Understanding Diabetic Retinopathy
Many of us take our eyesight for granted. We generally find life quite easy to navigate (even after a few too many drinks), and if you’re a muggle (non-diabetic - Harry Potter reference), then it’s likely you won’t even go to see an optician unless you literally see something wrong.
Having any kind of problem with your eyes is terrifying. The impact is profound and can weigh on your mental health and quality of life. Often the first complication that takes hold of a diabetic is retinopathy and this is a constant source of anxiety.
My blood pressure rises as soon as I think about the opticians. That moment when I’m sat in the chair opposite the eye chart thinking “today’s the day they tell me I can’t drive or I have glaucoma or I’ll need to strap military-grade binoculars to my face”. It never gets easier.
This fear was there before diabetes, as I grew up with poor and increasingly deteriorating eyesight. I finally got laser surgery but am now faced with dozens of those small black ‘floaters’. Trying to catch a fly is now practically impossible as I can’t tell the difference between the two.
Research tells us that there is hope. That if we can keep our blood sugars in the target range for as long as possible, we may not get retinopathy and could even reverse some damage already done. What is very important is that we first understand why our eyes are affected by high blood sugars, and this can give us the tools to take some control back.
Chronically high blood sugars are toxic and affects every part of a diabetic‘s body. It infiltrates your cells and damages your organs. Due to the relatively slow progression of injury at a metabolic level, many people continue their lives blissfully unaware that anything is wrong... until it is.
Many of us will have blurred vision when we’re diagnosed with diabetes. We may find it difficult to focus or refocus when changing views.
When I was diagnosed I struggled to focus on someone’s face whilst talking to them. Three years later I still question my ability to keep eye contact when in conversation.
When our blood sugars are chronically high it causes the lens of the eye to swell, resulting in a fuzzy outlook. According to Healthline: You may also get blurred vision when you start insulin treatment. This is due to shifting fluids, but it generally resolves after a few weeks.
Types of diabetic retinopathy
Early-stage - Proliferative Retinopathy: Blood Vessels leak into the center of the eye resulting in blurred vision, floaters or spots. Advanced stage - Macular Edema: This is when the macular swells due to leaking fluid. You may have wavy vision or colour changes.
Visiting the optician is not always the most pleasant experience, but like many other aspects of our life with diabetes, it is a requirement to manage our disease.
Once a year is the prerequisite to have a full exam Including dilation. If your blood sugar control is not where it should be I would highly recommend checking more frequently until you have your glucose levels under control.
Speaking of control: We‘re all tired of being reminded of it, but in the case of diabetes and retinopathy, strict glycemic control is the best preventative medicine. There are many anecdotal cases whereby diabetics have controlled or even reversed their eye disease by sustaining strict blood sugar control. There is no reason why you can’t.
In many countries, you will not be able to hold a driver's license if you don’t have good control over your blood sugars.
In general, your blood sugars need to be consistently in the range of 3.9 mmol (70mg/dl) to 6.7 mmol (120 mg/dl). Remember, we want the blood sugars of a non-diabetic with optimum metabolic health, not someone eating a Standard American Diet (SAD). Having control over our glucose levels provides the best chance of preventing retinopathy. According to a 2013 study by the heart and diabetes institute Australia - one in three people with diabetes will develop some form of diabetic eye disease.
Nearly 100% of type 1 diabetics and 60% of type 2 diabetics will develop it within 20 years of diagnosis. These statistics are improving coinciding with improved glycemic control (new insulins, increased use of GCM and Insulin pump therapy).
There are, of course, other factors at play, like genealogy, lifestyle factors, and blood pressure. So it always pays to be mindful of contributing factors as a diabetic.
These days we have a plethora of treatments capable of treating eye disease, from laser surgery to intravitreal injections and vitrectomy.
It's important to bear in mind, treatment is only required when retinopathy has advanced to the proliferative stage.
The statistics are not kind to a diabetic concerning eye disease. High blood sugars paint a pretty grim picture and this is a constant source of stress. We can take some control back by having strict glycemic control, keeping a healthy lifestyle - including a well-formulated low carb healthy fat diet, plenty of exercise and getting enough sleep.
I highly recommend familiarising yourself with the Cera 'Out of Sight' report - particularly if you live in Australia, but it is very relevant to all diabetics. To view, click HERE
Believe the hypo