Most Diabetes Patients Skip Eye Exams

This is something I do not understand. Why about 60 percent of people with diabetes do not have annual eye exams is a real puzzle. I was told to have an eye exam shortly after being diagnosed with type 2 diabetes. I had my exam within 4 months and would not have changed doctors if it had not been for a change in prescriptions that the office would not make right after giving me glasses that were creating vision problems.

I was fortunate when I changed eye doctors and the eye doctor could see what was causing the problem and ordered me a new set of glasses that really helped me. I have stayed with this office and have received the care I needed.

People with diabetes are at increased risk of developing serious eye diseases, yet most do not have sight-saving annual eye exams, according to a large study presented this week at AAO 2016, the 120th annual meeting of the American Academy of Ophthalmology. This is especially timely as the Academy is reiterating the importance of eye exams during the month of November, which is observed as Diabetic Eye Disease Awareness Month.

Researchers at Wills Eye Hospital in Philadelphia have found that more than half of patients with the disease skip these exams. They also discovered that patients who smoke as well as those with less severe diabetes and no eye problems were most likely to neglect having these eye exams.

The researchers collaborated with the Centers for Disease Control and Prevention to review the charts of close to 2,000 patients age 40 or older with type 1 and type 2 diabetes to see how many had regular eye exams. Their findings over a four-year period revealed that:

• Fifty-eight percent of patients did not have regular follow-up eye exams

• Smokers were 20 percent less likely to have exams

• Those with less-severe disease and no eye problems were least likely to follow recommendations

• Those who had diabetic retinopathy were 30 percent more likely to have follow-up exams

One in 10 Americans has diabetes, putting them at heightened risk for visual impairment due to the eye disease diabetic retinopathy. The disease also can lead to other blinding ocular complications if not treated in time – think cataracts, glaucoma, and a few others. Fortunately, having a dilated eye exam yearly or more often can prevent 95 percent of diabetes-related vision loss.

Eye exams are critical as they can reveal hidden signs of disease, enabling timely treatment. This is why the Academy recommends people with diabetes have them annually or more often as recommended by their ophthalmologist, a physician who specializes in medical and surgical eye care.

"Vision loss is tragic, especially when it is preventable," said Ann P. Murchison, M.D., MPH, lead author of the study and director of the eye emergency department at Wills Eye Hospital. "That's why we want to raise awareness and ensure people with diabetes understand the importance of regular eye exams."

The Academy has released a new animated public service announcement to help educate people about the importance of regular exams and common eye diseases including diabetic retinopathy. It encourages the public to watch and share it with their friends and family.

"People with diabetes need to know that they shouldn't wait until they experience problems to get these exams," Rahul N. Khurana, M.D, clinical spokesperson for the Academy. "Getting your eyes checked by an ophthalmologist can reveal the signs of disease that patients aren't aware of."

American seniors 65 and older may be eligible to get a medical eye exam at no cost through Eye Care America, a public service program of the Academy.

With Diabetes – Stay Positive

Diabetes can bring out the best and the worst in people. We should always look for the best and stay positive in our actions and thoughts. People newly diagnosed can have shock or even wonder how this happened, but should never develop anger or a negative attitude. Doing either may cause significant problems later in the management of their diabetes.

Yes, it takes a big commitment to keep your diabetes in check. Even so, you’ll be more motivated on some days than others, or you wonder how it’s going. Time for a fresh perspective! You can counter these negative thoughts whenever they strike.

The negative - ‘I Don’t Have Time to Exercise.’ Rethink It: Take it 10 minutes at a time. Tell yourself, “I don’t have to do it all at once.”

Exercising doesn't have to take a lot of time. Even a little will give you a burst of optimism and energy. Try 10-minute spurts of activity. You won’t need to change your clothes.

For example, instead of playing solitaire on your phone when you’re in a waiting room, ask the attendant if you have time to take a 10-minute walk around the

parking lot before your appointment.

The negative - ‘What's the Point?’ This is a classic "it’s too late for me" thought. Your goal weight feels always out of reach. Maybe you’ve tried to get there before and have been disappointed.

