Q: I understand that Type 2 Diabetes is common among those over 45 or with weight issues. What causes it? Are there other groups that are at a higher risk?
Dr. Gustafson: Type 2 diabetes occurs when the cells in the body do not respond to insulin normally. Insulin typically allows sugar from the bloodstream to enter cells, keeping the blood sugar at an acceptable level. When the cells do not respond to insulin and allow the sugar to enter, the sugar builds up in the bloodstream and causes problems throughout the body.
It isn’t known exactly what causes someone to have Type 2 diabetes, but there are several risk factors that contribute to a person’s risk. Being overweight is the main risk factor for developing type 2 diabetes. People with parents or siblings that have type 2 diabetes are also at a greater risk of having the disease.
Q: Will a change in a patient’s diet, exercise routine, or medication help at all?
Dr. Gustafson: The good news is that all three of those things can have a significant impact. Eating a healthy diet comprised of lean meats, fruits and vegetables can help lower one’s risk for type 2 diabetes. Exercise is another factor in decreasing one’s risk; aim for at least 30 minutes of moderate exercise per day, as approved by your physician.
There are several very effective medications available for patients with type 2 diabetes. Even when on medication, it is still important to maintain healthy eating habits and an appropriate exercise regimen.
Q: Why is it especially important for patients with diabetes or at risk for diabetes to have their eyes checked?
Dr. Gustafson: Diabetes is often first diagnosed at the optometrist’s office which makes it so important for everyone to undergo exams at regular intervals.
The eye is unique in that the blood vessels inside of the eye can be viewed directly – the eye is the only place in the body where this is possible. The fluctuation in blood sugar with diabetes places stress on the blood vessels and makes them more prone to damage. During an eye examination, the optometrist will look at your retina and inspect the blood vessels thoroughly for signs of change consistent with diabetes.
Q: What type of tests should patients with diabetes undergo at the optometrist?
Dr. Gustafson: Patients at risk or diagnosed with diabetes should have a comprehensive eye examination every year. The most important part of the examination for those with diabetes is to have their pupils dilated. This is a test where the eye doctor will use eye drops to temporarily enlarge the pupils (the black part of your eye in the center of your iris) to obtain more thorough views of the retina.
I always recommend that patients with diabetes undergo Optomap testing at my office as well. The Optomap is a scanning laser that obtains a high-resolution digital image of the retina. This allows me to inspect more closely for subtle changes and gives me a permanent record of the patient’s eye health.
Q: What does the diagnosis of Diabetic Retinopathy mean exactly? I’ve heard there are different types?
Dr. Gustafson: A diagnosis of diabetic retinopathy means that there are changes to the retina as a result of diabetes. These changes range from very mild to severe changes that can cause permanent vision loss. Diabetic retinopathy is the leading cause of blindness for US adults between the ages of 20-74, according to the CDC.
There are two different categories of diabetic retinopathy; proliferative and non-proliferative. Non-proliferative diabetic retinopathy is the less severe form of retinopathy and indicates that there is some leaking of fluid and/or blood from the vessels. Proliferative diabetic retinopathy means that new blood vessels are forming inside of the eye which is more likely to cause significant changes and/or loss of vision.
Q: What treatment options and/or care is available for this condition?
Dr. Gustafson: Typically non-proliferative changes do not require treatment, but they do require closer monitoring with frequent examinations.
Proliferative diabetic retinopathy typically requires treatment with a retinal specialist. These types of changes are most commonly treated with a series of injections of medication into the eye.