Diabetic retinopathy is damage to the retina, the light sensitive area at the back of the eye. The damage is caused by changes in the blood vessels that supply the cells of the retina with oxygen and nutrition. In the first stage of retinopathy, called background or nonproliferative retinopathy, the blood vessels develop small balloon-like swellings called microaneurysms and leak fluid and blood, or become clogged. When these changes happen to enough of the blood vessels, the cells of the retina are deprived of their blood supply. In response to the lack of blood, new blood vessels grow. These new blood vessels are abnormal, fragile and leak blood. The result is loss of vision or blindness. This phase is called proliferative retinopathy. Usually, diabetic retinopathy progresses from nonproliferative to proliferative over a period of years. Most often, there are no symptoms of diabetic retinopathy. In some cases mild-to-severe blurring, seeing “strings,” “cobwebs” or specks floating inyour visual field, or vision loss may be symptoms. Retinopathy can be treated with photocoagulation, laser treatment that stops blood leakage and shrinks blood vessels.

Your retina can be badly damaged before you notice any change in vision, and most people with nonproliferative retinopathy have no symptoms, the ADA says. Even with proliferative retinopathy, people sometimes have no symptoms until it’s too late to treat the condition. That’s why it’s crucial for people with diabetes to see an eye care professional every year for eye examinations.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

Other Complications

PREGNANCY AND DIABETES

Control of diabetes and its potential complications is especially important for women who are planning to become pregnant, as well as in those who already are pregnant. Controlling blood sugar levels before and during pregnancy decreases the risk of many complications in both the mother and the baby.

Glucose in the mother’s blood crosses the placenta to provide energy for the baby; thus, high blood glucose levels in the mother lead to high blood glucose levels in the developing baby as well.

High blood glucose levels can cause several problems:

• Early in pregnancy, high glucose levels increase the risk of miscarriage and birth defects. These risks are highest when hemoglobin A1C is >8 percent or the average blood glucose is >180 mg/dL (10 mmol/L).

More and more patients are considering intense insulin therapy using high-tech devices, as insulin pumps. There are a lot of enthusiasts for treatments with pumps. The question is whether an insulin pump is the right choice for each patient who considers it. The PUMP CORNER is our information section on insulin pumps.