Rethink It: Bring your thoughts back to the here and now. Mental health experts say most anxiety comes from worrying about the future. The more you focus on what you can do today, the better.

Little steps, over time, will move your health in a positive direction. Ask your doctor to help you set mini-goals along the way to your ultimate goal. You want reachable goals that you can build on. For instance, if you lose a little bit of weight at a time, it can lower your blood sugar levels and blood pressure sooner than you may think.

Start slowly. First, learn to eat more fruits, vegetables, and protein.

The negative - ‘I've Blown It!’ This is the "all is lost" attitude. You didn’t follow your meal plan when you ate a giant plate of macaroni and cheese, and now you think you’ve wrecked all your progress.

Rethink It: Give yourself credit for your good food choices. It could be that you used to overeat all the time, and now you’ve had balanced meals most days this week.

Aim for progress, not perfection. You don't have to give up your favorite foods completely. Just account for the carbs.

Set the setbacks aside. Tell yourself, “I can get back on track,” and the possibilities open back up.

3 More Ways to Shift Negative Thinking

It takes practice to turn your inner voice into your friend instead of your critic. Make it a habit with these tips:

#1. Keep a journal. Write down your thoughts. After about a week, read it to look for patterns.

#2. Write positive messages for yourself, like “I am healthy." "I am strong." "I am managing my health well.” Put them in places you'll see every day -- your wallet, bedside table, near your toothpaste.

#3. Make a point of saying something positive to yourself every time you look in the mirror. “Nice smile!” “My hair looks really good today!” “This is a great color on me!”

You would be surprised what a positive attitude can do for you. Granted, it will not prevent mistakes, but a positive attitude will help you minimize them and return to good habits.

Health Is Everything

A few months ago, I would not have given this a second thought, even with type 2 diabetes. Now it is part of my everyday thoughts and wondering how to improve my health.

What happened? On September 7, I was taking a trash bag out to the curb to have it ready for pickup the next day. As I set the bag down, I apparently caught my left foot in the crab grass growing near the sidewalk and over I went, full out onto the street.

When I came aware in a few minutes, I attempt to get up. However, the pain in my left shoulder would not allow any weight on it. The only thing I could determine was that I had injured my shoulder in trying to break my fall. About 15 minutes later, two individuals coming to visit someone in the apartment building next door stopped and asked if I needed help. My answer was yes.

They were able to get me into a sitting position and then my neighbor arrived and with him pulling on my right arm and the two of them grabbing my pants and lifting, I was standing. My neighbor was able to walk me to my entrance and I was able to get into my apartment.

After cleaning myself off, I knew I was in trouble and drove myself to the local hospital emergency room. After about 30 or more minutes of them prodding and poking me, I was sent for x-rays of my shoulder. My shoulder socket was separated from the ball of my left arm and the ball was broken, a crack extended almost to my elbow and the elbow was cracked. I was fitted with a motion immobilizer and a sling. I was given a class 2 narcotic pain killer and sent home with instructions to see a bone doctor as soon as possible.

Because my wife would not let me drive, the appointment was delayed for two days and I needed more pain medication. Because of all the fuss and restriction placed on class 2 pain meds, they can no longer call them to your pharmacy and the pharmacy can no longer receive a call or fax for these meds. A patient can carry a prescription once he/she has seen a doctor. As a result, I could only receive a prescription for tramadol.

The following week went okay, as I was able to avoid any pain meds. The following Monday and Tuesday, I required some pain meds and I took some of the tramadol. Unfortunately, not having taken tramadol, I had forgotten my blog here about tramadol, and did I receive a shock when I finally was awakened on Wednesday morning. I had received a shot containing glucose because my blood glucose level was 24 mg/dl. I was asked to have something more as the 15 minutes had passed. I asked for the gel as it had 25 grams of glucose. No, I don't remember my reading before the gel, but 15 minutes later, it was 60 mg/dl. At that point, I was able to get up and be dressed. They, my wife included, still wanted me to go to the hospital emergency room.

Once there, I was given more carbs – too many as far as I was concerned and after I was given a new chart for my insulin dosage, I was sent home. It is only a short walk, but my glucose reading at home was 164 mg/dl. I am very unhappy with the new insulin chart now that I am more than a month away and have adapted the chart to my needs. My insulin needs have decreased as my weight has dropped and I am using less insulin.

