Health Matters: Prevent Blindness by Aggressively Treating Diabetes

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Diabetes is a well-known cause of blindness, but by aggressively treating diabetes early, blindness and other consequences can be lessened, sometimes dramatically.

Diabetes causes blindness through diabetic retinopathy, a condition that occurs when the tiny blood vessels inside the eye are damaged from too much sugar (glucose) in the bloodstream. Glucose is the main source of energy for the body's cells, so it is essential that our bodies get an adequate supply. However, if the body loses its ability to regulate glucose, it can be very dangerous, especially over time.

The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. In type 2 diabetes, also called adult-onset diabetes, the body becomes desensitized to insulin, so it stops storing excess blood sugars. When the body can’t keep sugar levels at appropriate levels, glucose can damage the body’s tiniest blood vessels, including those that supply blood to your eyes, heart, and kidneys, among other places.

Sadly, this damage can be permanent. People with uncontrolled diabetes over long periods of time often confront all sorts of medical problems, not just blindness. When the kidneys no longer function properly, people go on dialysis. When diabetes damages the nerves, people complain of burning, numb, and tingling feet. When blood vessels in the penis are damaged, some men complain of difficulty achieving and maintaining an erection. Uncontrolled diabetes often affects the extremities, too. The hyperglycemia from diabetes increases the risk of infection, and because of reduced blood flow to the feet and legs, hyperglycemia can eventually lead to the need for amputation.

The good news is that much of this damage is preventable when people are diagnosed either with pre-diabetes or while they are still in the early stages of diabetes. Studies show that aggressive treatment early in diagnosis can have what’s called a “legacy effect” and decrease the incidence of late-stage complications (like those listed above) as compared to those who are not treated aggressively right from the start. The challenge we face as primary care providers is getting the opportunity to diagnose patients early, because people who feel fine rarely come in to get tested.

The Centers for Disease Control and Prevention (CDC) estimates that of the 30 million Americans with diabetes, about 7 million don’t know they have it. And these statistics do not include the 1 in 3 Americans with pre-diabetes. So, if you are 40 years or older, it’s important to schedule an annual exam with your primary care provider, not only to test for diabetes, but also to get screened for other common illnesses like high blood pressure and cancer.

People with diabetes can manage their condition with lifestyle changes like good nutrition, exercise, and maintaining a healthy weight. Exercise includes planned intense activity like walking/running, weightlifting, or attending exercise classes. Increasing physical activity by parking a few blocks from work so you spend a few more minutes walking each day can help, too. Sometimes lifestyle changes need to be supported by medication.

If you are diagnosed with pre-diabetes or diabetes, your primary care provider can refer you to a diabetes education class or support group where you can learn the ins and outs of managing your blood sugar. It does require discipline, but it’s definitely worth the effort.

Although diabetes often comes without any symptoms, it can present with excessive thirst, the need to urinate more often (with more urine), increased appetite, losing weight, feeling shaky, and/or headaches. Risk factors include being overweight, having family members with diabetes, diabetes during pregnancy, being over the age of 45, having high blood pressure, and being a member of one of the following high-risk ethnic or racial groups: Latinx, Native American, African American, Asian American, or Pacific Islander.

If you’re older than 40 and haven’t seen your primary care provider in the last year, now is a great time to pick up the phone and make an appointment.

Mario Espindola, MD, is a family medicine physician at MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental and behavioral healthcare to people in Lake and Mendocino Counties.

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