Diabetes isn’t just about sugar, it impacts every organ

From gulfnews.com

Dr Uwe Dalichow

Eyes, kidneys, heart and nerves are particularly at risk 

When people hear diabetes, they think blood sugar, diet, and medication. In fact, diabetes is a condition that affects the whole body. Over time, it can quietly impact several organs, in particular your eyes, kidneys, heart, nerves, and more.

Diabetes is one of the leading causes of death globally. In the UAE, where chronic diseases are rising, underestimating diabetes can have real consequences. For roughly 16 per cent of adults living with diabetes, complications can limit independence, reduce quality of life, and increase healthcare needs - often before symptoms are obvious.

Silent Damage from Diabetes

High blood sugar and high blood pressure can affect small and large blood vessels in the eyes, kidneys, heart, and brain.

· Eyes: Damage to tiny retinal vessels can lead to diabetic retinopathy and more than 60 per cent of people with type-2 diabetes develop it. Without treatment, it can progress to a more serious condition: diabetic macular edema (DME) which is a build-up of fluid that blurs central vision. Vision changes often arrive without pain or early warning with the resulting impact even more profound and life-changing, including vision loss, inability to work and severe limitation of independence. But timely treatment can stabilize or even improve sight.

· Kidneys: Diabetes is a leading cause of chronic kidney disease (CKD). Early kidney changes are silent, which is why screening matters. An estimated 40 per cent of people with diabetes develop CKD, which itself has stages (1-5). While CKD can be detected in earlier stages, patients may only see symptoms at stage 3 and at stage 5, patients require dialysis.

· Heart: Diabetes raises cardiovascular risk by 2-4 times. The combination of heart failure and other cardiovascular risks is a highly prevalent finding among people with diabetes in the UAE.

· Nerves: Diabetes damages nerves - especially in the feet, impacting balance, sensation, and mobility. This is known as diabetic neuropathy.

· Liver: High blood sugar leads to fat accumulation in the liver, which, if left untreated, can progress to liver scarring and liver failure.

While all this may sound alarming, early detection and treatment can make all the difference, yet many people living with diabetes simply don’t know that they need to ask for it.

What early action looks like

Most diabetes-related complications can be detected early through routine tests. You may ask your doctor about eye exams to detect any retinal vessel damage. Urine tests and specific kidney and liver function blood tests can identify onset or risk of CKD and liver disease. A lipid profile can help detect cardiovascular disease risk.

Because we require these whole-body assessments to help patients with diabetes, it is easy to see why an integrated care approach matters.

The UAE is building a more connected model of care

An integrated care model requires seamless exchange of data between care providers. In many health settings, this coordination is not easy to achieve, but in the UAE, health authorities are actively working towards this goal, as evidenced by recent initiatives.

In 2024, Emirates Health Services rolled out AI-based retinal imaging across multiple emirates, screening thousands of patients with diabetes and referring high-risk cases swiftly. With the expansion of health information exchanges such as Malaffi in Abu Dhabi and NABIDH in Dubai, the potential for integrated data sharing across hospitals is growing, helping physicians identify risks earlier and coordinate care across specialties.

Even when a patient does not have access to integrated care, they can still have the conversation with their healthcare provider to discuss and understand their risks. And this will only happen when patients view diabetes as more than just uncontrolled blood sugar.

A call to broaden how we see diabetes

Too often we treat diabetes as nothing more than a number on a glucose meter. That mindset misses the point: diabetes affects the eyes, kidneys, heart, nerves and more. When we recognize it as a systemic condition and act accordingly through prevention, routine screening and coordinated care, we can stop decades of preventable harm.

If you are someone living with diabetes: consult with your physician for proactive management of your blood sugar, and regular eyes, kidneys, heart, and nerves checks instead of waiting for symptoms to appear.

With proactive care, we can change the story of diabetes – from delayed detection of the systemic effects of diabetes to early action and healthier future.

Important note: This article is for general awareness and does not replace medical advice. Speak with your healthcare provider for personalized recommendations.

