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Sunday, March 16, 2014

Diabetes Positive Approach Newsletter #1403 on Eye Care

Welcome to Diabetes Positive Approach Newsletter #1403 on Eye Care. For this issue, it is not an accident that our discussion is on looking at a person in the eye because it is time to discuss taking care of our eyes since this is a very important aspect of the diabetes condition. Anyway, if we have trouble looking at a person in the eye, I have some kind of training for this.

Let us start by looking at ourselves in the eye in front of the mirror. We can set aside a few minutes to do this and while we look at ourselves in the eye, let us repeat the positive qualities that we listed down on a piece of paper. So while we are looking at the mirror, let's say those positive qualities we have like being compassionate and cheerful.

In This Issue: Diabetic Retinopathy“
What is Diabetic Retinopathy?

This is a complication of diabetes that have an effect on the eyes. What happens is that the blood vessels at the back of the eye are damaged. This can develop to anybody who has type 1 or type 2 diabetes whose blood sugar is less controlled and has had diabetes for a longer period of time.

What to do? Protect your eyes, control your blood sugar and get a yearly eye exam.

Is It Possible to Prevent Diabetic Retinopathy?

As they say “An ounce of prevention is worth a pound of cure.” How true is this! Just take any condition and put the Prevention of It and Its Treatment in a scale and you will see right off which one will win the contest. In terms of time and money alone, there is no comparison. And this is without considering the worry, stress and other emotional trauma that will come around. So? Am I skirting the issue? Enough being diabetes police already. Get down to the prevention ASAP.

You can reduce the risk of developing diabetic retinopathy by doing the following religiously. And I mean religiously. Okay, I am being a diabetes police again but really, don’t you know that I am on your side? I have been doing this for seven years expecting nothing in return. I have no ulterior motive.

It is just that I care, really and truly care. I am the one who cries when one of you gets hurt and some of you write to let me know about it. I am the one who prays for you every night to spare you all the pain and suffering you must be feeling. So go easy on me, will you? Again do the following and you reduce your risk to get that darn thing.

1. Commit to manage your diabetes really well by eating healthy and moving more like walking for at least 150 minutes a week. Take medications as prescribed.

2. Check and record your blood sugar level everyday and see what triggers the high and low and make adjustment where necessary.

3. Keep cholesterol and blood pressure at target levels and for goodness sake, don’t be like me eating shrimps like there’s no tomorrow keeping my cholesterol level up so my doctor is threatening to put me on medication. Ha! What she does not know is I have some weapon in my sleeves. I’m not going to eat eggs, caviar, foie gras, butter, prawns & Colonel’s Secret Recipe because I read they are bad for cholesterol level. So there!

4. Taking the A1C test to keep the blood sugar within your goal will slow down diabetic retinopathy and will lessen the need for surgery. In this connection, I have a secret to share with you. This is from someone I know who has had diabetes for a long time. She said that taking a walk even just for ten minutes after a meal will give lower A1C reading.

5. Pay attention to changes in your vision and take the dilated eye exam every year. For any sudden change, call the doctor very quick. That may not be grammatically right but that’s a nursery rhyme in my childhood and I can’t get it out of my head.

6. Stop smoking, pretty please, and quit the use of all other tobaccos for they only exacerbate diabetic retinopathy.

Symptoms of Diabetic Retinopathy

In the beginning, there are really no symptoms, and this is the scary part because it is not giving us any warning. So unfair! But as the condition matures, the following symptoms may appear:

  • 1. The vision is blurry and fluctuating.
  • 2. There are empty or dark parts of the vision.
  • 3. There may be vision loss.
  • 4. It is not easy to perceive colors.
  • 5. There are dark spots floating in my eyes.
Oh my God, I have floaters in my vision. But I only got them when I was watching a soccer game and the ball hit me in the eye! I will call the eye doctor first thing tomorrow.

