Prediabetes Testing

Westside Optometry is partnering with Vision Service Plan (VSP) in a Pilot Program to test patients for prediabetes. For the next 60 days, if you have VSP coverage for your vision care, you will be given a 7 question risk test to complete. The questions are quite simple: age, gender, family history… Depending on your score another test will be offered to measure your A1C. Glycated hemoglobin or A1C is a relatively quick and simple blood test that provides a picture of your average blood sugar level over the past 3 months. The higher the level, the greater the risk of developing diabetes complications.

The A1C test can identify prediabetes, which raises your risk for diabetes. It can be used to diagnose diabetes. And it’s used to monitor how well your diabetes treatment is working over time. It’s also a critical step in forming your game plan to manage diabetes with your diabetes care team.

A1C test results are reported as a percentage. The higher the percentage, the higher your blood sugar levels over the past three months. The A1C test can also be used for diagnosis, based on the following guidelines:

A1C scale

  • If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range.
  • If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.

    PREDIABETES

    What it means and what you can do 

    There are no clear symptoms of prediabetes so you may have it and not know it. But before people develop type 2 diabetes, they almost always have prediabetes—blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes. If you discover that you do have prediabetes, remember that it doesn’t mean you’ll develop type 2 diabetes, particularly if you follow a treatment plan and a diet and exercise routine. Even small changes can have a huge impact on managing this disease or preventing it all together.

    For some people with prediabetes, early treatment can actually return blood sugar levels to a normal range. Get educated, learn all you can, ask plenty of questions and listen to the answers you get. Start exercising, Start eating healthy and your life can be yours again.

definitions and guidelines from American Diabetes Association

What is Prediabetes?

Diabetes illness concepts word cloud illustration. Word collage concept.

I ask each patient about his general health. I often hear prediabetes as a health issue. Prediabetes means the blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. This is the stage where lifestyle changes can significantly improve health and prevent the development of diabetes.

Research shows that you can lower your risk for type 2 diabetes by losing 7% of your body weight (that’s 15 pound if you weigh 200 pounds) and exercising 30 minutes a day.

Symptoms are not always present with prediabetes. To accurately diagnose prediabetes your doctor will do some blood tests.

  • A1C measures your average blood glucose for the past 3 months.

Normal           less than 5.7%

Prediabetes    5.7% to 6.4%

Diabetes          6.5% or higher

  • Fasting Plasma Glucose tests your blood glucose after you have not eaten or drank anything for at least 8 hours.

Normal            Less than 100 mg/dl

Prediabetes     100 mg/dl to 125 mg/dl

Diabetes           126 mg/dl or higher

People with prediabetes are at higher risk for developing type 2 diabetes and cardiovascular disease. If you are prediabetic you may have no symptoms or you may have the same symptoms as someone with diabetes. The best way to find out if you’re prediabetic is to see your doctor and have your blood tested.

How Does Diabetes Damage Your Eyes?

November is Diabetes Awareness month. High amounts of blood sugar can harm the internal structures of the eye. Below are some of the things that diabetes can do to the eyes.

  • Blurry or Double Vision. Fluctuating blood sugar and fluctuating vision are connected. A change in glucose levels affects the eye’s ability to maintain sharp focus. It may take several months after your blood sugar is well controlled for your vision to stabilize.

 

  • Diabetic Retinopathy. The leading cause of diabetes-related vision loss is diabetic Diabetic Retinopathy retinopathy. This condition damages the network of blood vessels supplying the retina with blood and oxygen. It also causes abnormal growth of blood vessels on the retina. When these vessels leak they damage  the retina causing permanent vision loss.
  • (the picture on the left is an example of fluid and blood leakage in diabetic retinopathy.)

 

 

  • Cataracts. People with diabetes have a much greater risk of developing cataracts and at an earlier age. A cataract is clouding of the eye’s natural lens and results in glare and obscured vision.
  • Glaucoma. Diabetes also increases your risk of developing glaucoma. This condition results from an increase in fluid pressure inside the eyeball, which causes damage to the retina and optic nerve. If untreated, glaucoma leads to gradual but permanent vision loss.

Actions to take right now include the following: Eating sensibly, the American Diabetes Association recommends filling half your plate with vegetables, a quarter of the plate should be lean protein and the rest a carbohydrate. Make time for 30 minutes of exercise everyday. Take your medicine as prescribed and know your blood sugar level.