- The author, Uwe Dalichow is Head of Region EMA and Country Division Head MENA, Pharmaceuticals Division, Bayer

https://gulfnews.com/gn-focus/company-news/diabetes-isnt-just-about-sugar-it-impacts-every-organ-1.500440595

Medical Compass: Protecting your vision when you have diabetes

From tbrnewsmedia.com

By David Dunaief, M.D.

A serious complication of diabetes is diabetic retinopathy (DR), which is the leading cause of blindness among U.S. adults. DR develops when high blood sugar damages the tiny blood vessels that supply the retina—the light-sensitive tissue at the back of the eye. Over time, this damage can lead to blurred vision and even permanent blindness, often in both eyes.

Despite the risks, many people with diabetes are not getting regular eye care. As of 2023, only about 66 percent of adults with diabetes received the recommended annual eye exam. This is concerning because early detection makes a huge difference. When DR is caught early, treatments are far more likely to prevent or limit lasting vision loss.

                                                                                                                                   METRO photo

A common complication: diabetic macular edema

A serious consequence of diabetic retinopathy is diabetic macular edema (DME). With DME, fluid builds up in the macula, the central part of the retina responsible for sharp, detailed vision. Swelling in this area can significantly impair eyesight, making everyday activities like reading or driving difficult.

People who have had diabetes for many years face the highest risk for DME. Unfortunately, symptoms often do not appear until the condition is advanced. By then, some of the damage may already be irreversible.

How is diabetic macular edema treated?

Treatments for DME often include eye injections of anti-VEGF medications, sometimes combined with laser therapy. These medications block vascular endothelial growth factor (VEGF), a protein that contributes to abnormal blood vessel growth and leakage in the eye. This can slow disease progression and, in some cases, improve vision.

A randomized controlled trial found that injections of ranibizumab (Lucentis), used alongside laser treatment—whether the laser was given immediately or delayed—were effective in treating DME. Other treatment options may include anti-inflammatory eye drops, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids, which aim to reduce swelling in the macula.

Do diabetes medications reduce the risk of DME?

Surprisingly, medications used to treat type 2 diabetes do not necessarily reduce DME risk. In fact, some may increase it. The THIN trial, a large retrospective study, found that a class of diabetes drugs called thiazolidinediones—which includes Avandia and Actos—was linked to a higher incidence of DME compared to patients who did not use these medications.

After one year, 1.3 percent of patients taking these drugs developed DME, compared with just 0.2 percent of those who were not taking them. This increased risk continued throughout 10 years of follow-up. The FDA has also issued warnings about other serious side effects associated with this drug class.

The risk appeared even higher in patients who used both thiazolidinediones and insulin. However, researchers could not determine whether the increased risk was caused by the medications themselves or by more severe diabetes.

Not all studies agree. An ACCORD Eye sub-study did not find a link between thiazolidinediones and DME. That study examined retinal photographs from almost 3,000 participants. Both studies had limitations, including incomplete data on how long patients had taken the medications and how well their blood sugar was controlled. Researchers also noted that not all potential influencing factors could be accounted for.

Can diet and blood sugar control help protect vision?

Better blood sugar control does appear to reduce the risk of diabetic retinopathy. The main ACCORD trial showed that intensive glucose control using medications lowered the risk of DR progression. However, this approach also increased overall mortality and did not reduce major cardiovascular events.

These results suggest an important takeaway: how blood sugar is controlled matters. A nutrient-dense, plant-based diet that helps maintain healthy blood sugar levels may lower your risk of diabetic retinopathy and further vision loss—without the added risks seen with medication-intensive approaches.

Protecting your vision

If you have diabetes, the most effective way to protect your eyesight is to keep your blood sugar well controlled and to schedule yearly eye exams with an ophthalmologist. Regular screenings can identify problems early, when treatment is most effective and vision loss may still be preventable. This is especially important for people taking thiazolidinediones or those who have had diabetes for many years.

