Diabetic retinopathy is the leading cause of blindness in the developed world. Its ability to cause the disease of blood vessels of the retina is the primary cause for blindness in both type 1 and type 2 diabetes patients. It's time to take action and save your eyes! Introduction Diabetes Mellitus has more than what meets the eye - causing one to lose his or her sight. Almost all type 1 diabetes patients and 60% of type 2 diabetes patients have a certain degree of diabetic eye disease within twenty years of onset of the disease. On a more alarming note, a study by Wisconsin Epidemiologic Study of Diabetic Retinopathy showed that 3.6% of type I diabetics and 1.6% of type 2 diabetes patients were legally blind.
What is diabetic retinopathy?
To the public, Diabetes Mellitus usually brings with it images of amputated limbs, people with kidney failure undergoing dialysis and even the occasional heart attack. Sadly, the message of the complications of diabetic retinopathy has not been brought into focus. The primary reason could be because of the myriad of complicated terms that patients find hard to digest. In simple terms, diabetic retinopathy is basically the disease of the retina - the photographic film at the back of the eye that a person's visual images are focused upon. The macula is a particular spot on this 'film' that is responsible for our central vision. On the 'film' itself are many small vessels that deliver nutrients to it. Diabetes, being a disease of blood vessels, attacks the very walls of the vessels on the retina and causes the leakage of proteins and fats from these vessels. The end result? Thickening of the wall of the retina and the macula, as what is termed medically, Macular Edema. This can lead to the loss of our central vision and the distortion of the images focused upon the retina. Other complications include bleeding into the retina (retinal haemorrhages), formation of abnormal vessels (microaneurysms and venous beading) and, on a more serious note, formation of new blood vessels leading to bleeding into the vitreous jelly and detachment of the retina from the wall.
Screening for diabetic retinopathy
The dire consequences of complacency are enough to scare one into action. How does one get started? Firstly, it is recommended that for type 1 diabetes patients, first time screening of the eye should be done within three to five years of diagnosis of disease. For type 2 diabetes patients, screening should be done at the time of diagnosis. The urgency is because many of these diabetes patients would have already had diabetes for six to seven years but have not had prior knowledge of it. Screening of the eye involves taking photographs of the fundus of the eye and subsequent yearly follow-ups to record any progression of the disease. This can be done at the regular outpatient polyclinics or at the general practitioner's clinics with the appropriate facilities.
When do I need to see the eye specialist?
So when does the diabetes patient see the ophthalmologist? Diabetic retinopathy is basically classified into non-proliferative and proliferative type. The former is divided into mild, moderate and severe depending on the classification of the retinal picture. Referral to the ophthalmologist has to be made once the diagnosis of severe non-proliferative type or the proliferative type is made. This is to allow for the early intervention of laser to halt the progression of the disease before it bourgeons into more serious complications. In addition, if the patient complains of sudden onset of worsening of vision and is found to have more serious complications like bleeding into the vitreous or even detachment of the retina, urgent referral to the ophthalmologist has to be made for surgery. However, if the disease has already reached this stage, the visual prognosis would likely remain poor even with surgical interventions. Take action before it is too late.
Do I need to be follow-up regularly?
The story does not end here. Even with the intervention of laser and surgery, it is still crucial for the patient to continue follow-ups to monitor disease progression. For the mild to moderate type of non-proliferative diabetic retinopathy, it is recommended to have follow-up every six to 12 monthly but for the severe type, it is recommended to have one to four monthly follow-ups. For the proliferative type, urgent laser treatment is needed. Always ask your family doctor for his or her recommendations for the duration of follow-up according to the clinical guidelines.
Take charge
You need to take charge and be responsible in ensuring that there is adequate and good control of the blood sugar level and blood pressure. Studies have shown that poor control of these two factors could worsen the progression of diabetic eye disease. In diabetes patients with hypertension, it is recommended by the UKPDS study to have tight control blood pressure below 130/80mmHg to prevent diabetic complications.
