Ref: CHB/News Bulletin/004/2012

DIABETES
"When Sweet becomes Sour"

Diabetic Eye Disease
"Of all the senses, sight must be the most delightful." - Helen Keller

Diabetes And Cataracts?

diabetes_4aThe either constant or episodic high blood sugars that a diabetic is exposed to causes the lens of diabetic patients to swell. Over time this causes changes in the lens that cause it to become less transparent.

diabetes_4bDiabetics who suffer from cataracts need to have them removed to allow for the essential examination of other parts of the eye, damage to which can lead to more serious types of blindness which are less easily treated.Cataracts can now be easily removed by a procedure known as phacoemulsification.

Diabetes and Glaucoma

Glaucoma is a condition characterized by loss of side vision due to damage to the eyes nerve due to high eye pressure. Though diabetes is not the only risk factor for development of glaucoma, it is one of the most important. If increased eye pressures are picked early, medications can be used to preserve vision.

diabetes_4c

However, most people who begin to lose vision due to high eye pressure do not report symptoms until it is too late. This is because vision that is lost in glaucoma is from the side first which is usually not noticed. Unfortunately vision lost due to glaucoma cannot be recovered and thus it is important for diabetics to regularly check their eye pressure.

Diabetic retinopathy:

The retina of the eye is part of the eye on which pictures are formed and transmitted to the brain. It is like the film of a camera. As with other parts of the body, the blood vessels of the eyes of a diabetic, with time begin to undergo changes. These changes can eventually stimulate the growth of new blood vessels in the light sensitive retina of the eye. These newly formed vessels are fragile and can cause bleeding into the retina. This can lead to permanent blindness if not detected early. However if noticed early by the eye specialist laser therapy can be used to prevent further new vessel formation and thus preserve sight.

The diabetic eye visit

As mentioned earlier it is important for diabetics to visit an eye specialist once a year. The eye specialist will check a number of things during this visit. First to be checked is usually the central vision. This is checked by asking the patient to read letters on a chart placed 6 feet from the patient. After this the patient's side vision is tested using a special machine. This provides information about early vision loss due to high eye pressure.

The eye specialist will then examine the eyes in detail from outside to in. eye pressure is measured, cataracts are looked for and most importantly the retina is examined. This examination of the retina is an invaluable examination because it gives an idea about the state of vessels of a diabetic; the eye is the only place in the body where vessels can be seen directly. If these vessels show changes due to diabetes then it gives the physician the idea that other parts of the body will also be suffering from complications.

DIABETES IN PREGNANCY

Pregnant women can suffer from two different types of diabetes. Some women may already be diabetic and then become pregnant. Other women who were not diabetic previously may develop high sugars during their pregnancy only. This type of diabetes occurs due to hormonal changes during pregnancy. Both types of diabetes in pregnancy require special care. The obstetrician and physician need to work together to ensure the birth of a healthy baby to a healthy mother.

How Does Diabetes affect the unborn child?

Babies born to mothers who suffer from diabetes are at risk of suffering from a number of complications. In the mother's womb babies of diabetic mothers are exposed to their mother's high blood sugars. As a result the babies own bodies over secrete insulin. Apart from helping the body to utilize blood sugar, insulin also plays a role in growth. In babies of diabetic mothers the constant over secretion of insulin in their own bodies leads to excessive growth of the baby and an abnormally big baby. In addition these babies are at risk of developing abnormally. They are at high risk of having abnormalities of the heart. Also often the lungs do not mature completely leading to breathing problems at the time of birth.

Also the risk of having a complicated pregnancy with fetal loss, still births and preterm deliveries is greater than in non-diabetic women.At the time of delivery because of their big size babies of diabetic mothers run the risk of getting the shoulder stuck in the birth canal. This leads to injury at the time of delivery. Also once the baby is born, the high insulin levels that the baby had needed earlier now causes the babies sugar to plunge down leading to dangerously low sugar levels. This can cause twitching or even fits in the baby. Infants of diabetic mothers are also more prone to develop jaundice after birth.

What care should a pregnant diabetic woman take to prevent these complications?

For those women who are diabetic prior to their pregnancy it helps to plan the pregnancy. Before trying to conceive the doctor should be consulted. At this time the doctor will advise you on how to improve your blood sugar control and will also adjust your treatment so that none of your medications will harm your baby.

In addition you will be evaluated for diabetic complications especially eye and kidney and cardiovascular complications. Diabetic eye disease is twice as likely to progress during pregnancy and so frequent checkups are required during the pregnant state.Regular follow up with both the physician and obstetrician is important. Women are recommended to get a special can of their babies in the second trimester to look for heart problems.

How is diabetes treated during pregnancy?

Just as in non-pregnant patients, diabetes is treated with a combination of dietary changes and medications. However there are some differences between treatment in the pregnant and non-pregnant state. Firstly weight loss is usually not recommended. Instead women are advised by their doctors on what is appropriate weight gain for the. Second, though dietary restrictions are needed, these restrictions should not deprive the fetus of its requirements. A healthy diabetic diet for pregnancy uses fruits and whole grain for the required carbohydrates avoiding refined sugars. In addition it is advisable to eat smaller portions more frequently.

To know whether the diet you are following is working well for you and your baby it is essential to monitor your sugars closely. It is also important to have regular visits to your doctor and obstetrician who will check you sugar charts, monitor your weight as well as your baby's growth.

Most women in pregnancy whose sugars are not controlled on diet are put on insulin. Usually tablets are not used to treat diabetes in pregnancy because lack of safety for the baby. However metformin and glyburide are two tablets that are allowed to be used in the treatment of diabetes during pregnancy.

Dr Nasreen Hirji

Extracted from www.bbc.co.uk

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