Diabetes Management
Diabetes
must be managed for long-term preservation of sight
By Dana M. Deupree,
MD
 Nearly everyone has a friend or loved one affected
by Diabetes Mellitus and is aware of some of the
serious consequences the disease may cause. At a
young age, I noticed my uncle had difficulty with
his
vision and required an injection every day to
regulate his blood sugar. Having spent the last
fifteen years treating
diabetic eye disease, it has
become increasingly clear that the careful and timely
management of ocular disease is critical
in preserving a patient's sight.
Recently,
in the
Journal of the American Medical
Association it was reported that in the USA
only 50% of all diabetics, even those with high risk
disease, were receiving the recommended regul ar eye
examinations for detection and prompt treatment of
the
retinopathy. This means that there are millions
of Americans with diabetes who are putting their
eyesight in serious jeopardy.
While diabetes is broken down into:
Type 1, or insulin dependent and Type II, or
non-insulin dependent, they both have similar impact
on the eyes and are managed with nearly the same
protocol. Both of these types lead to a thickening
of the internal diameter of the small capillaries
that deliver oxygen and nutrients to the tissue.
This may cause damage to the tissues involved
whether it is
retina, peripheral nerves or the
kidneys. It is recommended that yearly
dilated eye
exam be carried out for anyone diagnosed with
diabetes and should any early changes be noted more
frequent follow-up is needed.
People often wonder what factors are
important in control of their diabetic retinopathy.
It is clear from the results of the
Diabetes Control
and Complications Trial (DCCT), a large
multi-center study o 1400 patients over a five-year
period, that strict control of blood sugar
significantly reduces the severity of retinopathy.
Methods to achieve this strict control begin with
education through your endocrinologist, internist or
local hospital education programs. You must learn
the basics about diet, exercise and glucose
control. Careful blood
sugar monitoring is vital.
There is certainty that cigarette smoking causes
increased damage to the diabetic and ignoring this
can only lead to rapid and more severe progression
of the retinopathy.
While treatment starts with the
above, the focus of the
retina specialist is to detect early damage to the
retina and anticipate its effect.
There are excellent criteria from years of study
that guide us concerning the timing and laser
technique to be used to seal microcapillary leakage
for the preservation of
visual
acuity. This should be
done with great care to protect the central vision.
A more severe stage of retinopathy, known as
proliferative diabetic retinopathy, may develop
demonstrating hemorrhages and scar tissue
membranes. For this, prompt surgical intervention
may be required.
With the many technical advances
available to the retina specialist, the care of the
diabetic eye is very clearly defined and effective.
However, this all depends on the patient seeking
advice. If you or a loved one has diabetes, manage
the disease and do not let it manage you. |