Next, I have had a prostate biopsy and that result showed that I now have prostate cancer. I will not know more until the last of this month when I will see the Urologist again.

If you are wondering about how important your health is, and if reading this hasn't caused some concern, just realize how quickly the situation can change. I will update this as I learn more and my arm continues to heal.

Diabetes Complications and Preventing – Part 2

Eye Damage (Diabetic Retinopathy)

To protect your vision, see an eye doctor at least once a year. He should dilate your pupils while you're there. People with type 1 diabetes who are older than 10 should start these visits within 3 to 5 years of diagnosis. If you have type 2 diabetes, make an appointment as soon as you’re diagnosed. If you have problems, you’ll need to go more often. If you get pregnant, schedule a comprehensive exam during the first trimester and a follow-up later in your pregnancy.

Gastroparesis

Diabetes can damage the nerves that control your stomach so they stop working properly. Known as gastroparesis, this condition causes it to take too long to empty. That makes it hard for you to manage blood sugar levels. Sometimes a change in diet can help. There are medications and other treatments, too.

Erectile Dysfunction

Diabetes makes men more likely to get erectile dysfunction or become impotent. Sometimes all you need to do is adopt a healthier lifestyle, quit smoking, exercise regularly, and reduce stress. It's important to talk to your doctor about these problems. He can suggest medications or remedies like a vacuum constriction device and other products.

Skin Problems

Many people with diabetes will have a skin condition related to it at some time in their lives. The sugar in your blood provides a perfect breeding ground for bacteria and fungi. It also lowers your body's ability to heal itself. Fortunately, most of these problems can be prevented and treated if caught early on. If you have type 2 diabetes and don’t take care of yourself, a minor scratch could turn into a serious infection.

Infection

Type 2 diabetes slows your body's ability to fight infection. High sugar levels in your body's tissue means bacteria grow more easily and infections set in more quickly. Common sites for them are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment can prevent serious complications.

Dental Problems

The less controlled your blood sugar is, the more likely you’ll have problems in your mouth. That’s because the disease harms white blood cells, which are your body's main defense against oral infections. Brush, floss and rinse with antiseptic mouthwash each day. See your dentist for regular cleanings and checkups.

Diabetes Complications and Preventing – Part 1

How to Prevent Diabetes Complications

If you have diabetes, you spend a lot of time keeping it under control. That’s good because it can cause a lot of complications that can affect nearly every organ in your body. Learn what you can do to prevent these problems.

Heart Disease

This is one of the most common diabetes complications. In office visits, your doctor may do tests that screen for heart disease to help you prevent serious problems. At every visit, he’ll check your blood pressure. He’ll probably test your blood for cholesterol level and triglycerides at your first visit. And he should do an EKG as part of a complete medical record. Learn more about your risks for heart disease. Does it run in your family? Do you smoke? Make a prevention plan that includes weight loss, regular exercise, and stress management, as well as keeping your blood pressure, cholesterol, and triglycerides at normal levels.

What Are the Complications of Diabetes?

Stroke

Symptoms of a stroke include:

• Sudden weakness on one side of the face or body
• Numbness in the face, arm, or leg
• Trouble speaking
• Trouble seeing
• Dizziness

If you have any of these, see a doctor immediately. He may refer you to a neurologist or other stroke specialist.

Kidney Disease (Diabetic Nephropathy)

If you have diabetes, get your urine tested every year to look for kidney disease. Your doctor should do a creatinine blood test to check how these organs are working. He’ll also check your blood pressure regularly. It's key to slowing this disease. Your reading should be less than 130/80.

Nerve Damage (Diabetic Neuropathy)

Over time, diabetes can cause nerve damage. You might feel numbness, burning, or pain in your hands, feet, or legs. If your skin loses feeling, you may not notice small wounds that could grow to become bigger ones. Check these parts of your body daily for redness, calluses, cracks, or other damage. If you notice any of these symptoms, tell your doctor right away.

Diabetic Shock – Part 2

How Is Hypoglycemia Treated?