Preventing diabetes is the best way to avoid diabetic damage to the eyes, but if you already have diabetes, regular eye examinations can prevent permanent damage to the eye due to elevated blood sugar.

 

How does Diabetes Damage the Eyes?

Vision Loss

Over time uncontrolled blood sugar and poor circulation can harm the internal structures of the eye.
Blurry or Double Vision
Fluctuating blood sugar and fluctuating vision are connected. A change in glucose levels affects the eye’s ability to maintain sharp focus. It may take several months after your blood sugar is well controlled for your vision to stabilize.
Diabetic Retinopathy
The leading cause of diabetes-related vision loss is diabetic retinopathy. Diabetic retinopathy can damages the network of blood vessels supplying the retina or cause the growth of  abnormal  blood vessels on the retina. When these fragile blood vessels leak, the fluid and blood damage the retina and can cause permanent vision loss.
Cataracts
People with diabetes have a much greater risk for developing cataracts and at an earlier age. A cataract is clouding of the eye’s natural lens and results in the inability to focus light, glare and compromised vision,
Glaucoma
Diabetes also increases your risk of developing glaucoma. Glaucoma causes irreversible damage to the retina and optic nerve. If untreated, this damage leads to vision loss.

Scheduling regular eye exams can help detect diabetes-related eye diseases before they cause irreversible damage.
Exercise, a healthy diet and keeping glucose levels and blood pressure controlled can also help control eye problems.

Diabetic Awareness Month

If you have diabetes, it requires attention every day of the year, not just the month of November. But I am going to take advantage of Diabetes Awareness Month to remind you that your eyes are important and can be significantly impacted by diabetes.
First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment developed retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already have retinopathy, the condition progressed in the tight-control group only half as often.

Diabetic Retinopathy

These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.

Second, keep blood pressure under control. High blood pressure can make eye problems worse.

Third, quit smoking.

Fourth, see your optometrist at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough.

Fifth, see your optometrist if:

your vision becomes blurry
you have trouble reading signs or books
you see double
one or both of your eyes hurt
your eyes get red and stay that way
you feel pressure in your eye
you see spots or floaters
straight lines do not look straight
you can’t see things to the side as you used to

Don’t procrastinate. If you have diabetes and haven’t had a dilated eye exam in the last 12 months, schedule an eye exam now.

How to Prevent Eye Complications due to Diabetes

There are steps you can take to avoid eye problems due to diabetes.

First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment got retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already have retinopathy, the condition progressed in the tight-control group only half as often.

These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.

Second, keep blood pressure under control. High blood pressure can make eye problems worse.

Third, quit smoking.

Fourth, see your optometrist at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough.

Fifth, see your optometrist if:

  • your vision becomes blurry
  • you have trouble reading signs or books
  • you see double
  • one or both of your eyes hurt
  • your eyes get red and stay that way
  • you feel pressure in your eye
  • you see spots or floaters
  • straight lines do not look straight
  • you can’t see things to the side as you used to

Don’t procrastinate. If you have diabetes and haven’t had a dilated eye exam in the last 12 months, schedule an eye exam now.

For more information, check out the American Diabetes Association.

 

 

 

 

Diabetes Myths

November is Diabetes Awareness Month.

To begin the  month of diabetes awareness, let’s start by dispelling some myths:

Myth: Diabetes is not that serious of a disease.

Fact: Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.

Fact: Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes. Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Myth: Eating too much sugar causes diabetes.

Fact: The answer is not so simple. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors.

Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories from any source contributes to weight gain. Research has shown that drinking sugary drinks is linked to type 2 diabetes.

The American Diabetes Association recommends that people should limit their  intake of sugar-sweetened beverages such as soda, energy and sports drinks and fruit drinks, to help prevent diabetes. These beverages will raise blood glucose and can provide several hundred calories in just one serving!

 

Myth: People with diabetes should eat special diabetic foods.

Fact: A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive and can also have a laxative effect if they contain sugar alcohols.

Myth: If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.

Fact: Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portions. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods per meal is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.

Myth: People with diabetes can’t eat sweets or chocolate.

Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes than they are to people without diabetes. The key to sweets is to have a very small portion and save them for special occasions so you focus your meal on more healthful foods.

