November is American Diabetes Awareness Month. World Diabetes Day (WDD) is celebrated globally on November 14 to raise awareness about both Type 1 and Type 2 diabetes. The date of November 14 was chosen to honor Dr. Frederick Banting, co-discoverer of insulin back in 1921 along with Dr. Charles Best. This blog will look at defining what diabetes, how it can affect your eyes, and the best ways to control it once diagnosed.
What is Diabetes?
The information in this section is taken directly from two articles from the Centers for Disease Control (CDC). Article one discusses statistics of the disease and article two goes over defining what it means to have it.
Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. Currently there are 34.2 million Americans (just over 1 in 10) have diabetes, and approximately 88 million (or just over a third) are prediabetic, meaning they are at a high risk of developing it.
Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy.
If you have diabetes, your body either does not make enough insulin or cannot use the insulin it makes as well as it should. When there is not enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
There are three main types of diabetes, Type 1, Type 2, and Gestational. Many people, however, will go through a prediabetes stage first.
Prediabetes raises your risk for type 2 diabetes, heart disease, and stroke. With prediabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes.
Type 1 is thought to be caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1.
In type 2 your body does not use insulin well and cannot keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults).
Gestational diabetes develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health problems. Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life.
How Diabetes can Affect the Eyes
Information from this section comes from the American Diabetes Association. People with type 1 and type 2 diabetes are at a heightened risk for eye complications and peripheral neuropathy. They also have a have a higher risk of blindness than people without diabetes. But most people who have diabetes have nothing more than minor eye disorders over time.
With regular checkups, you can keep minor problems minor. And, if you do develop a major problem, there are treatments that often work well if you begin them right away. The three main categories of diabetic eye issues are glaucoma, cataracts, and retinopathy.
Glaucoma: Glaucoma occurs when pressure builds up in the eye. The pressure pinches the blood vessels that carry blood to the retina and optic nerve. Vision is gradually lost because the retina and nerve are damaged. There are several treatments for glaucoma. Some use drugs to reduce pressure in the eye, while others involve surgery.
Cataracts: Many people without diabetes get cataracts, but people with diabetes are more likely to develop this eye condition. People with diabetes also tend to get cataracts at a younger age and have them progress faster. With cataracts, the eye’s clear lens clouds, blocking sight. To help deal with mild cataracts, you may need to wear sunglasses more often and use glare-control lenses in your glasses. For cataracts that interfere greatly with vision, doctors usually remove the lens of the eye and replaces it with a new artificial lens. In people with diabetes, retinopathy can get worse after removal of the lens, and glaucoma may start to develop.
Retinopathy: Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. There are two major types of retinopathy: nonproliferative and proliferative.
- Nonproliferative retinopathy: In nonproliferative retinopathy, the most common form of retinopathy, capillaries in the back of the eye balloon and form pouches. Nonproliferative retinopathy can move through three stages (mild, moderate, and severe), as more and more blood vessels become blocked.
- Macular edema: Although retinopathy does not usually cause vision loss at this stage, the capillary walls may lose their ability to control the passage of substances between the blood and the retina. Fluid can leak into the part of the eye where focusing occurs, the macula. When the macula swells with fluid, a condition called macula edema, vision blurs and can be lost entirely. Although nonproliferative retinopathy usually does not require treatment, macular edema must be treated, but fortunately treatment is usually effective at stopping and sometimes reversing vision loss.
- Proliferative retinopathy: In some people, retinopathy progresses after several years to a more serious form called proliferative retinopathy. In this form, the blood vessels are so damaged they close off. In response, new blood vessels start growing in the retina. These new vessels are weak and can leak blood, blocking vision. The new blood vessels can also cause scar tissue to grow. After the scar tissue shrinks, it can distort the retina or pull it out of place, a condition called retinal detachment.
Huge strides have been made in the treatment of diabetic retinopathy. Treatments such as scatter photocoagulation, focal photocoagulation, and vitrectomy prevent blindness in most people. The sooner retinopathy is diagnosed, the more likely these treatments will be successful. The best results occur when sight is still normal. (See the linked article for a more in depth look at the treatment options available)
Ways to Control Diabetes
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides a four step plan on the best ways to control your diabetes.
Step 1: Learn about diabetes. Talk to your doctor about how you can best care for your diabetes to stay healthy. Also inquire about other specialists you should be seeing such as nutritionist, eye doctor, dentist, and podiatrist. It may also be beneficial to participate in a diabetes class to learn all the ins and outs of controlling your disease.
Step 2: Know your diabetes ABC’s. A is for A1C. The A1C is a blood test that measures your average blood sugar level over the past three months. It is different from the blood sugar checks you do each day. B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. C is for cholesterol. There are two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.
Step 3: Learn how to live with diabetes. Cope with your diabetes not letting stress overwhelm you. Eat well making a diabetes meal plan with the help of your health care team. Be active setting a goal to be active most days of the week. Know what to do everyday including taking your medication and checking your glucose levels. Talk to your health care team with any questions or concerns.
Step 4: Get routine care to stay healthy. See your health care team at least twice a year to find and treat any problems early.