If your hypoglycemia is mild or moderate, the best way to raise your blood sugar level quickly is to eat or drink some form of sugar. You might take glucose tablets, which you can buy at the drug store. Alternatively, you may want to drink a half a cup of fruit juice or eat five to six pieces of hard candy.

Other snacks you can use to raise your sugar level include:

• One-half cup of regular soda -- not diet
• Cup of milk
• 1 tablespoon of sugar
• 1 tablespoon of honey
• One-quarter cup raisins
• 2 large or 6 small sugar cubes dissolved in water

You can also ask your doctor or certified diabetes educator (CDE) for recommendations for other snack items that can help raise your blood sugar level when you need to.

After you've taken a snack, wait 15 minutes and check your blood sugar level again. If it is still low, eat another snack, then wait 15 minutes and check it again. Repeat the process until your blood sugar level is in its normal target range.

If you lose consciousness, you will need immediate medical attention. It's important that you educate the people in your family and the people you work with about diabetic shock and about what to do if it happens. Someone should call 911 or arrange to get you to an emergency room if that's not possible.

You can ask your doctor to prescribe a glucagon rescue kit and then teach others how to use it. Glucagon is a natural hormone that rapidly causes the level of sugar in your blood to rise. If you are unconscious, someone injecting you with glucagon even before emergency help arrives can prevent further complications and help you recover.

Can Diabetic Shock Be Prevented?

There are things you can do to lower your risk of diabetic shock or hypoglycemia.

One of the most important things to do is to understand the medication you are using, whether it is insulin or a pill that increases the body's production of insulin. Ask your doctor how and when to take the medication and be sure to always take the recommended dose at the recommended time. Also,  ask your doctor to explain when you need to make adjustments to your medicine when there is a change in your schedule or routine.

Be sure to follow your meal plan, eating the right amount of the proper food at the right time. Don't skip any meals or snacks, especially before going to sleep or exercising. Discuss your snacks with your dietitian. Some snacks may be better than others at certain times for preventing hypoglycemia. During periods of more intense physical activity, be sure to eat more carbohydrates.

Be sure you check your blood glucose level routinely according to the plan you've worked out with your doctor. Also, check it before you begin to exercise and at regular intervals during exercise or other exertion. And check it again after you've finished any physical activity.

Discuss your use of alcohol with your doctor. Your doctor can help you understand how to drink safely so you don't increase your risk of hypoglycemia.

Are There Special Precautions People with Diabetes Should Take Because of Hypoglycemia?

Because hypoglycemia can occur quickly at any time, always be sure that you carry with you or have quick access to snacks that raise your blood sugar.

Never drive a car if you have hypoglycemia or suspect it is coming on. Diabetic shock can cause you to pass out behind the wheel. If you are driving and notice symptoms, stop and check your blood sugar. If it's low, take a snack and don't start driving until the level is back in the normal range.

Wear a medical ID bracelet or carry a card that identifies you as having diabetes. Be sure the card says what to do if you've become unconscious.

Be sure your family members know what hypoglycemia is and what not to do -- give you insulin, put their hand in your mouth, try to give you food or fluids -- if you pass out.

The most important precaution is to always follow the diabetes plan you've worked out with your doctor. Not only will it lower your risk for hypoglycemia. It will also help prevent long-term, major complications.

Diabetic Shock – Part 1

Diabetic shock, or severe hypoglycemia, is a serious health risk for anyone with diabetes. Also called insulin reaction, because of too much insulin, it can occur anytime there is an imbalance between the insulin in your system, the amount of food you eat, or your level of physical activity. It can even happen while you are doing all you think you can do to manage your diabetes.

The symptoms of diabetic shock may seem mild at first. But they should not be ignored. If it isn't treated quickly, hypoglycemia can become a very serious condition that causes you to faint, requiring immediate medical attention. Diabetic shock can also lead to a coma and death. It's important that not only you, but also your family and others around you, learn to recognize the signs of hypoglycemia and know what to do about them. It could save your life.

What Is Hypoglycemia?