Because your eyes are often affected long before you notice symptoms, it’s important to stay proactive. It can make the difference between preserving your vision and losing it.

https://tbrnewsmedia.com/medical-compass-protecting-your-vision-when-you-have-diabetes/ 

The Quiet Epidemic: Why People With Diabetes Lose Their Sight

From mynewstouse.com

For the nearly 40 million Americans living with diabetes, the threat to their vision unfolds quietly, often without warning. Diabetic retinopathy, a complication that damages blood vessels in the retina, has become the leading cause of blindness among working-age adults in the United States. Yet what makes this epidemic particularly tragic is that it doesn’t have to be this way. 

“The vast majority of severe vision loss from diabetic retinopathy is preventable,” said Janice C. Law, MD, retina specialist in Tennessee. “Studies show that regular eye examinations and timely interventions can reduce the risk of severe vision loss by 90 percent.” 

Still, many Americans are falling through the cracks. Only about 60 percent of people with diabetes receive the annual dilated eye examinations recommended by the American Academy of Ophthalmology, a shortfall driven by lack of access, awareness, and time. 

Expanding Access to Care 

If you or someone you care about has diabetes, schedule a dilated eye exam today. Uninsured or underinsured? See if you qualify for a no out-of-pocket cost medical eye exam through EyeCare America®. This public service program matches volunteer ophthalmologists, physicians who specialize in medical and surgical eye care, with eligible patients aged 18 and older who need eye care. Visit www.aao.org/eyecare-america to learn more. 

                                   People with diabetes are particularly at risk for vision problems and should see an eye doctor regularly

When to See a Doctor 

In its early stages, diabetic retinopathy often presents no symptoms at all—a fact that underscores the importance of preventive screening rather than waiting for problems to emerge. 

“Even if your vision seems fine, a yearly dilated eye exam is important,” said Dr. Law. “By the time patients notice flashing lights, blurred vision, floating spots, or other warning signs, the disease may have already progressed significantly.” 

When should a person with diabetes have an eye exam? 

If you have type 1 diabetes, you should have eye examinations at least yearly beginning 5 years after being diagnosed with diabetes. Your ophthalmologist may recommend more frequent examinations. 

If you have type 2 diabetes, you should see an ophthalmologist at least yearly as soon you are diagnosed, regardless of your age. Follow your eye doctor’s recommendation about how often you should be rechecked, as this varies for every individual. You may need to have your eyes checked more often than once a year. 

But diabetes isn’t the only reason to see an ophthalmologist. All healthy adults should have a comprehensive eye exam by age 40 when early signs of cataract, glaucoma, and age-related macular degeneration?may begin to emerge. 

“Forty is typically when subtle signs of eye disease begin to emerge,” Laura C. Fine, MD, chair of EyeCare America, explained. “Many times, people don’t even notice any changes to their vision during these early phases of disease. However, vision-saving treatments are most effective when the disease is caught early.” 

The Treatment Gap 

Ophthalmologists have more tools than ever before for diagnosing and treating eye diseases. But these innovations cannot help patients whose disease goes undiagnosed or who remain unaware of their condition’s severity. 

The message is clear: The technology to save sight exists. What’s needed now is making sure that everyone who needs it can access it in time. 

https://www.mynewstouse.com/stories/untitiled,37792 

Diabetic retinopathy is treatable and preventable – but only if you catch it in time

From eu.usatoday.com

The five human senses include sight, hearing, smell, taste, and touch. While each of these matter for different reasons, they aren't perceived as being equal. For instance, according to a YouGov public survey, only 2% of Americans say that, of the five senses, they would miss their ability to smell the most; 3% of respondents said their sense of touch matters most; and 5% said taste is most important. 7% said their ability to hear was the sense they appreciated more than any other. But by far the sense people cared most about was their ability to see. A whopping 70% of Americans say they would miss their sense of sight more than losing any of the other five senses.