Myth: You can catch diabetes from someone else.

Fact: No. Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.

Myth: People with diabetes are more likely to get colds and other illnesses.

Fact: You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to control, and people with diabetes who do get the flu are more likely than others to go on to develop serious complications.

Myth: If you have type 2 diabetes and your doctor says you need to start using insulin, it means you’re failing to take care of your diabetes properly.

Fact: For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.

Myth: Fruit is a healthy food. Therefore, it is OK to eat as much of it as you wish.

Fact: Fruit is a healthy food. It contains fiber and lots of vitamins and minerals. Because fruits contain carbohydrates, they need to be included in your meal plan. Talk to your dietitian about the amount, frequency and types of fruits you should eat.

For more facts check out the American Diabetes Association.

 

Dry Eye and Diabetes

November is National Diabetes Month. Last year and in previous blog posts, I wrote about diabetes and the eye. Today I want to talk about dry eye disease (and diabetes).

Dry eye can lead to decreased vision, corneal scarring and secondary bacterial infections. Not to mention the general discomfort and reduced quality of life from the symptoms.

There are 8 Risks Factors for the Development of Dry Eye Disease:

  • AGE The older you are the greater the risk for dry eye.
  • GENDER Women are twice as likely to develop dry eye than men.
  • ENVIRONMENT This includes smoking, airplane travel, computer use, low humidity environments and several other considerations
  • LID MARGIN DISEASE This is especially true of meibomian gland dysfunction. Meibomian, an icky sounding word on its own, but you should see the glands under a microscope when they are plugged or inflamed. It’s not pretty.
  • CONTACT LENS WEAR Contact lens wear contributes to dry eye and increased symptoms
  • OCULAR SURGERY Surgical procedures  such as LASIK or cataract removal can cause temporary dry eye in patients who have predisposing risk factors.
  • MEDICATIONS Many drugs including oral anti-histamines or anti-acne medications like (Isotretinoin)

And for the risk factor that ties this all in with Diabetes Month…

  • SYSTEMIC CONDITIONS This includes not only diabetes but also rheumatoid arthritis and thyroid disease.

The mechanism responsible for dry eye disease in diabetic patients is unclear, but many studies have been done. One study found that the rate of dry eye disease was higher if the HbA1c values were higher. Yet another good reason to maintain diabetic control and lower HbA1c values.  Another study showed that the tear proteins of diabetic patients are different from those of healthy subjects. More than half of the people who have diabetes experience dry eye symptoms and suffer from ocular dryness. Controlling the diabetes and managing the dry eye disease can lessen or alleviate the discomfort of ocular dryness.

Diabetic Retinopathy

In the previous blog post I wrote about the reasons I dilate patient’s eyes. If you have diabetes, I will dilate your eyes at least once a year. Diabetes can affect many organs of the body, in the eyes it causes blindness.
Many problems develop in the retina due to diabetes. There is abnormal blood vessel growth, hemorrhages and lipid leakage. If these problems are allowed to continue without treatment they will cause scarring which leads to detachment of the retina. Another complication is the leakage of fluid under the macula which will severely reduce vision.
Not all these conditions will have symptoms. Only when the bleeding or fluids reach a certain size will you notice blur or dark spots. The earlier changes in the retina are detected, the better treatment results will be.

The picture above shows some of the changes diabetes causes in the retina. There is bleeding and some areas where blood isn’t flowing properly (ischemia). This patient did not notice any changes in his vision.

National Diabetes Awareness Month Conclusion

The most important thing you can do if you have diabetes, is educate yourself about the disease. There are some excellent resources available. Start with the National Diabetes Education Program (NDEP) sponsored by the National Institute of Health. http://ndep.nih.gov/ . In addition to information about diabetes and other resources, you can order free pamphlets about controlling your diabetes and preventing type 2 diabetes. Information is available in English and Spanish.

Another resource is the American Diabetes Association, http://www.diabetes.org/. There is information about food, fitness and medications.

Most American are aware that being overweight and physically inactive increases the risk for type 2 diabetes. Unfortunately, that awareness does not translate into action. The NDEP was created to provide tools and resources to help people be proactive in preventing and controlling diabetes. If you have a family history of diabetes, had gestational diabetes and/or are overweight, you are at risk.  Take action. Check out the NDEP website and educate yourself.