Diabetes and its complications

Q	What are the complications caused by diabetes?
A	Uncontrolled diabetes can give rise to many complications these are either acute or short tem; and chronic or long term. Acute problems are due to either low blood sugar causing hypoglycemia or high blood sugar causing hyperglycaemia or diabetes ketoacidosis.  Chronic late complications associated with diabetes are high blood pressure and heart problems leading to heart attacks and heart failure; difficulty in vision and eye problems leading to blindness; kidney problems, leading to kidney failure; nerve damage primarily leading to problems of the foot but also to problems such as diarrhoea, constipation, nausea, vomiting etc. arising from damage to nerves in other parts of the body.	Top
Q	What is diabetic retinopathy?
A	Damage to the retina, the innermost layer of the eye caused by prolonged and inadequate blood glucose control is called diabetic retinopathy. In this condition the small blood vessels in the eye are affected - the arteries supplying blood to the retina become narrow and leaky and the veins become enlarged and twisted causing fluid to leak into the retina causing swelling of the retina. Reduced oxygen supply to the retina stimulates formation of more new blood vessels, which are not stable, and bleed. Fibrous bands are formed which sometimes pull and tear the retina from the underlying attachment.	Top
Q	What are the common symptoms and causes of diabetic eye disease?
A	The early symptom of eye problem related to diabetes is blurred vision. High blood sugar changes the shape and flexibility of the lens of the eye distorting the ability to focus and causes blurred vision. Another symptom is double vision - it means two objects are seen when only one exists. It occurs when the nerves controlling the eye muscle are damaged. Cloudy vision - can occur because of cataract and swelling of the retina, it may occur over a period of months. Floating spots in the visual field - The vitreous of the eye (transparent gel like substance that helps keep the shape of the eye) contains small transparent threads, which lose their transparency with age and may be seen as dark spots or lines. Curtain like shadows in the eye - A retinal detachment or major bleeding in the retina may cause curtain like shadows in the front of the eye. Red irritated eyes may be due to infection in the eye and sudden pain in the eye may be due to raised pressure in the eye (glaucoma).	Top
Q	How is diabetic retinopathy detected?
A	Your doctor will either advise or perform certain tests to check your eyes. These include: Visual acuity (sharpness of vision) test - This eye chart test measures to see how well we can see small and large objects at various distances. Ophthalmoscopy - Examination of the eye with a fundoscope after pupil dilation. The doctor puts some medicine in the eye to widen the pupil which is the central hole in the iris or curtain of the eye, so that he can look for signs of diabetic retinopathy more clearly. He looks for changes in shape, thickness and distribution of blood vessels in the eye, or, for presence of any leaking blood vessels; swelling of the retina in general and of the macula (a special portion used for sharp vision), in particular (macular oedema); exudates - pale, fatty deposits on the retina - sign of leaking blood vessels Tonometry - A test that determines the fluid pressure in the eye to look for glaucoma	Top
Q	How is diabetic retinopathy treated?
A	The best solution is to avoid retinopathy by proper diabetes control. Depending on the severity, grade and nature of the problem there are two treatments for diabetic retinopathy. They are both very effective in reducing vision loss. Laser Surgery - Doctors perform laser surgery to burn off bleeding new blood vessel formation around the macula to save vision. Vitrectomy - Vitreoretinal surgery is done to restore vision to the eye caused by a vitreous bleed or opacity.	Top
Q	What complications take place in the eyes due to diabetes?
A	Corneal erosion - Cornea the central transparent portion in the front part of the eye can develop ulcer or erosion that may heal with difficulty and lead to corneal opacity and blindness requiring corneal transplant Cataract - Partial or complete opacity of the lens of the eye initially causes blurred vision, and later blindness Changing power of spectacles due to change in size of the lens caused by fluid accumulation Bleeding in the vitreous, macular swelling, retinal hemorrhage, retinal exudates, retinal detachment - all causing blindness Double vision due to nerve damage and paralysis of muscles that make the eyes move upwards, sideways and obliquely.	Top
Q	How does one prevent further complications of the eye due to diabetes?
A	Ensure good control of blood sugar and blood pressure to avoid further progression of eye disease. Prevention is better than cure. Quit smoking if a smoker. Ensure regular and proper check up. Children above 10 years and adults below 29 years should get their eyes tested within 3-5 years of diagnosis and then tested once a year. Adults above 30 years should get their eyes tested at the time of diagnosis of diabetes and then once a year. Pregnant women in pre diabetic state should get their eyes tested prior to becoming pregnant and then in the 1st trimester Those already diagnosed with abnormal findings of the eyes need to be tested more frequently	Top