Eyes, extremities first place diabetes shows up

As registered nurse and diabetes educator Argelia Prieto notes, diabetes can affect a patient from head to toe.

Some of the first places diabetes’ impacts can be seen are the eyes, feet and hands, health providers say.

Optometrist Dr. G. Chase Jackson said in an email that poor control of blood sugar increases risk of diabetic eye change. He said he doesn’t diagnose the disease, but he sees the changes it can cause and one of those is diabetic retinopathy.

The prevalence of the eye disease in diabetics varies between studies and populations, but could generally be around 40 percent, Jackson said in an email. Diabetic eye change is more common in Type I diabetes than in Type II, he said.

“You are at a higher risk of diabetic eye change the longer you have diabetes,” Jackson said. “About 50 percent of diabetics will have diabetic eye change after 10 years and about 90 percent after 30 years,” Jackson said.

He added that if you have poorly controlled hypertension or smoke, the risk of diabetic eye change is greatly increased.

Sometimes the vessels can become a “little leaky” and they don’t bring blood to certain tissues as well as they could.

“In the eye, it’s the only place in the body where you can look directly at blood vessels right at the back of the eye. Sometimes we can see there is a little bit of diabetes change here. These vessels are becoming a little leaky or twisty, for example. Then we might get a patient in touch with their primary care or a diabetes doctor … and start getting the condition controlled,” Jackson said.

He added that he’s had patients come in just thinking they needed new glasses, but they may be experiencing a lot of diabetes eye change, or even bleeding inside the eye and they don’t notice.

“There’s no pain associated with it,” Jackson said. “Sometimes they don’t even have a vision complaint. That’s why we do a comprehensive eye exam to rule these things out and make sure their eyes are in good health and not affected by any conditions that can hurt the eyes like diabetes.”

Jackson said diabetes is the leading cause of blindness in the United States for working-age people. Part of his job is to detect any diabetic eye change and get his patients in contact with a good diabetes doctor who can get the disease under control.

“… One of the most motivating things to help patients keep their blood sugar under control and lower their risk of diabetic eye change is just showing … pictures of the changes diabetes can do to the eyes,” Jackson said.

Jackson recommends getting a complete eye exam once a year as a general rule.

“Some people have certain eye conditions that require them to get their eyes checked more often. Sometimes it’s every two years or three years. We tailor those intervals to the patients’ need. Most vision insurances will cover eye exams once a year,” Jackson said.

He added that smoking, HIV and tuberculosis can cause eye changes.

“There’s a type of cataract you can get from high blood sugar or fluctuating blood sugar that can decrease your vision in a week permanently and make you need to have a cataract surgery to fix that. It can change your vision really quickly,” Jackson said.

Along with eyes, Prieto said diabetes affects the heart, hands and feet.

Lack of circulation is one of the problems with feet. Once there is nerve damage, it causes neuropathy, which causes a burning, tingling, painful sensation that’s due to elevated blood sugar.

Patients can also lose feeling in the soles of their feet, so if they get cut they don’t realize it. It can get infected, get a wound that won’t heal and that infection turns into gangrene.

“That’s where the amputations come from,” Prieto said. “… It’s big if they don’t take care of themselves. That’s why it’s very important for them to check their feet every day.”

If patients bring their blood sugar down, they can get some of the feeling back.

As for eating habits, Prieto said it is better to eat at home where people can regulate what they take in. She said it’s good to order salads, but once you add the croutons, cheese, salad dressing and nuts it’s a meal.

Prieto suggests ordering lite dressing, or ordering dressing on the side because dressings tend to have a lot of fat in them.

“The vinaigrettes have a lot less grease than the ranch and the thousand island, but it depends on how much you add. You can dip the salad in the dressing,” Prieto said.

Fresh vegetables are best, but frozen are OK. Canned vegetables tend to contain a lot of salt.

“Fruit is a natural sugar source, but it’s still a carbohydrate …,” Prieto said.

Dairy also has fat, protein and sugar, which will convert to glucose, she said. Low-fat milk still has carbs.

In diabetes education classes, Prieto said patients are advised to eat healthier, do physical activity, take medication, if you’re on it, and reduce stress.

“Stress is one of the biggest things causes a lot of the elevated blood sugars,” she said.

Prieto noted that diabetes is a chronic disease.

“But ultimately it comes up to you. You are the one that will learn to control it. The doctor can help you medications. … We can give the education and help you, but it’s up the person if they are willing to do it and start taking care of themselves as medications only help so much,” she said.

A picture of a healthy retina vs. someone with uncontrolled diabetes. The healthy retina has easily visible retinal arteries and veins. The optic nerve is also clear with an unobstructed view. The other picture shows an eye of a patient who came in asking for a glasses prescription to help them see better. It turned out they had poorly controlled diabetes and glasses would not help this individual see better. It is much harder to see the retina anatomy in this picture due to leaking blood vessels and a hindered blood supply to the eye.

Courtesy photo

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