| It
has been found that thousands of Asian people in the UK are at risk
of needlessly losing their sight through treatable eye conditions
such as Diabetes.
The Asian community is at increased risk of developing diabetes,
due to a greater genetic predisposition to diabetes.
The good news about diabetes is that treatments are very effective
and the more you know about your condition, the more you can do
to help yourself stay healthy; lead the sort of life you want to
live, and to avoid the health problems associated with diabetes
in later life.
To keep well and healthy, everyone needs good and regular healthcare.
This is especially important if you are diabetic. The early detection,
treatment and continued control of your diabetes is very important
as this will reduce your chances of developing the serious health
problems linked to diabetes, such as heart disease, amputation and
blindness.
The majority of people with diabetes are unaware of the dangers
of not managing their condition properly.
Most of the food that we eat is turned into glucose or sugar for
our bodies to use as energy. The pancreas, an organ that lies near
our stomach, makes a hormone called insulin to help glucose get
into the cells of our bodies where it is used as an energy fuel
for the body. Diabetes occurs when the body cannot use glucose or
sugar properly. As a result, the levels of sugar in the blood are
too high because the body cannot use it properly.
There are 2 types
of diabetes
Type 1 diabetes develops if the body is unable to produce any insulin.
This type of diabetes usually appears before the age of 40. It is
treated by insulin injections and diet and regular exercise is recommended.
Symptom checklist for type 1 diabetic:
Exceptional thirst
Dry mouth
Frequent urination
Loss of weight
Weakness or fatigue
Blurred vision
Type 2 diabetes develops when the pancreas can still make some insulin,
but not enough, or when the insulin that is produced does not work
properly (known as insulin resistance). In most cases this is linked
with being overweight.
This type of diabetes usually appears in people over the age of
40, though in Asian and African-Caribbean people often appears after
the age of 25. However, recently, more children are being diagnosed
with the condition, some as young as seven.
Type 2 diabetes is treated with lifestyle changes such as a healthier
diet, weight loss and increased physical activity. Tablets and/or
insulin may also be required to achieve normal blood glucose levels.
Symptom checklist for type 2 diabetic:
Blurred vision
Cuts or sores that take a long time to heal
Itching skin or yeast infections
Excessive thirst
Dry mouth
Frequent urination
Leg pain
There is no such thing as mild or borderline diabetes. Diabetes
is a progressive condition, which can lead to serious complications
if sugar levels are not properly controlled long term.
The healthy diet for people with diabetes is the same as that recommended
for everyone – low in fat, salt and sugar, with meals based
on balanced amounts of starchy foods like bread and pasta and plenty
of fruit and vegetables. Sugar containing foods sometimes inappropriately
labelled as “diabetic versions” offer no special benefit.
They still raise blood glucose levels, are usually more expensive
and can also have a laxative effect.
A well-balanced vegetarian diet, with an emphasis on low fat, high
fibres, and high carbohydrates can be particularly suitable for
diabetic patients
People with diabetes are encouraged to exercise regularly for better
blood sugar control and to reduce the risk of cardiovascular diseases.
The reason for this is that muscles, which are working, use more
glucose than those that are resting.
Muscle movement leads to greater sugar uptake by muscle cells and
lower blood sugar levels. Additional benefits of exercise include
a healthier heart, better weight control and stress management.
Diabetes and the eye
In order to understand how diabetes can affect the eye, it is worth
looking at how the eye works.
Your eye has a lens and an aperture (opening) at the front, known
as the pupil which adjust to bring objects into focus on the retina
at the back of the eye, as shown in the diagram below.
To be able to see, light must be able to pass to the retina. It
passes through the cornea (a clear covering in front of the eye),
lens and vitreous (a clear, jelly-like substance that gives support
to the back of the eye). The focused light or images are then carried
to the brain by the optic nerve.
The retina is made up of a delicate tissue that is sensitive to
light, rather like the film in a camera. It also contains a fine
network of small blood vessels. At the centre of the retina is the
macula, which is a small area about the size of a pinhead. This
is most specialised part of the retina and is vital because it allows
you to see fine detail for activities such as reading and writing,
and also to recognise colours. The other parts of the retina give
you side vision (peripheral vision)
Diabetes can affect the eye in a number of different ways. The most
serious eye condition associated with diabetes involves the network
of blood vessels lying in the retina. The name of this condition
is diabetic retinopathy.
Retinopathy is commonly caused by diabetes, but is sometimes caused
by other diseases such as very high blood pressure. If you have
high blood pressure in addition to diabetes, it can make retinopathy
worse, or progress more quickly. Poor sugar control will also accelerate
the progression of retinopathy.
How does diabetic retinopathy occur?
Over several years, a high blood glucose (sugar) level can weaken
and damage the tiny blood vessels in the retina. Diabetic retinopathy
is graded according to how severe it is.
Background diabetic retinopathy
This condition is very common in people who have had diabetes for
a long time. Your vision will be normal with no threat to your sight.
