show hyaline thickening. ## Organs and what diabetes does to them | Organ | Lesion | Clinical result | | --- | --- | --- | | [Heart and large arteries](https://durgical.com/en/conditions/myocardial-infarction/) | Accelerated atherosclerosis | Myocardial infarction, stroke, peripheral artery disease | | [Kidney](https://durgical.com/en/conditions/diabetic-kidney-disease/) | Basement membrane thickening, mesangial and nodular sclerosis, arteriolosclerosis | Albuminuria, nephrotic syndrome, chronic kidney disease | | [Retina](https://durgical.com/en/conditions/diabetic-retinopathy/) | Microaneurysms, haemorrhages, neovascularisation | Visual loss, vitreous haemorrhage, retinal detachment | | [Peripheral nerve](https://durgical.com/en/conditions/peripheral-neuropathy/) | Axonal loss, demyelination | Stocking-glove numbness, foot ulcers, autonomic failure | | [Foot](https://durgical.com/en/conditions/diabetic-foot/) | Neuropathy plus ischaemia plus infection | Ulcers, osteomyelitis, gangrene, amputation | | [Immune defence](https://durgical.com/en/conditions/necrotising-otitis-externa/) | Impaired neutrophil function, poor blood flow | Infections: pyelonephritis, mucormycosis, malignant otitis externa | ## Clinical notes - Albuminuria is the earliest sign of diabetic kidney disease. - Daily foot inspection and annual retinal examination are basic prevention. - Diabetic retinopathy is a leading cause of preventable blindness in Latin America. ## Memory aid Diabetes writes its signature in pink: hyaline arterioles, PAS-positive basement membranes and pink Kimmelstiel-Wilson nodules. ## Test yourself Think of the answer, then tap the question to see it. ## What is the commonest cause of death in diabetes? Myocardial infarction from accelerated atherosclerosis. ## Why is diabetic microangiopathy leaky despite thicker basement membranes? The glycated, abnormal basement membrane is structurally defective and more permeable to plasma proteins. ## Which arterioles show hyaline arteriolosclerosis in the diabetic kidney? Both the afferent and the efferent arterioles. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/diabetes-chronic-lesions/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow](https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/) - [Arterial vs venous thrombi; mural thrombi and lines of Zahn](https://durgical.com/en/general-pathology/arterial-vs-venous-thrombi-mural-thrombi-and-lines-of-zahn/) ## Connections ## Related 5 - [Diabetes: how hyperglycaemia damages tissue](https://durgical.com/en/general-pathology/diabetes-how-hyperglycaemia-damages-tissue/) - [Diabetic nephropathy](https://durgical.com/en/general-pathology/diabetic-nephropathy/) - [Arteriosclerosis: the three patterns](https://durgical.com/en/general-pathology/arteriosclerosis-the-three-patterns/) - [Consequences of atherosclerosis](https://durgical.com/en/general-pathology/consequences-of-atherosclerosis/) - [What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow](https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/) ## Related conditions 9 - [Diabetic kidney disease](https://durgical.com/en/conditions/diabetic-kidney-disease/) - [Diabetic retinopathy](https://durgical.com/en/conditions/diabetic-retinopathy/) - [Peripheral neuropathy (diabetic and other)](https://durgical.com/en/conditions/peripheral-neuropathy/) - [Diabetic foot](https://durgical.com/en/conditions/diabetic-foot/) - [Peripheral artery disease](https://durgical.com/en/conditions/peripheral-artery-disease/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/) - [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Diabetes Complications](https://medlineplus.gov/diabetescomplications.html) (MedlinePlus, US National Library of Medicine, 2025); [Diabetic Retinopathy](https://www.ncbi.nlm.nih.gov/books/NBK560805/) (StatPearls (NCBI Bookshelf), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/diabetes-chronic-lesions/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/diabetes-chronic-lesions/