There are two types of diabetic retinopathy depending on the stage the condition is in. They are the early diabetic retinopathy and the advanced diabetic retinopathy. I won’t go into the details of both of them because to tell you the truth, I am scared so unless you write to me at the email below the name of the author, asking for more details, I will let this be. I will concentrate on the prevention. After all, this is a Diabetes Positive Approach Newsletter. Anyway, regardless of types, this condition affects both eyes.

When Should I See the Doctor?

To prevent this from happening, let’s carefully manage our diabetes. Easier said than done, right? Just get the annual dilated eye exam even if we feel our eyes are fine to make sure because we do not feel it coming at the beginning stage. Pregnant women may have to get the exam more than annually. But call the doctor right away if there are any changes in your vision.

Causes of Diabetic Retinopathy

Too much sugar in the blood as has been mentioned earlier is the culprit. This is what can damage the blood vessels in the retina and may even totally obstruct them. The poor eye grows new blood vessels to compensate but these blood vessels are not very smart. For one thing they do not develop properly and they leak!

What Are The Risk Factors?

While diabetic retinopathy can happen to any PWD (Person With Diabetes), the following factors can increase the risk:

1. Poor blood glucose control so eat foods rich in magnesium like avocados, raw pumpkin and sun flower seeds, almonds, green vegetables like spinach and green chard, raw broccoli, raw organic cacao, black beans, navy beans and peas. Snacks for low blood sugar? Mozzarella string cheese, whole wheat crackers and natural peanut butter, pear with handful of almonds, sugar- free jello and pudding, humus and veggies. Hey, where’s my walnuts? They’re supposed to be good, too. Don’t tell me I’ve been eating them religiously for nothing!

2. Length is a risk factor, for the longer one has had diabetes, the greater the risk but don’t despair because just think of Mary Tyler Moore and Sonia Sotomayor, Associate Justice of the Supreme Court of the United States who has had diabetes since she was a child. It just goes to show, all of us can be anybody we want to be, diabetes or not, so there!

3. High cholesterol so avoid eating caviar, eggs, foie GRAS, Colonel’s Secret Recipe, butter and prawns for I read that they’re bad for the cholesterol that will increase the risk to develop retinopathy. This is another one of those that should come with OMG because my cholesterol is now bad according to my doctor which happened only since we moved to the Toronto area where I have been eating a lot of shrimps. This is it; I will stay away from them starting now! Red Lobsters, get away from me!

4. High blood pressure is a risk so fight this by eating more of potatoes, bananas, (watch your carbs though), cantaloupe, yogurt, beetroot juice, hot cocoa and beans because they’re supposed to lower the blood pressure. I have all these foods in my Ipod so I can be ready to buy them when shopping for groceries.

5. Smoking - please stop smoking, that’s all I can say.

6. Pregnancy - I can’t do anything about this.

Complications of Diabetic Retinopathy

Complications? What are you talking about? Diabetic retinopathy is already a complication, for crying out loud. How can a complication have its own complication? Are you messing up with our mind? I know, you’re the experts so here it goes but I refuse to dwell on them: The complications are glaucoma, bleeding of the blood vessels, detachment of the retina and blindness. Hmm, thanks a lot! (Whisper to you, my friends, sarcastically of course!)

How Do We Get Ready For Our Doctor’s Appointment?

Time for the visit is short so let’s write down what we need to remember before we go, like so:

  • 1. List all medications you take.
  • 2. Write a brief history of your diabetes.
  • 3. Write all your symptoms related or unrelated to problems with the eyes.
  • 4. Bring a friend or a family member so you’ll get help remembering all the things that will transpire at the doctor’s office.
  • 5. Write all the questions you want to ask your doctor.
Be ready to answer the doctor’s questions like your eye symptoms and floaters, how long have you been feeling your symptoms, your last A1C reading, any eye injury and surgery, your diabetes management, and any other health conditions like the high blood pressure and cholesterol.

Be prepared to answer those questions as good doctors are very nosy and want to know everything about you.