Save your Eyes
Diabetes is a battle that can be fought if the proper armour is used. The same is true for diabetic eye disease. Armed with the above information, the patient and the physician can work hand in hand to prevent vision impairment. The message to the diabetic patient is clear - save your sight before it is too late.
Read more about how many have fought and won with dbethics. Read it at www.dbethics.com; www.springwell.biz
Friday, October 3, 2008
Oh No I have Diabetes !
What goes on in your head and heart when you find out you have diabetes? Is it the end of the road? After weeks of constantly feeling tired and thirsty, being plagued by mood swings and poor sleep, you muster enough courage to see a doctor and he gives you the bad news - you have diabetes. You try to make sense of the slew of instructions about medication, diet, blood testing regime and lifestyle changes. Before you can catch your breath, you are due to see the dietitian and diabetes nurse educator.
How did you feel? Lost? Confused? Overwhelmed? Angry? Disbelieving? Guilty? Afraid? How else can you feel? After all, you have just been told that you are stuck with an incurable illness for life. Rest assured, these emotions are natural - it's called "grief".
WHAT IS THIS GRIEF? Grief is a natural response to loss. We grieve for the loss of a loved one or precious item. We experience grief when we lose our health and even a certain way of life. You may have felt as if some part of you died when you found out you had diabetes. Your future seems so uncertain. You mourn for the loss of being "normal". With all the changes (insulin, oral medications, home glucose monitoring) needed now, life dust isn't the same. You may also resent the food restrictions.
Such negative feelings are all part of the bereavement process. Grief is not necessarily a bad thing. It usually opens our eyes and changes our attitudes. While grief is normal, incomplete recovery from loss can have a lifelong effect on a person's capacity for happiness.
It is important to work through the different stages of grief. Elizabeth Kubler-Ross identified the different stages of grieving using an abstract model. The stages are, however, not as neatly experienced as they are described. People seldom move from one stage to another in a straight line. You may find yourself in more than one stage at a time. You may also find yourself moving back and forth between stages or be stuck in one.
Denial - the initial reaction
You may initially refuse to believe what you heard from your doctor. Did you perhaps request more blood tests? Did you seek a second opinion? Perhaps you have chosen to disregard your doctor's advice and refused to take your medicine or make lifestyle changes.
Anger - reality sets in
As the reality of diabetes takes root, feelings of anger. and a sense of unfairness may begin to surface. You resent your loved ones and blame them for this disease. You may be angry with yourself or even God for "giving" you diabetes.
Bargaining - your head takes over
At this point, reason and logic take over. You realise that this disease is not going away. So what do you do now? You try to delay taking medicine by losing weight or becoming more conscientious in controlling your diet.
Depression - the full impact sinks in
When realisation finally sinks, you feel the full force of how serious your condition is and how much change you need to make. You feel very heavy hearted and depressed. It is common for newly diagnosed diabetics to feel depressed, overwhelmed, hopeless and helpless.
Acceptance - at peace with yourself
This is the ultimate stage where we hope to be. It means that you are finally dealing with the reality of diabetes. The condition is now part of your daily living. You have a sense of hope and a positive frame of mind.
HOW TO HANDLE IT
Have a good support network
• Identify some people whom you trust to help you
• Let them know that you may need their moral support
• Surround yourself with people who care and whom you feel comfortable with.
Don't be afraid to ask for help
• To ask for help does not mean that you are incapable or weak
• Let yourself be helped by your friends and loved ones. It is okay to ask for help every now and then
Talk
• Do not keep things bottled up inside
• Stress is bad for you and may worsen your diabetes
Permit yourself to feel
• Let yourself feel sad, angry or even cry
• It will be better to let it out than fight your emotions
WHEN TO SEEK PROFESSIONAL HELP?
• When your sadness is starting to interfere with your daily routine
• When you neglect taking care of yourself and your health.
