Don’t Lose Sight of Diabetic Eye Disease Information for People With Diabetes

Diabetes is a very serious disease that can cause problems like blindness, heart disease, kidney failure, and amputations. But by taking good case of yourself through diet, exercise, and special medications, you can control diabetes. And there is more good news. Diabetic eye disease, a complication of diabetes, can be treated before vision loss occurs.

All people with diabetes need to get a dilated eye exam at least once a year.

1. What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

Diabetic retinopathy

Damage to the blood vessels in the retina

Cataract

Clouding of the eye’s lens.

Glaucoma

Increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision

2. What is the most common diabetic eye disease?

Diabetic retinopathy: This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

3. What are its symptoms?

Often there are none in the early stages of the disease. Vision may not change until the disease becomes severe. Nor is there any pain.

Blurred vision may occur when the macula - the part of the retina that provides sharp, central vision - swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. But, even in more advanced cases, the disease may progress a long way without symptoms. That is why regular eye examinations for people with diabetes are so important.

4. Who is most likely to get diabetic retinopathy?

Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime.

5. How is it detected?

If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam. That means eye drops are used to enlarge your pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.

6. Can diabetic retinopathy be treated?

Yes. Your eye care professional may suggest laser surgery in which a strong light beam is aimed onto the retina to shrink the abnormal vessels. Laser surgery has been proved to reduce the risk of severe vision loss from this type of diabetic retinopathy by 90 percent.

If you have macular edema, laser surgery may also be used. In this case, the laser beam is used to seal the leaking blood vessels. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

7. Can diabetic retinopathy be prevented?

Not totally, but your risk can be greatly reduced. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible had much less eye, kidney, and nerve disease. This level of blood sugar control may not be best for everyone, including some elderly patients, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

8. How common are the other diabetic eye diseases?

If you have diabetes, you are also at risk for other diabetic eye diseases. Studies show that you are twice as likely to get a cataract as a person who does not have the disease. Also, cataracts develop at an earlier age in people with diabetes. Cataracts can usually be treated by surgery.

Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults. Arid, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser, or other forms of surgery.

Diabetes Diet and Tablets

Diabetes occurs when the pancreas, a gland which lies behind the stomach, fails to produce sufficient insulin. Insulin is needed by the body to handle the food we call carbohydrates (sugar and starches). These foods are normally broken clown to a sugar called glucose and insulin is necessary to convert this glucose to energy. Without sufficient insulin, the level of glucose in the blood rises and spills over into the urine causing large volumes of urine to be passed and as the body is unable to convert glucose to energy, excessive tiredness can also result. When diabetes occurs in middle age or later, there is usually only a partial deficiency of insulin. This is called maturity onset or type II diabetes (as distinct from insulin dependent or type I diabetes) and it can be controlled by diet or a combination of diet and tablets. If the person is overweight it is more difficult for the reduced amount of insulin produced to act on the cells of the body and so achieving and maintaining a normal weight is the corner stone of treatment.

GOOD FOOD FOR ALL

Eating the right food is important for the health of the whole population but especially for those with diabetes.

Now that you have developed diabetes your body is unable to break down and use carbohydrate as it should. In order to control your condition you need to follow a few simple rules, whether you take tablets or not. In fact these simple dietary rules are the principles of healthy eating for everybody, they are: —

1) To avoid sugar in all forms

2) To eat less fat

3) To eat more fiber

4) To eat regular meals

Sugar, and foods containing it, will make your blood and urine sugar level rise considerably. Foods to avoid include sugar, glucose, jams/marmalades, sweetened fizzy drinks, sweets and chocolates.

Sugar free drinks and saccharin sweeteners are useful, but diabetic jams, biscuits and sweeteners are not necessary. They are expensive and most contain sorbitol which is fattening and can cause diarrhea.

Fats are high in calories and a large intake can lead to heart disease and circulatory problems, so try to avoid fried and fatty foods and cut down on butter and margarine.