At this stage, the blood vessels in the retina are only mildly affected;
they may bulge slightly to form tiny microaneurysms, and tiny leaks
of fluid (exudates) and tiny bleeds (haemorrhages) in various parts
of the retina. The macula area of the retina remains unaffected.
Different parts of the retina can
be affected
Over time, background diabetic retinopathy can become severe, especially
if sugar control of diabetes is poor. Retinopathy can affect the
macula (when it is called maculopathy), the peripheral (outer part)
of the retina, or both.
It is much more serious if the macula is affected, with central
vision gradually becoming worse, making it difficult it to recognise
faces in the distance, or seeing detail such as small print. The
amount of central vision affected varies between individuals. Vision
that allows you to get around at home and outside (peripheral vision)
remains intact.
Maculopathy is the main cause of loss of vision, and may occur gradually,
and progressively. It is rare for someone with maculopathy to lose
all their sight.
Retinopathy usually develops gradually and tends to become worse
over a number of years.
Proliferative retinopathy
As the eye condition progresses, the blood vessels in the retina
can become blocked, and new tiny blood vessels grow (proliferate)
from the damaged blood vessels. This is called proliferative diabetic
retinopathy, and is nature’s way of trying to repair the damage
so that the retina has a new blood supply.
However, these new blood vessels are delicate, and can easily bleed
on the surface of the retina and into the vitreous gel, and cause
scar tissue to form. This can also affect vision by blocking light
rays going to the retina. Scarring pulls and distorts the retina,
which can lead to retinal detachment.
Whilst the new blood vessels will rarely affect your vision, sight
loss due to bleeding or retinal detachment is often sudden and severe.
Your eyesight may become blurred and patchy as bleeding obscures
your vision.
Total loss of vision can occur with proliferative retinopathy if
left untreated, and therefore, regular and careful monitoring of
the retina in all diabetic patients is of vital importance.
Laser treatment is a beam of high intensity light, which is focused
with extreme precision so that the blood vessels leaking fluid into
the retina can be sealed. If new blood vessels are growing, more
extensive laser treatment has to be carried out. This is done in
an outpatient hospital eye department. You do not usually have to
stay in hospital.
With treatment, sight-threatening diabetic problems can be prevented
if caught early. However, laser treatment will not restore vision
that has already been lost.
Pregnancy and Diabetes
Women who develop diabetes during pregnancy are said to have gestational
diabetes. Some will remain diabetic after delivery of the baby,
whilst others will revert to apparent normality.
Pregnancy may cause a rapid increase in the progression of diabetic
retinopathy. That is, if a woman has one type of retinopathy, it
may progress into a much more severe form in a short time during
pregnancy. This may be very serious indeed.
Nevertheless, good diabetic control during and of course before
the pregnancy prevent this increase in retinopathy, or at least
make it less severe.
In order to reduce the risk of contracting gestational diabetes,
women pre-pregnancy should opt for healthy lifestyle choices pre-pregancy.
These include eating a balanced diet, exercising regularly and appropriately
and making certain to maintain a normal body weight.
Other ways diabetes can affect the eyes
Temporary blurring of vision can occur as one of the first symptoms
of diabetes, although it can occur at any time when your sugar levels
are not well controlled. It is important to monitor your sugar levels
carefully, as advised by your GP, in order to observe patterns with
raised sugar levels and blurred vision.
A cataract is a clouding of the lens in the eye which causes vision
to become blurred or dim because light cannot pass through a cloudy
lens to the back of the eye. This is a very common eye condition
that develops as people get older, but someone with diabetes may
develop cataract at an earlier age,than someone who is not diabetic.
The treatment for cataract involves an operation to remove the cloudy
lens, which is then usually replaced by a plastic lens, helping
the eye to focus properly again.
In addition, the abnormal blood vessels in proliferative diabetic
retinopathy increase the likelihood of a type of glaucoma that is
very difficult to treat
If you have diabetes, it is vital to have your eyes checked at least
once a year even if you do not wear or need glasses, as early diagnosis
of diabetic retinopathy, and other eye conditions is of vital importance.
A sight test is an important eye health check, and you should not
wait until your vision has deteriorated.
Eye examinations are free for people with diabetes.
Information can be obtained about services for people with diabetes
in a range of different languages.
Further information is available from The Royal National Institute
of the Blind who produces leaflets, and audiotapes in Gujarati along
with other languages on a range of topics.
You can also call the help line with any queries or questions you
may have regarding eye health and your sight. It is possible to
talk in Gujarati to the help line officers, you just need to request
a Gujarati language speaker at the beginning of your call.
Royal National Institute of the Blind
105 Judd Street
London, WC1H 9NE
Telephone 020 7388 1266
Helpline 0845 766 9999
www.rnib.org.uk
Diabetes UK can also provide invaluable information on all your
medical and welfare questions.
Diabetes UK
10 Queen Anne Street
London
W1G 9LH
Telephone 020 7323 1531
diabetes Uk careline 020 7636 6112
www.diabetes-uk.org.uk
Both organisations can put you in touch with various local societies
and self help groups.
|