While many eye conditions can affect or diminish vision, myopia is the most prevalent one with about 30% of the global population having it. Other degenerative eye conditions or diseases go beyond diminished vision, however, and can completely rob you of your ability to see. For example, age-related macular degeneration, retinitis pigmentosa and glaucoma can all lead to blindness. 

Diabetic retinopathy is another condition that can cause complete loss of vision - and it's also one of the most frequently occurring. "Diabetic retinopathy is the most common cause of irreversible vision loss and blindness among people in the working age range in the USA and in many other countries," says Dr. Charles Wykoff, a medical and surgical retina specialist and an ophthalmologist practicing in Texas. 

What is diabetic retinopathy?

Diabetic retinopathy (DR) is an eye-related complication that can occur in people who have diabetes. It affects blood vessels in the retina - the "light-sensitive layer of tissue in the back of the eye," explains Wykoff. DR can lead to peripheral or night-time vision loss, visual disturbances such as oversensitivity to light and floaters, and, if left untreated, blindness. 

DR has two stages, explains Dr. Sun Kim, an endocrinologist at Stanford University, who specializes in treating diabetes. The first and earlier stage is called nonproliferative retinopathy and occurs when the retina begins to swell, leading to mild vision loss. "Proliferative retinopathy is the advanced stage of DR that can cause severe and sometimes even complete loss of vision," Kim says.

The National Eye Institute estimates that nearly half of the 800 million people with diabetes worldwide will develop some degree of diabetic retinopathy. "The biggest risk factor for the development of DR in type 2 diabetes is duration of the disease - how long a person has had it," says Dr. Sara Weidmayer, a practicing physician at the LTC Charles S. Kettles VA Medical Centre in Michigan. 

What causes diabetic retinopathy?

DR is caused by high blood sugar levels that, over time, "affect the integrity of blood vessels, especially very small micro-vessels called capillaries," says Weidmayer. She explains that sustained glucose levels can cause the inside lining of these capillaries to become damaged, which then causes leakage that harms the retina. "The capillaries can also become plugged, leading to inadequate blood flow to many areas of the retina," she adds, which can further deteriorate vision.

While such leakage and plugged capillaries can persist for extended periods of time without causing noticeable vision loss, "if left untreated, it can eventually progress to permanent and irreversible vision loss," says Dr. Lloyd Paul Aiello, a professor of ophthalmology at Harvard Medical School. 

In fact, the longer someone has diabetes and the less controlled their blood sugar is during that time, the more likely they are to develop more advanced degrees of DR. This is especially worrisome because "many patients don’t know they have prediabetes or diabetes for years before an official diagnosis due to lack of screening," cautions Weidmayer.

Indeed, about one in three American adults have prediabetes and more than eight in ten don't know they have it, notes the U.S. Centers for Disease Control and Prevention. 

How is diabetic retinopathy treated?

Because of this, treating DR starts with monitoring your blood sugar levels and getting checked for prediabetes or type 2 diabetes. This is essential when it comes to preventing the worst outcomes of vision loss associated with DR, because, unlike type 1 diabetes where it is very rare to have severe diabetic retinopathy within the first 5 years after diagnosis, "in type 2 diabetes, retinopathy can exist at the time of diagnosis," Aiello explains. "For this reason, an initial retinal eye exam is recommended at the time of diagnosis for those with type 2 diabetes - and even if there is no retinopathy initially discovered, a patient will generally need to have their eyes examined at least annually." 

Once the condition has been diagnosed, treatments are usually first focused on preventing further damage. "In early stages of DR, optimizing...risk factors such as elevated blood sugar levels, high blood pressure, and cholesterol levels is ultimately the best thing to do to prevent the development and/or worsening of diabetic retinopathy," says Weidmayer. 

She says such measures include things like improving your diet, getting regular cardiovascular exercise, and quitting smoking. If needed, losing weight can be especially beneficial in improving blood sugar levels, Kim says - especially if your body mass index (BMI) is high.

