Diabetes and the Eye
Diabetes is a very common disease in the United States and is the leading cause of blindness in adults under the age of 65. More than half of all people living with diabetes do not get the recommended annual dilated eye exam. One-third of Americans do not know they have diabetes and 90% of severe vision loss from diabetes can be avoided. There are often no warning signs in the early stages of diabetic eye disease but with proper care and an annual dilated eye exam most people with diabetes can maintain normal eyesight. Treatment does not cure diabetic retinopathy, but it is effective in preventing further loss of vision.
In general, there are five main potential complications with diabetes. They are kidney disease, peripheral neuropathy, infection, accelerated rate of arteriosclerosis and diabetic retinopathy. This brief overview will outline diabetic retinopathy and explain its treatment.
Diabetic retinopathy may affect patients with both Type 1 (juvenile onset) and Type 2 (adult onset) diabetes. Younger diabetics are usually free of retinopathy for the first five years after onset of the diabetic condition. Adults may acquire retinopathy at any time after diagnosis is made.
Diabetic retinopathy is a disease of the blood vessels in the delicate tissue called the retina. It is the retina that acts like film in a camera and does the actual sensing of light in the eye. These vessels become damaged and leak fluid and blood which fail to supply the nutrients necessary for good health in the retina.
Retinopathy is divided into two forms Non-Proliferative Background Retinopathy (NPDR) and Proliferative Retinopathy (PDR). NPDR consists of hemorrhages, leaky spots and small dilations in the vessel walls. PDR consists of the same problems as NPDR plus the growth of new blood vessels. These new vessels are always abnormal and will leak and bleed if left untreated. About 40% of all diabetics will develop PDR over a ten year span.
The most common cause of decreased vision with diabetes is NPDR with swelling in the retina from leaky blood vessels. This is very difficult to treat, but with focal applications of LASER light to seal these leaks, vision may be preserved and occasionally improved. PDR poses a very serious threat to vision as well. Large hemorrhages may obscure vision for months at a time. These new abnormal vessels should be treated with LASER therapy. Retinal detachments may also occur because of traction created by these new vessels.
Other factors may contribute to the progression of diabetic retinopathy. This list includes high blood pressure, elevated levels of sugar, cholesterol and triglycerides in the blood stream. Each of these factors must be controlled to assist in the treatment of the retinopathy. Regular examinations are critical to early diagnosis and therapy. We now have more to offer diabetics than ever before. Most do well, and vision can be preserved in the majority of people. Help and cooperation with regular eye examinations are needed in controlling the basic disease.
Living with Diabetes Getting the diagnosis: Being diagnosed with diabetes can be frightening and/or depressing for many people. If you are familiar with diabetes, you may have heard about the possible severe complications, such as eye problems, kidney failure, heart disease and amputations. You may not have heard the good news. The complications of diabetes can be delayed or even prevented by taking good care of yourself. Here are some things you should know about.
Basic Facts There are 4 common types of diabetes:
Type 1 diabetes happens when you have little or no insulin. Your pancreas just stops making it. This usually happens in childhood or young adulthood. The cause is not yet understood. It may be due to an injury or viral illness affecting the pancreas. It might also be caused by an autoimmune disease (where your body attacks part of itself). Type 1 diabetes requires taking insulin for the rest of your life.
Type 2 diabetes happens when you become unable to use your own insulin. There are many factors that put people at higher risk of developing Type 2 diabetes. They include race, family history, too little physical activity, overweight and a high-calorie diet.
A woman who starts having high blood sugar during pregnancy has gestational diabetes. Diagnosis and treatment of this type of diabetes is very important. Not only can the mother have problems from high blood sugar, but the baby can have problems, such as being born too early.
Prediabetes is a new term used for people whose blood sugar is above normal but not yet high enough to be called diabetes. People who have prediabetes are at very high risk of developing diabetes unless they do things to lower their risk, such as learn how to eat healthy and increase their activity.
All of these types of diabetes have one thing in common which is the blood sugar level is too high when not treated.
Effects of High Blood Sugar Having high blood sugar over time damages the blood vessels. This damage occurs throughout the body, but some organs are more sensitive to the changes in the blood vessels. The organs most often affected are the eyes, heart, kidneys and the blood vessels in the legs and feet. The blood vessels to the brain are also damaged, which makes it more likely that people with diabetes will have a stroke.
The most important part of staying well with diabetes is controlling your blood sugar. People who keep their blood sugar in the range recommended by their healthcare provider(s) (usually close to or at a normal level) can delay or prevent the complications of diabetes.
The steps to controlling your blood sugar are:
Learn how to eat healthy.
Get enough exercise.
Keep track of your blood sugar at home and at your healthcare facility.
Take your medicine regularly.
Keep all appointments with your healthcare provider(s).
The second most important part of staying well is keeping your blood pressure normal. Like high blood sugar, high blood pressure damages blood vessels. Damage to your organs can happen much faster when these two are working together. A person with diabetes and high blood pressure is at high risk for heart attack, stroke, eye damage, and kidney failure. The best ways to control your blood pressure are very similar to the way you control your blood sugar.
Keep track of your blood pressure at home and at your healthcare facility.
Follow you provider’s recommendation for limiting the salt in your diet.
Exercise according to your provider’s exercise plan.
Take your blood pressure medicine regularly.
Keep your blood pressure checkups with your provider.
The third part to staying well is to try to prevent infection. People who have diabetes are more susceptible to infection. Here are some things you can do to stay healthy.
Check your skin, especially your feet (top and bottom) every day for sores, blisters, or other injuries. Report any problems to your provider for prompt treatment.
Keep your blood sugar normal (bacteria and fungus, which can cause infections, thrive on high levels of sugars).
Stay up to date on all of your shots, especially tetanus, pneumonia and your annual flu shots.
Get a tuberculosis (TB) test every year.
Finally, an important part of staying well is avoiding as much stress as possible. Stressful events or situations affect the body’s hormones. One hormone in particular, cortisol, increases blood sugar. Stress also makes your blood pressure rise. If stress is part of your life, find ways to lower you stress level. Reducing your stress can take many forms, such as exercise, counseling, better money management and family meetings. Reducing your stress will help you control your blood sugar and stay healthy.
Diabetic Retinopathy can be corrected with the following:
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Stay Well. Control your blood sugar, keep your blood pressure normal, and prevent infection.