Fiber is the part of the diet, which is not digested. It makes your diet more satisfying and helps to keep your sugar levels under control in addition to encouraging healthy bowel action. It is found in unrefined foods such as whole meal bread, whole meal flour, jacket potatoes, peas and beans, Branflakcs, Weetabix and digestive biscuits. Choose these instead of refined foods such as white bread, Cornflakes/Rice Krispies and white flour.

Being overweight does affect your diabetes and you should try to correct it. By eating less fat and more fibre and avoiding sugar you should find this relatively easy.

By making these long-term changes in your eating habits you will improve your health.

URINE TESTS

Your Doctor will advise you at what time and how often you should test your urine for sugar. Read and follow carefully the instructions on the container of your test strips. It is important that you empty your bladder completely half an hour before you do a test. You should then still be able to pass sufficient urine to test for sugar.

Keep a record of your urine tests and take it with you each time you visit your Doctor. Record diaries should be available from your surgery or clinic.

If your urine tests persistently show 1% sugar or more, seek medical advice.

BLOOD TESTS

Your Doctor may ask you to do finger prick blood sugar tests instead of urine tests. These are more accurate and some people find them more convenient. The Doctor

TABLET TREATMENT

If dieting fails to control your diabetic symptoms and your blood and urine sugar levels, your doctor will most probably prescribe a diabetic tablet. There are 2 groups of diabetic tablets for which there are different medical indications.

The first group includes the following drugs:

(Company or Proprietary name in brackets)

Acetohexamide Chlorpropamide Glibenclamide Glibornuride Gliclazide Glipizide Gliquidone Glymidine Tolazamide Tolbutamide

(Dimelor) (Diabinese Glymese Melitase) (Daonil Euglucon Libanil Malix) (Glutril) (Diamicron) (Glibenese Minodiab) (Glurenorm) (Gondafon) (Tolanase) (Glyconon Pramidex Rastinon)

These drugs are all very similar and they work by stimulating the pancreas to produce more insulin. They are safe but they can occasionally cause mild indigestion or skin rashes, and very rarely jaundice or anaemia. As they act by causing the pancreas to produce more insulin they can cause low blood sugar levels and symptoms of what is called a “hypoglycaemic reaction”. These reactions are extremely rare and are more likely to occur in elderly people, or when alcohol is taken on an empty stomach, or when strenuous exercise is taken after missing a meal. The symptoms of hypoglycaemia include weakness, drowsiness, confusion, difficulty in focusing, tingling especially around the lips and unsteadiness, and can be corrected by a sweetened drink, of sugar lumps in water, repeated if necessary. If it is left untreated it can progress to unconsciousness necessitating a hospital admission.

Chlorpropamide and to a lesser extent some of the other tablets in this group can cause an unpleasant flushing when alcohol is taken. If this is a problem a different tablet can be substituted.

There is only one tablet in the second group and this is called Metformin (Glucophage). This tablet is usually used to treat very overweight people whose diabetes is poorly controlled on diet alone. It does not stimulate the pancreas to produce more insulin and cannot therefore cause a hypoglycaemic reaction. It acts by altering the way the body deals with sugar. Side effects include mild indigestion or diarrhea or a metallic taste in the mouth.

REMEMBER WHEN TAKING TABLETS TO FOLLOW CAREFULLY THE DOSAGE INSTRUCTION ON THE BOTTLE AND KEEP ALL TABLETS OUT OF THE REACH OF CHILDREN.

Very occasionally these tablets fail to control maturity onset diabetes and then insulin treatment is advised.

OTHER TABLETS AND MEDICINES

Whenever your Doctor prescribes a new tablet or medicine remind him that you have diabetes or that you are taking a diabetic tablet. Some medicines can aggravate diabetes and result in high blood sugar levels whereas others can increase the effect of diabetic tablets and cause too low a blood sugar level.

Steroids and to a lesser extent, certain diuretics (‘Water’ tablets) can aggravate diabetes. Certain anti-angina and blood pressure tablets, some anti-depressants, some antibiotics, an anti-fungal tablet, some tablets used to treat joint conditions and some tablets used in the treatment of high cholesterol levels may increase the effect of diabetic tablets. Remember also that some cough medicines have a high sugar content.