If damage persists despite dietary and exercise improvements and you're found to have advanced DR, other interventions are recommended. "Medications may be injected into the eyes, laser procedures may be used, and often surgeries are needed to manage complications of DR," Weidmayer says. 

"Most people with diabetic retinopathy do not go blind if they are screened for diabetic retinopathy as needed and receive appropriate treatment by a retina specialist," offers Wykoff. "This is why you shouldn't wait until you have blurry vision to see an eye doctor." 

https://eu.usatoday.com/story/life/health-wellness/2024/12/17/what-is-diabetic-retinopathy/76879190007/

Why Episodes of Low Blood Sugar Worsen Eye Disease in People With Diabetes

From neurosciencenews.com

Summary: People with diabetes who experience low blood sugar are more likely to experience worsening diabetic retinopathy.

Source: Johns Hopkins Medicine 

People with diabetes who experience periods of low blood sugar—a common occurrence in those new to blood sugar management—are more likely to have worsening diabetic eye disease.

Now, researchers at Johns Hopkins Medicine say they have linked such low blood sugar levels with a molecular pathway that is turned on in oxygen-starved cells in the eye.

The research, involving human and mouse eye cells and intact retinas grown in a low sugar (low glucose) environment in the laboratory, as well as mice with low glucose levels, was published in the January issue of Cell Reports.

“Temporary episodes of low glucose happen once or twice a day in people with insulin-dependent diabetes and often among people newly diagnosed with the condition,” says Akrit Sodhi, M.D., Ph.D., the Branna and Irving Sisenwein Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins Medicine.

Low glucose levels can also occur during sleep in people with non-insulin dependent diabetes. “Our results show that these periodic low glucose levels cause an increase in certain retinal cell proteins, resulting in an overgrowth of blood vessels and worsening diabetic eye disease,” adds Sodhi.

Eye disease among people with diabetes is among the most preventable causes of blindness in the U.S. Diabetic retinopathy, which occurs in up to a third of people with diabetes, is characterized by the overgrowth of abnormal blood vessels in the retina.

Sodhi says the current study suggests that people with diabetic retinopathy may be particularly vulnerable to periods of low glucose, and keeping glucose levels stable should be an important part of glucose control.

For the study, the researchers analysed protein levels in human and mouse retinal cells and intact retinas grown in an environment of low glucose in the laboratory, as well as in mice that had occasional low blood sugar.

Low glucose levels can also occur during sleep in people with non-insulin dependent diabetes. Image is in the public domain

The researchers found that low glucose levels in human and mouse retinal cells caused a cascade of molecular changes that can lead to blood vessel overgrowth. First, the researchers saw that low glucose caused a decrease in retinal cells’ ability to break down glucose for energy.

When the researchers looked specifically at so-called Müller glial cells, which are supportive cells for neurons in the retina and rely primarily on glucose for energy production, they found that the cells increased the expression of the GLUT1 gene, which makes a protein that transports glucose into cells.

The researchers found that, in response to low glucose, the cells increased levels of a transcription factor, called hypoxia-inducible factor (HIF)-1α. This turned on the cellular machinery—including GLUT1—needed to improve their ability to utilize available glucose, preserving the limited oxygen available for energy production by retinal neurons.

However, in low-oxygen environments, as occurs in the retinas of patients with diabetic eye disease, this normal, physiologic response to low glucose triggered a flood of HIF-1α protein into the cells’ nucleus, the cell’s control centre.

This resulted in an increase in the production of proteins such as VEGF and ANGPTL4, which cause the growth of abnormal, leaky blood vessels—the key culprit of vision loss in people with diabetic eye disease.

The researchers plan to study whether low glucose levels in people with diabetes may impact similar molecular pathways in other organs, such as the kidney and brain.

