Diabetes

This page was last updated on Monday, 17 Sep 2001 at 2120Z

Diabetes is something that has been, in a manner of speaking, thrust upon me. My boyfriend is an insulin-dependent (Type I - IDDM) diabetic. I am involved with the ocular involvement and management of Diabetes on a daily basis in my profession, as an Optometrist, and I spotted the classic signs and symptoms in him in January 1997. This resulted in a burst of medical activity ending in insulin treatment and dependency within four days of my 'diagnosis'.

Type I Diabetes (Insulin dependent Diabetes Mellitus - IDDM) typically affects people who are under the age of 30 and are of slender build - Mark is now 29 and no longer skinny but his usual slim build now that his Diabetes is under control with a careful diet and 4 injections a day.

As we were well aware that Diabetes is a possible early sign of HIV infection, an HIV test was essential. We both tested negative.

The main points, from my professional point of view, in diabetic management are:

Control of blood glucose
Control of blood pressure
Non-smoking or giving it up
Awareness of the risks of pregnancy
The importance of a thorough annual eye examination, including Ophthalmoscopic and Slit Lamp examination through dilated pupils
Stress management

Also look at my boyfriend's Diabetes page and this general information site, this one too.

There follow some of the points about the possible damage to the eyes in someone who is diabetic - from Jack Kanski's book 'Clinical Ophthalmology' Fourth edition (1999) - this book is my main Ophthalmology reference book (published by Butterworth-Heinemann Ltd). Jack is an eminent Ophthalmologist who works in our area and I met him while he was examining my Dad's eyes in 1996, though we have had professional contact since 1981.

Diabetic Retinopathy

Introduction
Diabetes is characterised by sustained hyperglycaemia (raised blood glucose) secondary to lack, or diminished efficacy, of endogenous insulin. It affects between 1 and 2% of the population of the UK. Although there is a certain amount of overlap, the following are the two main types of Diabetes:

1. Insulin-dependent diabetes (IDDM), also known as Type I, which develops most frequently between 10 and 20 years of age, although elderly patients can also be insulin dependent.

2. Non-insulin dependent diabetes (NIDDM), also known as Type II, which develops most frequently between the ages of 50 and 70 years.

The prevalence of diabetic retinopathy (DR) is higher in Type Is (40%) than in Type IIs (20%), and DR is the most common cause of legal blindness in individuals between the ages of 20 and 65 years. Clinically, the three main types of DR are: (1) background, (2) preproliferative and (3) proliferative.

RISK FACTORS FOR DIABETIC RETINOPATHY

1. The duration of diabetes is the most important factor. In patients diagnosed as having diabetes before the age of 30 years, the incidence of DR after 10 years is 50% and after 30 years 90%. It is extremely rare for DR to develop within 5 years of the onset of diabetes, but about 5% of Type IIs have background DR at presentation.

2. Good metabolic control of diabetes will not prevent DR, although it may delay its development by a few years. Conversely, poorly controlled patients may develop DR sooner than well-controlled diabetics. The growing conviction that complications are linked to poor metabolic control has led to aggressive efforts to normalise blood glucose. However, in some patients, worsening of DR has been observed during the first few months of improved blood glucose control, whether achieved by continuous subcutaneous infusion with insulin pumps or by multiple injections.

3. Miscellaneous factors which may have an adverse effect on DR include pregnancy, systemic hypertension (high blood pressure), renal (kidney) disease and anaemia. If possible the latter three factors should be strictly controlled in diabetic patients.

Back to my front page