Hypoglycemia is a low level of blood sugar. The cells in your body use sugar from carbohydrates for energy. Insulin, which normally is made in the pancreas, is necessary for sugar to enter the cells. It helps keep the levels of sugar in the blood from getting too high.

It's important to maintain the proper level of sugar in your blood. Levels that are too high can cause severe dehydration, which can be life threatening. Over time, excess sugar in the body does serious damage to organs such as your heart, eyes, and nervous system.

Ordinarily, the production of insulin is regulated inside your body so that you naturally have the amount of insulin you need to help control the level of sugar. But if your body doesn't make its own insulin or if it can't effectively use the insulin it does produce, you need to inject insulin as a medicine or take another medication that will increase the amount of insulin your body does make. So, if you need to medicate with insulin, it becomes your responsibility to see that you have the amount of insulin you need when you need it.

When to take insulin or another medication and how much to use depends on when, what, and how much food you eat. It also depends on your level of physical activity since the cells in your body use more sugar when you are active. Hypoglycemia is basically a reaction to too much insulin in your system. The insulin speeds up the lowering of the blood glucose level. Then without eating or with your body burning sugar faster because of physical activity, the level of sugar becomes dangerously low.

What Causes Hypoglycemia?

Several things can cause hypoglycemia. Your blood sugar level could be low if you:

• Become more physically active than usual
• Miss a meal
• Change when or how much you normally eat
• Take your insulin or medication at a different time than usual
• Drink alcohol excessively without eating

Are There Symptoms of Hypoglycemia or Warning Signs of Diabetic Shock?

The symptoms of hypoglycemia can be classified as mild or early, moderate, and severe. Mild symptoms include:

• Dizziness
• Irritability
• Moodiness or sudden changes in behavior
• Hunger
• Shakiness
• Sweating
• Rapid heart beat

Moderate symptoms include:

• Confusion
• Headache
• Poor coordination

When hypoglycemia becomes severe, symptoms include:

• Fainting and unconsciousness
• Seizures
• Coma

Hypoglycemia can also occur overnight while you sleep. Symptoms include:

• Crying out in your sleep
• Nightmares
• Damp pajamas or sheets resulting from perspiration
• Waking tired, irritable, or confused

If you experience any possible signs of hypoglycemia, it's important to check your blood sugar to make sure it isn't low. If it is, you should treat it quickly or seek emergency care. If you can't check your blood sugar level for some reason, you should go ahead and treat yourself for low blood sugar if you notice symptoms or seek emergency care. If symptoms are moderate, severe, or you are unable to help yourself, seek emergency medical attention.

Treatments for Type 2 Diabetes – Part 2

Continued from the prior blog.

Other medicines help insulin work better. They lower insulin resistance from your cells so your pancreas doesn't have to work as hard. Doctors call these thiazolidinediones, TZDs, or glitazones.

Some slow the digestion of food with complex carbohydrates, like bread, pasta, rice, potatoes, and corn. This keeps your blood sugar from shooting up after you eat. These are alpha-glucosidase inhibitors.

Some work by letting your kidneys pee out extra sugar. They're SGLT2 inhibitors.

Cholesterol-lowering drugs called bile acid sequestrants can also help lower your blood glucose.

You can take these medications by themselves or in combination with others, including insulin. Some pills have more than one kind of drug. More on diabetes drugs in the next blog.

Injectable Drugs These medications slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes.

Some also help your pancreas make insulin. These are GLP-1 receptor agonists. Some of them you take every day, while others last a week.

A different drug acts like a hormone, amylin, that your pancreas sends out with insulin. You only take pramlintide (Symlin) if you're also using insulin.

Insulin People with type 2 diabetes sometimes need insulin. It could be a short-term fix for a stressful situation, or because other medicines aren't enough to control their blood sugar.

You can take insulin with a needle and syringe, with a device called an insulin pen, or with an inhaler. Some people use an insulin pump to get it continuously.

Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

Weight Loss Surgery

Of course, this gets rid of extra pounds. And that alone will help control your blood sugar.  However, be aware that many bariatric surgeons will rush you into surgery with out doing all the necessary tests and explaining all the requirements you will need to do for the rest of your life.

But it also raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication.

It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds.

Part 2 of 2 Parts