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Dr. John Kitchens is a retina specialist in Lexington, Kentucky. He specializes in eye problems related to diabetes. Here are some of the sobering facts on diabetes and its impact on the eyes.

Diabetes and African Americans: 

Compared to the general population, African-Americans are disproportionately affected by diabetes: 13.2% of all African Americans aged 20 years or older have diagnosed diabetes. African Americans are 1.7 times more likely to have diabetes as non-Hispanic whites.

African-American adults are 70 percent more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician.  In 2008, African American men were 2.7 times as likely to start treatment for end-stage renal disease related to diabetes, as compared to non-Hispanic white men. In 2008, diabetic African Americans were 1.7 times as likely as diabetic Whites to be hospitalized. In 2010, African Americans were 2.2 times as likely as non-Hispanic Whites to die from diabetes.

Diabetes and Eyesight: 

And diabetes can impact most systems in the body, including eyesight. Diabetic retinopathy is the leading cause of vision loss in working age patients. Diabetic macular edema (DME) is the leading cause of moderate vision loss in patients with diabetic retinopathy.

It is swelling in the light sensitive tissue in the back of the eye (the retina) in the region responsible for the central vision (the macula).  It is caused by elevated blood sugars over years that results in damage to the smallest blood vessels (the capillaries).  These blood vessels become “leaky” and this results in swelling (edema).  The most common symptom of DME is blurred vision.

Proliferative Diabetic Retinopathy (PDR) is the leading cause of severe vision loss in diabetic patients.  It occurs when abnormal blood vessels grow in the back of the eye.  These blood vessels can bleed (vitreous hemorrhage) or scar and pull the retina off the eye wall (tractional retinal detachment).

Dr. Kitchens answered your questions about diabetes below:

Is there a way to test for diabetes at home?

Although there are ways to check your blood sugars at home, the best way to check for diabetes (if you haven’t already been diagnosed) is with a fasting blood sugar level done by your physician.

I wear glasses and just found out I have high blood pressure is my kidneys. Is that because of diabetes?

It’s difficult to say. Both high blood pressure and diabetes can affect your kidneys.  It is best to ask your doctor.

Doc, I drink coffee and eat sweets. What can I do to live longer?

The first thing is to do these things in moderation. Drinking too much coffee or eating too many sweets can cause problems.

I’m borderline diabetic. What is the best way to keep my sugar down?

The first thing is to routinely check your sugars – too many times people just don’t know how high their sugars are. The second thing is diet. Eat as healthy as possible. Drink water routinely but not excessively. Try to exercise daily. Take your medications as prescribed by your doctor. These are all healthy tips which can help lower your blood sugar level.

How is it that one can have diabetes for 8-10 years and not know it? Is that because there is not a wellness program where the person is visiting the doctor on a regular basis?

Diabetes can be very “sneaky.” Often in  the first few years, people just feel fatigued and may have increased thirst or urination. Without routine visits to the doctor and regular laboratory testing (especially important if you’re noticing these symptoms) it would be impossible to know that you have elevated blood sugar levels.

In order to dilate your eyes, must they use drops?

Yes.

Recently, I get numb hands and arms when I sleep in the wrong position. The numbness used to go away, but now stays in my fingertips on one side. Is it diabetes?

This is unlikely to be diabetes and more likely a problem with nerve compression. It’s best to see your doctor about this.

I have a cousin who is diabetic, He had surgery on his eyes to clear the nerve growth. He was told he might lose his vision but it would come back gradually. What is going on? 

Abnormal blood vessels can grow in the back of the eye. This is the most severe form of diabetic retinopathy called proliferative retinopathy. Injections into the eye, laser, and even surgery may be necessary to treat this stage of diabetic eye disease.

What are some things you can do to lower your blood sugar levels? 

Maintaining a healthy diet and taking your medicines as prescribed along with routine exercise are the most critical components of maintaining a low blood sugar level.

What about swelling of the legs? Is that a part of diabetes?

Swelling of the legs is not routinely seen in diabetes. It can be a sign of heart or kidney disease. It’s best to check with your doctor.

Do you have any information on injections in the eye to help patients with diabetic vision loss?

Yes. There are a variety of medications which can be injected into the eye and can result in improvement in vision. The decision as to which medication to use depends upon how your eyes are affected. If you do need treatment for diabetic vision loss, it’s best to see a retina specialist who can diagnose the cause of vision loss and discuss the treatment options with you.

What causes diabetes? And if you are pre-diabetic, what are the best things to eat and will it ever go away?

There are two types of diabetes, type I and type II.  Type I diabetes often occurs in younger people is caused by a failure of the pancreas to create insulin.  Type II diabetes often occurs in older patients and is due to the body’s resistance to insulin, rather than a lack of insulin. For type I patients, it is unlikely to “go away.”  In some cases of type II diabetes, weight loss can reverse the diabetes.

I’m borderline diabetic, what is the best way to keep my sugar down?

Diet and exercise are the most important aspects of blood sugar control.

I caught the end of the doctor’s segment. I’m a diabetic who lost the vision in my right eye. What is the retina transplant for?

Tom was likely referring to a corneal transplant. Currently, there is no way to transplant a retina.

If you have constant watering of the eyes throughout the day, what could that be?

It is most likely ocular surface dryness (a.k.a. dry eyes).

What can we eat to prevent diabetes?

Reducing refined sugars (high fructose corn syrup) is the best way to avoid diabetes.

My daughter was born with cataract all over her left eye. She underwent surgery at age 4  and had an implant. We were told to patch and she would see about 80% by 10 years old. She is now 14 and not seeing out of the eye. She saw a specialist at Emory last year, but no improvement.

It is tough to make a diagnosis without seeing the patient. Often when a child has a “lazy eye” (amplyopia), if it is not corrected by the age of 8 or 9 with patching – it is impossible to regain vision.  It is best to talk with her doctor about why she is not seeing.

With diabetes and blindness being related, what are some of the first indicators that you may be diabetic?

Increased thirst, urination, fatigue are some of the clinical symptoms.

What should my numbers be? How often should I check them?

As a rule of thumb, it’s best to have your sugars below 140. If you are really well-controlled or have mild diabetes, checking your sugars once or twice a day may be sufficient. If you are poorly controlled or have worse diabetes then you may want to check your sugars three or four times a day.

My HGA1C is at exact level where diabetes starts. Instead of taking pills, I exercise 6 days a week. When should I get checked again. It’s been 3 months. I don’t have health insurance.

Given your excellent history of exercise and borderline A1c level, it’s probably reasonable to be rechecked in 6 to 12 months.

What do you do if you have kidney trouble and it cause a lot of swelling?

This is a complicated question which depends on the cause and degree of your kidney trouble. You should talk to your physician about your specific case and a treatment plan.

Dr Kitchens, I’m a female African American 5” 5″ 150 lbs. I exercise frequently, don’t eat a lot of sweets, soft drinks, pasta, breads, etc. I’m 59. My last two AIC count was 5.8. I do drink wine daily, about 8 oz. What can I do to lower my A1C count?

It sounds like you’re doing everything right. It’s a very difficult to lower  your A1c when it is fairly low already. This level should be safe when it comes to diabetic eye disease, kidney disease, or nerve disease. Stay diligent and keep up the good work!

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