Sodhi says the HIF-1α pathway may serve as an effective target for developing new treatments for diabetic eye disease.

https://neurosciencenews.com/blood-sugar-eye-diabetes-22378/

The importance of regular eye screenings for diabetes patients

From wsaw.com

WAUSAU, Wis. (WSAW) - An estimated 25% of diabetes patients have undiagnosed diabetic eye disease, according to a 2016 study Diabetes, rates of which have steadily increased in the U.S. over the past decade, affects many aspects of people’s health and can lead to serious eye diseases like diabetic macular edema (DME). However, 87% of Americans do not receive routine eye care and less than half of diabetes patients get the recommended standard of care eye screenings, even though early detection is key to minimizing vision loss.

With Diabetic Eye Disease Awareness Month coming up, people should keep their eye health top of mind. Eye protection is vital year-round.

DID YOU KNOW?

•        DME is caused by diabetic retinopathy, which occurs when too much sugar in the blood damages the retina.

•        Diabetic macular edema is characterized by fluid build-up in the retina, leading to blurry vision and even permanent vision loss.

•        Diabetic retinopathy is prevalent in approximately 40% of people with diabetes. Of the 7.7 million Americans with diabetic retinopathy, nearly 750,000 have DME.

•        Diabetic macular edema and diabetic retinopathy disproportionately affect Hispanics and African Americans.

•        The longer a person has diabetes, especially if it is poorly controlled, the higher the risk of developing diabetic retinopathy and vision loss.

•        Diabetic retinopathy and diabetic macular edema often have no early symptoms but can be diagnosed early with a dilated eye exam to help prevent progression.

https://www.wsaw.com/2020/10/22/the-importance-of-regular-eye-screenings-for-diabetes-patients/

How diabetes can affect your eyes

From telanganatoday.com

Diabetes is a condition wherein blood glucose levels are abnormally high

New Delhi: Glucose is an essential energy source for all living cells of the human body, which is programmed in a way wherein the glucose levels in the blood are maintained at an optimal level through various hormones.

Blood glucose levels are normally referred to as blood sugar levels in our day to day life. Diabetes is a condition wherein blood glucose levels are abnormally high. Consistently high glucose levels cause damage to various organs of the human body in the long run.

‘Diabetic Retinopathy’ is one such condition wherein abnormally high blood glucose or blood sugar levels cause slow, progressive and long-standing damage to the eyes.

Diabetes has now assumed the title of a silent global pandemic. With India set to become the diabetic capital of the world, the threat of visual loss due to diabetic retinopathy has gained massive proportions.

To understand how diabetes impacts the eyes, let us ? first understand the structure of the human eye. The human eye has structures and functions roughly equivalent to those of a simple camera. Similar to the light sensitive of a camera, the human eye has a light-sensitive structure called the retina.

It is this retina or the light sensitive structure of the human eye that is most adversely affected by diabetes. This condition is called diabetic retinopathy or is also referred to as diabetic eye disease in common understanding.

The advent of diabetic retinopathy simply starts as the appearance of small bleeding spots or “microaneurysms” on the surface of the retina. This is the initial stage of the disease or non-proliferative diabetic retinopathy, wherein the vision remains reasonably good despite having an abnormality.

The retinal blood vessels eventually develop leaks that cause the retinal tissue to “swell up like a sponge” (also called macular edema) It is this stage wherein an individual’s vision starts getting affected and prompts her to seek medical attention.

Treatments like the application of laser spots to the retina or instilling injections into the eye at this stage are very effective if instituted in time.

If the blood sugar levels continue to remain uncontrolled, the retina suffers from larger bleeding spots and blood may entirely fill up the jelly inside the eye causing a sudden loss of vision. Many patients go undetected until this stage of the disease because they miss undergoing an eye check-up while they suffer from diabetes all these years.

In the later stages of the retina starts getting crumpled and this results in a near-permanent loss of vision and blindness. Major surgery is then required to remove the blood and fix the retina back to its original position. Despite multiple major surgeries, only a few individuals may gain back their original vision.

As the diabetic eye disease progresses through the late stages, the microscopic damage to the cells of the retina leads to permanent structural and functional changes that, unfortunately, cannot be reversed.