• If you feel that you are unable to cope with your grief alone anymore
Seb Thiam is a health volunteer passionate to help those who have diabetes Type 1 and 2 control their blood glucose level. After seeing many who suffered from complications of Diabetes including a relative who died of it at age 30. He would like to Unite To Fight Diabetes with those who are equally interested in this subject.
Check out how celebrities fight diabetes and win at www.dbethics.com
www.springwell.biz
How did you feel? Lost? Confused? Overwhelmed? Angry? Disbelieving? Guilty? Afraid? How else can you feel? After all, you have just been told that you are stuck with an incurable illness for life. Rest assured, these emotions are natural - it's called "grief".
WHAT IS THIS GRIEF? Grief is a natural response to loss. We grieve for the loss of a loved one or precious item. We experience grief when we lose our health and even a certain way of life. You may have felt as if some part of you died when you found out you had diabetes. Your future seems so uncertain. You mourn for the loss of being "normal". With all the changes (insulin, oral medications, home glucose monitoring) needed now, life dust isn't the same. You may also resent the food restrictions.
Such negative feelings are all part of the bereavement process. Grief is not necessarily a bad thing. It usually opens our eyes and changes our attitudes. While grief is normal, incomplete recovery from loss can have a lifelong effect on a person's capacity for happiness.
It is important to work through the different stages of grief. Elizabeth Kubler-Ross identified the different stages of grieving using an abstract model. The stages are, however, not as neatly experienced as they are described. People seldom move from one stage to another in a straight line. You may find yourself in more than one stage at a time. You may also find yourself moving back and forth between stages or be stuck in one.
Denial - the initial reaction
You may initially refuse to believe what you heard from your doctor. Did you perhaps request more blood tests? Did you seek a second opinion? Perhaps you have chosen to disregard your doctor's advice and refused to take your medicine or make lifestyle changes.
Anger - reality sets in
As the reality of diabetes takes root, feelings of anger. and a sense of unfairness may begin to surface. You resent your loved ones and blame them for this disease. You may be angry with yourself or even God for "giving" you diabetes.
Bargaining - your head takes over
At this point, reason and logic take over. You realise that this disease is not going away. So what do you do now? You try to delay taking medicine by losing weight or becoming more conscientious in controlling your diet.
Depression - the full impact sinks in
When realisation finally sinks, you feel the full force of how serious your condition is and how much change you need to make. You feel very heavy hearted and depressed. It is common for newly diagnosed diabetics to feel depressed, overwhelmed, hopeless and helpless.
Acceptance - at peace with yourself
This is the ultimate stage where we hope to be. It means that you are finally dealing with the reality of diabetes. The condition is now part of your daily living. You have a sense of hope and a positive frame of mind.
HOW TO HANDLE IT
Have a good support network
• Identify some people whom you trust to help you
• Let them know that you may need their moral support
• Surround yourself with people who care and whom you feel comfortable with.
Don't be afraid to ask for help
• To ask for help does not mean that you are incapable or weak
• Let yourself be helped by your friends and loved ones. It is okay to ask for help every now and then
Talk
• Do not keep things bottled up inside
• Stress is bad for you and may worsen your diabetes
Permit yourself to feel
• Let yourself feel sad, angry or even cry
• It will be better to let it out than fight your emotions
WHEN TO SEEK PROFESSIONAL HELP?
• When your sadness is starting to interfere with your daily routine
• When you neglect taking care of yourself and your health.
• If you feel that you are unable to cope with your grief alone anymore
Seb Thiam is a health volunteer passionate to help those who have diabetes Type 1 and 2 control their blood glucose level. After seeing many who suffered from complications of Diabetes including a relative who died of it at age 30. He would like to Unite To Fight Diabetes with those who are equally interested in this subject.
Check out how celebrities fight diabetes and win at www.dbethics.com
www.springwell.biz
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