HEALTH CARE

As there is an increased risk of heart attacks and strokes among people with diabetes it is important for your diabetes to be well controlled and for you to achieve and maintain your normal weight and to take regular exercise. Brisk walking is a very good way to exercise, If you wish to undertake a more vigorous exercise programme ask your doctor’s advice first.

Smoking and high blood pressure also increase the risk of heart attacks and strokes so it is vital for you to STOP SMOKING and advisable for you to have your blood pressure checked once a year by your clinic or family doctor.

You should also have your eyes checked once a year by your doctor or an Optician. Diabetes can affect the blood vessels at the back of the eyes and although it is rare for such changes to cause any deterioration of vision in people with your kind of diabetes it is obviously best for serious changes to be recognised and treated before they can do any harm.

FOOT CARE

People who have diabetes are more likely to be troubled with corns; blisters or infections and they need to take special care of their feet. Wash your feet regularly and dry carefully between the toes. Cut your toe nails straight across preferably after a bath when the nails are soft. Do not cut them too close to the skin. If you do not sec well or your hands shake ask someone to help you. Very thick or in growing toe nails should be treated by a Chiropodist.

Do not walk barefoot. Always wear shoes that fit well and do not wear new shoes for more than half an hour at a time.

Avoid excessive heat or cold. Keep the feet warm and wear soft roomy socks or stockings, preferably woolen or cotton. Do not use hot water bottles. If you have cold feet wear bed socks instead. Do not put plasters on corns or try to cut them yourself - see a Chiropodist.

Report any sore places, blisters, discolored areas or callouses, however trivial, to your Doctor.

ILLNESSES

Any illness is likely to cause a deterioration in the control of your diabetes.

If, when you are ill, your urine tests show persistent 1% sugar or more, or your blood tests 13 mmol/per litre or more, seek medical advice.

If you become increasingly thirsty and start to pass more urine than normal, or if you rapidly lose weight and feel unwell or if you vomit, contact your Doctor.

CAR DRIVING

Diabetes is specifically mentioned on the driving license application form and people who have diabetes must mention it when completing the form. If you hold an existing driving license when your diabetes is first diagnosed you should write to the D.V.L.C. at Swansea and inform them. You should also declare your diabetes to your Insurance Company.

ALCOHOL

Like the rest of the population you should be sensible a flout the amount of alcohol you drink. Do not drink more than a couple of ‘shorts’ or 2 glasses of dry wine, or 2 dry sherries, or 2 pints of ordinary beer a day. If you drink spirits, e.g. gin, whisky etc., choose a slim line mixer. Beer or lager drinkers should be aware of carbohydrates and calories. Diabetic lagers (low in carbohydrate) are available, but remember that they are high in alcohol and calories, and tend to be expensive.

Liqueurs, sweet wines and ordinary mixers should be avoided. Never drink on an empty stomach. For those taking diabetic tablets, remember too much alcohol could have the effect of lowering your blood sugar and make you feel unwell.

FINALLY: DON’T DRINK AND DRIVE.

IDENTIFICATION

You should carry some form of identification card with you. Identification cards are available from your Doctor or Diabetic Clinic and should contain details of your name, address, Doctor and tablets.

PRESCRIPTION EXEMPTION

People with diabetes are exempt from prescription charges. Get a form from your Family Practitioner Committee for your General Practitioner to sign in order to receive your Prescription Charge Exemption Certificate.

If you have any questions concerning anything in this booklet please ask your Doctor, Nurse Specialist or Dietitian when you next visit your Diabetic Clinic.

Boehringer produce Diabur Test 5000 for urine glucose testing and BM Test Glyccmie 20-800R for blood glucose testing. Readers are invited to write to B.C.L.. Boehringer Mannheim House, Bell Lane, Lewes, East Sussex, BN7 1LG, for diabetic diaries, pocket guides and other useful literature for use with these tests.

FINALLY REMEMBER

WITH GOOD CONTROL OF YOUR DIABETES

AND REGULAR HEALTH CHECKS

YOU CAN BE AS HEALTHY OR EVEN HEALTHIER

THAN THE NEXT PERSON