Early detection of diabetic retinopathy and early treatment is hence, the key to preventing permanent visual loss due to diabetic eye disease.

It is strongly recommended to get a retina evaluation for every diabetic individual, at least once in a year. This retina evaluation is performed by an eye doctor who is a retina specialist and usually takes about an hour at the doctor’s clinic.

Long-standing diabetes, poor blood sugar control, associated hypertension, and deranged lipid pro? These are the most important risk factors for the development and progression of diabetic eye disease. Hence, all diabetics must have regular evaluations with the physician.

https://telanganatoday.com/how-diabetes-can-affect-your-eyes

Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss

From health.harvard.edu/blog

By Leo Kim, MD, PhD

Over 30 million people in the United States live with diabetes, and approximately 7.7 million people have diabetic retinopathy, making it the most common cause of vision loss in working-aged adults. The prevalence of diabetic retinopathy has increased significantly over the past 20 years, due to the rise in the number of people diagnosed with diabetes.

How does diabetes affect the retina?

The retina is the light-sensing component located in the back of the eye. It is composed of blood vessels, nerve cells (neurons), and specialized cells called photoreceptors that are involved in directly sensing light. The ability of the retina to sense light requires energy, which is dependent on the oxygen supplied by blood circulating through blood vessels.

In diabetes, elevated blood sugar levels damage the blood vessels of the retina. These damaged blood vessels leak fluid, bleed, and do not provide adequate oxygen to the retina, leading to retinal ischemia. As a result, retinal cells begin to die and the retina is unable to function properly. In addition, diabetes also damages the neurons of the retina directly. Together, these effects cause diabetic retinopathy.

Vision loss associated with diabetic retinopathy may initially affect central vision due to a condition called diabetic macular edema. This swelling of the macula, a portion of the retina responsible for sharp, central vision, can lead to blurry vision and distortion of images.

Advanced diabetic retinopathy is characterized by the formation of irregular blood vessels that can bleed inside the eye, causing a rapid loss of vision. This results in a sudden, curtain-like vision loss as blood fills up the inside of the eye. Further worsening of advanced diabetic retinopathy can lead to retinal detachment, which requires urgent surgical intervention and can result in permanent, irreversible vision loss if not promptly treated.

What can I do to prevent diabetic retinopathy?

The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to prevent the risk of complications. As blood glucose directly damages retinal blood vessels, there is strong epidemiological evidence that blood sugar control translates to decreased incidence and severity of diabetic retinopathy.

In order to reduce the cardiovascular and microvascular complications of diabetes, which include retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage), it is recommended that people achieve and maintain a normal blood pressure. Blood pressure reduction can delay the onset of diabetic retinopathy, but it is unclear if controlling blood pressure can alter the course of established diabetic retinopathy. Similarly, managing cholesterol is advocated for overall diabetes management, but it is not clear whether doing so reduces the risk of diabetic retinopathy.

How can I find out if I have diabetic retinopathy?

An ophthalmologist can diagnose and begin to treat diabetic retinopathy before sight is affected. In general, people with type 1 diabetes should see an ophthalmologist once a year, beginning five years after the onset of their disease. People with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that. You may need to see an ophthalmologist more frequently if you are pregnant or have more advanced diabetic retinopathy.

What can I do to prevent or slow down vision loss if I have diabetic retinopathy?

As mentioned above, damage to the blood vessels deprives the retina of oxygen. Insufficient oxygen leads to production of a signal protein called vascular endothelial growth factor (VEGF). VEGF and its role in eye disease were first discovered at Harvard Medical School.

Currently, there are medications that can bind VEGF and subsequently improve the symptoms of diabetic retinopathy. These “anti-VEGF” agents are injected directly into the eye and can improve diabetic macular edema, and can even improve the severity of diabetic retinopathy. In some people, steroids injected directly into the eye may also improve diabetic macular edema. In some advanced cases of proliferative diabetic retinopathy (the most advanced form of diabetic retinopathy), patients may require retinal laser therapy or retinal surgery to stop or slow bleeding and leakage, to shrink damaged blood vessels, or to remove blood and scar tissue.

https://www.health.harvard.edu/blog/diabetic-retinopathy-understanding-diabetes-related-eye-disease-and-vision-loss-2020011618394

Why You Need To See Your Eye Doc If You’re At Risk For Diabetes....

