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Magazine
An eye on diabetes
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World Diabetes week is being observed from November 14 to 21. Its focus this year is eyecare in diabetes mellitus, writes Dr. T. SELVARAJU.
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DIABETES mellitus is an endocrine carbohydrate metabolic disorder in which blood sugar is increased from the normal 90-110 mg/100ml (or Post Prandial 140mg/100ml with glycosuria — sugar in the urine) due to absent or reduced secretion of insulin by the beta cells of islets of Langerhans present in the pancreas.
There are two types of diabetes mellitus — Type I (young diabetics) or Insulin dependent Diabetes Mellitus (I.D.D.M.) is treated with injection insulin only. Type II, or Non Insulin Dependent Diabetes Mellitus (N.I.D.D.M.), is treated with tablets alone (Metformin, Glibenglamide, etc) or tablets with injection insulin (Human insulin is preferable).
Hypoglycemia is a condition in which the blood sugar is very low and the person may go into a coma (unconsciousness) and is likely to occur in the early treatment of diabetes mellitus if he does not have his meal on time. The earliest symptoms are sweating, confusion, a loss of balance, cloudiness of vision and diplopia (double vision). The immediate treatment is to have a little sugar.
Hyperglycemia is a condition in which the blood sugar is high and the person may go into a diabetic coma (unconscious) stage. It is likely to occur when the patient is not treated at all, is not following treatment or even consuming more sugar. It is treated with insulin only in the hospital.
Diabetic retinopathy is a major cause of blindness and depends upon heredity, duration of diabetes mellitus — more than 10 years, diet, pregnancy, control of diabetes mellitus, smoking, physical exercise and control of cholesterol and hypertension.
Treatment:
Prophylaxis: Management of the risk factors in diabetes retinopathy is more important to have a good life.
Heredity is considered to be the chief factor and it is ideal to have counselling before marriage.
Obesity: Weight reduction is a must according to the person's height and age.
Fundus examination: If a person has had diabetes mellitus for a decade, it is recommended that a fundus examination is done. Prophylactic application of laser to the retina may be necessary to preserve vision.
Pregnancy aggravates simple and proliferative diabetic retinopathy. It is ideal to limit the number of pregnancies.
Smoking and tobacco in any form is to be avoided because it constricts the blood vessels and reduces the blood supply to the retina.
High blood pressure reduces the blood supply to the retina by reducing the size of the artery and must be controlled.
Increased blood cholesterol is responsible for thickening of the arteries and reduced blood supply to the retina. It is ideal to stop the intake of saturated fat like butter, ghee, cheese and poultry products, and have fresh vegetables and fruits.
Avoid a sedentary lifestyle. Physical exercise like walking for 45 minutes every day is good to control blood sugar.
Treatment:
Medical treatment with human insulin or anti-diabetic tablets or tablets with injection insulin and control of blood sugar definitively prevents and postpones the appearance of diabetic retinopathy.
Argon or krypton laser is used in treatment.
Kidney transplantation may be necessary when there is proliferative diabetic retinopathy.
Early transplantation of pancreas with beta cells of islets of Langerhans is a complete cure for diabetes mellitus.
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