Preventing Diabetic Retinopathy

In diabetes, there is too much sugar in the blood. When the blood sugar is constantly or frequently high, many complications occur: eyesight can suffer, heart attacks, stroke, and other blood vessel problems can occur, and one’s life span can be shortened. When the blood sugar is maintained at a normal level, between 80 and 120 mg/dl, the complications of diabetes can be reduced, including serious diabetic retinopathy. Controlling blood sugar is the single most important thing a person with diabetes can do to prevent or reduce the complications of diabetes and diabetic retinopathy.

Type 1 diabetes usually begins at a young age. People with Type 1 diabetes must take insulin to survive and to control blood sugar. Most people with Type 1 diabetes take an intermediate-acting type of insulin, such as human NPH or Lente, or a long-acting type of insulin, such as human Ultralente, to provide a small, constant level of insulin throughout the day. In addition, they often take quick-acting regular human insulin before meals to control the rise in blood sugar that occurs with meals. Some people with diabetes wear insulin pumps. People with Type 1 diabetes should test their own blood sugar with a blood
sugar-monitoring device or meter several times daily so they can adjust their diet, exercise, and insulin doses to keep the blood sugar level between 80 and 120 mg/dl most of the time. They should follow a controlled diet of carbohydrates and foods that are low in fat and cholesterol. Regular exercise is also very important as it helps reduce blood sugar.

Type 2 diabetes usually starts in adult life and is often not dependent on insulin for control of blood sugar. Maintaining normal weight and a diet low in calories, fat, and cholesterol is very important. Blood sugar can be controlled either with diet alone or in combination with pills to lower blood sugar. In some cases, insulin treatment is also necessary.

All people with diabetes should remain under the care of a general physician, internist, or endocrinologist who has knowledge of the important ways to help people with diabetes carefully control their blood sugar. The doctor will probably measure the patient’s hemoglobin A1c, which reflects the average blood sugar level for the past three months, several times yearly, review control of blood sugar, and look for other complications of diabetes.

In addition to the importance of diet and exercise, there are other factors that can affect diabetes. High blood pressure is very bad for people with diabetes because it increases the likelihood of complications, including loss of vision. Blood pressure should be strictly controlled and kept normal if at all possible. Smoking is known to be particularly bad for people with diabetes because it promotes the obstruction of blood vessels.

Finally, the severity of diabetic retinopathy is often related to the length of time the person has had diabetes. It is unusual for someone with Type 1 diabetes to have significant diabetic retinopathy during the first 10 years of the disease. After 10 years, and especially after 20 years, most people with Type 1 diabetes have some retinopathy, although it may not be severe, especially if the blood sugar level has been well-controlled. In people with Type 2 diabetes, the diabetic retinopathy may be discovered shortly after, or sometimes even before, the diabetes has been diagnosed.

All people with diabetes should have regular eye examinations, particularly examinations of the retina through a dilated pupil. This is especially important to those who have had diabetes a long time. This will insure that diabetic retinopathy is not developing or progressing to a level at which laser surgery is required.

New Treatments for Diabetic Retinopathy

Many scientific studies to find new treatments for diabetic retinopathy are currently being conducted. New treatments, which may be helpful for severe macular edema, are the injection of steroid medication into the vitreous cavity, vitrectomy, or both. New drugs to prevent blood vessel leakage or closure, or new blood vessel growth (neovascularization), are also being used; new ones are also being investigated. We will be able to discuss these with you.