....And if you already have the condition, too.

From womenshealthmag.com/health

If you've never stopped to think about your diabetes risk, there's no time like the present! Currently, more than 100 million Americans are living with diabetes or pre-diabetes.

According to the American Diabetes Association, people with parents or siblings with the disease have a higher risk of getting diabetes themselves. Those with high blood pressure or polycystic ovary syndrome (PCOS) are also more susceptible, as are people who are overweight or inactive.

If you can relate to any of these things, you should consider doing something that may seem, well, a little random: making an appointment to see your eye doctor.

What does diabetes have to do with eye health?

When you have diabetes, your blood sugar levels are higher than they should be, which can damage the blood vessels in the back of the eye. This can cause the blood vessels to leak blood or fluid into the retina. In turn, the macula—the part of the retina that helps you see the fine details of objects directly in front of you—begins to swell, explains VSP network doctor Jarrett Johnson, OD, MPH.

“The back of the eye is the only place in the body where you can directly view the blood vessels,” Dr. Johnson said. “That’s why regular eye exams are vital, as we can get a clear view of what’s going on with your health.”

In addition to spotting warning signs of pre-diabetes and diabetes during an exam (which is so important if you're at risk for the condition), your eye doctor can also detect diabetic eye diseases, such as diabetic retinopathy and diabetic macular edema. These conditions don’t always have symptoms so it's easy for people to overlook them for years. If left unnoticed and unmanaged, these issues can eventually lead to vision loss.

“Early detection is key because the earlier diabetes and diabetes-related eye issues are detected and treated, the more you can prevent damage to the retina,” Dr. Johnson says.

OMG, scary! Tell me more about diabetic eye diseases.

According to Dr. Johnson, there are a bunch. Here are some of the most common:

• Diabetic retinopathy - This occurs when high blood sugar damages the blood vessels of the retina. It can lead to blurred vision, spots in your vision, dark areas of vision, and vision loss.

• Diabetic macular edema (DME) - This occurs when the macula swells. Symptoms include blurry vision or wavy vision. You may also experience vision loss.

• Cataracts - While cataracts tend to affect older folks, people with diabetes have an increased risk for the condition. This is because high blood sugar levels can cause deposits to build up in the lenses of the eye, according to the National Institutes of Health (NIH). Cataracts can cause blurry, hazy, or less colourful vision.

• Glaucoma - When diabetic retinopathy progresses, it leads to the growth of abnormal blood vessels in the eye. This can interfere with the normal flow of fluid out of the eye, causing increased pressure. That increased pressure can damage the optic nerve, leading to glaucoma. The condition can cause tunnel vision, severe headaches, blurred vision, or eye redness.

So, how can regular eye exams help keep my peepers healthy?

During a comprehensive eye exam, your eye doctor will dilate your eyes. This allows them to examine your retinas to check for any abnormalities—such as leaky blood vessels, macular swelling, and nerve tissue damage, Dr. Johnson notes. Your near and far vision and eye pressure will also be checked.

If your eye doctor detects anything suspicious, you may be referred to your primary care doctor or another specialist to see if you may have diabetes. “It’s important that you, your primary care specialist, and your eye doctor work together as a team to create a personalized care plan to help manage and monitor your health,” Dr. Johnson explains.

While it’s important for everyone to see an eye doctor every year, for those already diagnosed with diabetes or pre-diabetes, it is even more crucial. According to the Centres for Disease Control and Prevention, early detection (through an eye exam!) and treatment can prevent or delay blindness due to diabetic retinopathy in 90 percent of people with diabetes.

https://www.womenshealthmag.com/health/a28511138/diabetic-eye-exam/