We’ve all heard of diabetes. We probably all know someone that has diabetes. But what is it, how does it affect our health and how does it affect our vision? November is Diabetes Awareness Month. Diabetes affects over 30 million Americans and about 25% of these diabetics don’t know they have it. Another 84 million are considered pre-diabetic. Many of these will go on to develop diabetes in the next 5 years. This is a serious disease that affects so many. Read on to learn more about the good, the bad and they ugly of diabetes and the effects on your vision.
Diabetes is a metabolic disease that affects the body’s ability to produce insulin. Insulin is the hormone that helps our bodies use the simple sugar (glucose) produced during digestion. Glucose is absorbed into the bloodstream and transported to the cells where it is stored and used as fuel by the body to perform daily activities. Insulin plays an extremely important role in regulating the amount of glucose the body has at any given time. Too much or too little glucose can be detrimental to our health.
Insulin is constantly released by the pancreas to maintain consistent glucose levels. When the glucose levels increase as food is digested, the pancreas releases more insulin to push more glucose into the cells for storage, keeping the glucose in the bloodstream fairly constant. When the pancreas doesn’t produce enough insulin, the bloodstream has too much sugar in it causing high blood sugar, which can wreak havoc on our bodies.
There are 3 types of diabetes, Type-1, Type-2 and Gestational Diabetes:
Type-1 diabetes occurs when the pancreas doesn’t produce any insulin. This form usually develops in people under the age of 20, although it can occur later as well. People suffering from Type-1 diabetes must use injections of insulin to control the blood sugar in their bloodstream.
Type-2 diabetes is the most common form, sometimes called “adult-onset” diabetes. In this form, the body produces insulin, but may not produce enough, or the bodies cells are insulin resistant. Either way, the blood sugar needs to be controlled via diet, exercise, medications or by insulin injection. Type-2 diabetes is preventable. It usually occurs in adults 40 years and older who are overweight. It can sometimes occur in people who are not overweight though and is occurring more frequently in children as obesity becomes a more prevalent problem in our society.
Gestational diabetes is caused by hormonal changes during pregnancy. Those at risk for developing gestational diabetes are generally a little overweight pre-pregnancy and have a family history of diabetic disease. Blood sugar levels usually return to normal shortly after childbirth, but those suffering from gestational diabetes should be aware that they are at a greater risk of developing Type-2 diabetes later in life.
So how does this affect our health?
Symptoms of diabetes may be gradual, and therefore difficult to detect, or more sudden, depending on the type.
- In Type-1, sudden onset is more common. A person may notice they are constantly hungry, even shortly after eating, they may experience unexplained weight loss, frequent urination and blurry vision.
- In Type-2, more gradual onset of symptoms is the norm. Usually a person will notice weight gain, itchy skin, yeast infections or tingling in feet and hands. These symptoms will generally occur after a person has been diabetic for some time, whether they realize it or not. Type-2 diabetes often goes undetected for quite some time before these symptoms manifest themselves.
If you notice any of these symptoms, contact your physician immediately.
The effects of diabetes on our systems is tremendous. Problems related to diabetes include but are not limited to:
- Kidney disease
- Heart disease / High Cholesterol
- Skin conditions / slow healing cuts and sores
- Nerve pain
- Ocular / vision related problems
How does diabetes affect our vision?
For the purpose of this blog, let’s focus on the effect diabetes has on our vision.
Visual disturbances from diabetes can come in the form of blurry vision, glaucoma, cataracts and diabetic retinopathy. Common symptoms of diabetes from a visual standpoint are as follows:
- Spots or dark strings floating through your vision
- Blurred vision
- Fluctuating vision
- Eye pain
- Halos around lights
- Empty spots in your vision
- Difficulty with color vision
- Vision loss
When the blood sugar goes above normal levels due to diabetes, it commonly causes swelling in the back of the eye. This condition is known as Macula Edema. When light enters your eye, it focuses on the macula. This is the area of the eye responsible for allowing us to see detailed images. It is the most central part of our vision. With a normally functioning macula we are able to read fine print, see greater details and appreciate colors. Swelling distorts the image being projected on the macula causing blurry vision. Glasses or contacts can not correct this. The only way to correct this is to reduce the swelling through careful monitoring, diet, exercise and blood sugar control. This condition can usually be reversed over a few months.
Blurry vision can also occur when Diabetic Retinopathy exists. Diabetic retinopathy is caused when the blood vessels in the back of the eye become damaged. The retina is nourished by these blood vessels. When blood sugar is too high, the tiny blood vessels become blocked. New vessels tend to grow to make up for the blockages, but these vessels are weak and thin and are prone to leak. These leaks can obstruct vision as the blood appears as objects “floating” in a person’s vision. The blood can sometimes completely block vision if there is a lot of blood. If the diabetes is monitored properly, the blood should eventually dissipate, and vision may return to normal. If caught early enough, a doctor can use a laser to shrink the abnormally growing blood vessels.
Diabetic retinopathy can also cause retinal detachments. This is extremely serious, as it can lead to complete blindness and may progress very quickly. Retinal detachments occur when the growth of new, inferior blood vessels grow and scar tissue forms around these poorly developed vessels. The scar tissue may “tug” on the retina, pulling it away and detaching from the back of the eye. When this occurs, it is imperative to see a retina specialist as soon as possible to reattach the retina for any quality vision to return. When “floaters” are accompanied by “flashes” of light, get to an ophthalmologist IMMEDIATELY.
Glaucoma is an increase of pressure inside the eye. This pressure build-up, left untreated, can damage the optic nerve, which causes vision loss around the periphery. Glaucoma is often called “the silent thief of sight” as it asymptomatic, and often goes unnoticed. Open Angle Glaucoma is the most common type, and while diabetes is one cause of open angle glaucoma, there are other causes as well. Neovascular Glaucoma is another form of glaucoma which only diabetics can get. In this type, the retina forms extra blood vessels in the conjunctiva (whites of your eyes) that grow into the iris and cause ocular pressure to rise. In either case, glaucoma left untreated will undoubtedly rob the unsuspecting person of precious sight. Medications to control the ocular pressure can help. But it is important to be diligent and compliant with the medication schedule as well as regular and frequent eye exams to ensure the pressure remains under control.
While Cataracts are a normal part of the aging process, those with diabetes tend to get them earlier in their life, and they tend to advance at a more rapid pace. A cataract forms when the natural lens in the eye becomes clouded. The only way to correct this affect of diabetes is to undergo cataract surgery to remove the clouded lens and implant a clear plastic lens. This is a common surgery and will restore vision to pre-cataract levels if the diabetes is managed properly.
The Bottom Line:
There are a few things your eye doctor can do to mitigate the consequences and problems associated with diabetes if caught early enough and monitored religiously. But it comes down to compliance and managing the diabetes every way possible for the best visual outcome.
Doctors Krebs and Zemanek have seen and helped many patients through this disease. If you show symptoms of diabetes, you should see your primary care physician as soon as possible as well as make an appointment with an ophthalmologist or optometrist to determine whether your vision has been affected and address any problems quickly.
Schedule your appointment today if you experience any symptoms or there is a family history of diabetes.
For further information on diabetes, please see the following websites for a more in-depth overview.
and so much more…