Diabetes & Your Eyes

90% of the 26 million Americans with diabetes have Type 2 diabetes but 79 million more Americans are at risk for developing the disease.  1.8 million new cases are diagnoses each year. Type 2 diabetes in those less than 20 years old has grown 1100% since 1970.  It is the leading cause of blindless in those less than 74 years old, the leading cause of kidney failure and the leading cause of non-traumatic amputation.  In addition, it is a major cause of heart disease and stroke and the 7th leading cause of death in the US.

Diabetes is a failure of the pancreas to produce enough insulin or a resistance of the body’s cells to the action of insulin.  Insulin acts to allow the cells in the body to absorb glucose (sugar) from the bloodstream.  Glucose and insulin are needed for the brain, heart and kidneys to function. We get most of our glucose from the carbohydrates we eat, but also from muscle and liver stores of glucose.

When blood sugar levels go up, the tiny blood vessels are damaged and leak blood which leads to eye disease, kidney disease, nerve disease and heart disease.  When Dr Wrightnour notes bleeds and leakage in the eyes, that finding is predictive of these other diseases.  

Diabetes is classified as gestational (GDM), insulin-dependent (IDDM) or non-insulin-dependent (NIDDM).  NIDDM is becoming more common; those who are overweight and sedentary are predisposed to develop it, as well as those with a family history.  MANY NIDDM patients have few or no symptoms until serious complications occur (ie: heart attack).

Symptoms of LOW blood sugar may include shaking, sweating, fast heart beat, dizziness, hunger, impaired vision, weakness, fatigue, headache, and irritabilitiy.  Dr Wrightnour has rapid-acting carbohydrates in the office for the rare occasions when a patient may come in in a hypoglycemic state or become hypoglycemic during the time they are in the office.

Symptoms of HIGH blood sugar include extreme thirst, frequent urination, blurred vision, dry skin, difficulties healing, hunger and drowsiness.  If you are concerned that your blood sugar is too high or too low, then call your internist or primary care physician.  

Diabetes is treated with insulin and oral hypoglycemics as well as important dietary and lifestyle changes.

Diabetes can affect the eyelids, cornea, lens, and iris as well as the retina.  The photo at the top of this page show diabetic effects on the optic nerve and retina.  The patient has had laser treatments to destroy selected areas of the retina in order to provide better overall function for a longer period of time.  Diabetics are twice as likely to develop glaucoma and more likely to lose vision when they do develop it.  

A big problem with diabetes and the eyes is that all complications of diabetes have a slow progression in the beginning but that can lead to patient non-compliance and more severe complications down the road.  Current thinking is that 20% of type 1 diabetics have retinopathy at one year and 67% have retinopathy at 5 years (30% of type 2s)—95% have it after 15+ years, compared to 80% of type 2 diabetics.  Risk factors include hypertension, smoking (MAJOR risk factor) and disease duration.  Yet less than 50% of persons with diabetes get dilated eye exams yearly!

75% of all diabetic retinopathy could be eliminated with proper control of the disease.  Early diagnosis is key.  Patients need to take charge and ask their endocrinologist to schedule them with diet and exercise consults.  Most major medical insurances cover diabetes education classes!

Complications from obesity kill more Americans than smoking—and smoking kills 1000 Americans per day!  Take control: portion control!  Begin to exercise.  Step away from the computer!  Take charge of your fasting blood glucose and know your A1c number.  Make your diabetes doctor explain your disease to you!  Controlling hypertension to less than 130/80 will lower the risk of all diabetes complications.  And finally, getting an annual dilated eye exam will cut the risk of going blind by up to 95% by allowing for early detection of eye complications.

For more information:

American Optometric Association: aoa.org

American Diabetes Association: diabetes.org

National Institutes of Health: ndep.nih.gov

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Source materials taken from copywrited information from the American Optometric Association