Tests and Diagnosis

1. The dilated eye exam is the test used to diagnose diabetic retinopathy. How is this done? The doctor puts drops on the eyes to make the pupils of the eye open widely. This enables the doctor to see inside the eye better. In the meantime, you will have blurry vision for several hours after this test.

What Will the Doctor Look For?

  • Blood vessels that are abnormal
  • Swelling in the retina
  • Presence of cataract
  • Optic nerve abnormalities
  • Detachment of the retina
  • Presence of new blood vessels
  • Bleeding
2. Optical coherence tomography is an eye exam the doctor may request . This is an imaging test that will show cross-sectional images of the retina. It will provide the doctor the information on how thick the retina has become which will show if fluid has licked into it. This is also the test they use to see how the treatment is coming along.

3. Fluorescein angiography is the photography test of the retina that the doctor may do. While the pupils of the eyes are dilated, he will take pictures inside the eyes. The doctor will inject a special dye into your arm and take more pictures as the dye flows through your eyes. The doctor will be able to see from the pictures which blood vessels are leaking fluid, closed or broken.

What Treatments and Drugs Are Used to Treat Diabetic Retinopathy?

The treatment depends on the type, the severity, and the track record of the previous treatments.

The early diabetic retinopathy may not be treated at all but it has to be carefully watched by the eye doctor. This is to see when treatment may be needed. Meantime it will be wise to consult with the endocrinologist to see how the diabetes can be better managed. At the early stage of this condition, good blood sugar control can slow the progress of diabetic retinopathy.

The advanced diabetic retinopathy, if it is proliferate, needs prompt treatment which is surgery. Even for the ones that are not propagating but severe, the recommendation is also sometimes surgery. Here are the different options depending on the specific problems:

1. The focal laser treatment is done in the doctor’s office in a single session or in the eye clinic. It can slow down or even stop the leakage of fluid and blood in the eye. What they do is treat the leaks from the abnormal blood vessels with laser burns. After this treatment you may have blurry vision for around a day and see small spots that will go away within weeks. For some, vision improves but those with swelling of the central macula may not totally regain normal vision.

2. The scatter laser treatment, also done in the doctor’s office in two or more sessions or eye clinic, can reduce the size of the abnormal blood vessels. How they do this is they treat the areas of the retina away from the macula with scattered laser burns. After the procedure you will experience some blurry vision for around a day. It is also possible to lose some night and peripheral vision.

3. Vitrectomy is used to remove blood from the middle of the eye plus the scar tissue on the retina in a surgical procedure in the hospital or surgery center with the use of local anesthesia. The doctor makes a small cut in the eye, removes the blood and scar tissue and replaces it with a salt solution to maintain the normal shape of the eye. He sometimes puts a gas bubble in the eye cavity to help the reattachment of the retina. For days you remain facedown until this gas bubble dissolves.

Unfortunately, surgery is not a cure although it stops or slows down the progression of diabetic retinopathy. Vision loss and damage to the retina are possible. Regular eye exams are still needed. They are studying new treatments like medicine and direct injections to the eye that shows potential but they have not gone trough long term studies.

Are There Alternative Options to Treat Diabetic Retinopathy?

There are home therapies and natural cures but nothing has really been proven as yet. What is important is not to postpone standard treatment to try others that have not been proven. To treat early before losing the vision is still the best policy. Other alternative treatments have shown benefits like the following:

  • Blood vessels that are abnormal
  • Butcher’s broom
  • Grape seed and extract
  • Ginkgo
  • Pycnogenol (Pine bark)
  • Bilberry
I tried Bilberry but it caused some discomfort to my eyesight so I gave it up.

Inform your doctor of all the supplements and herbs you’re taking as they may interfere with your other medications. Or worse during surgery they may cause complications and extreme bleeding.

How Does One Cope With The Devastating Vision Loss?

Losing one’s sight is a biggie. It’s up there with Oh My God Lists. After all, the eyes are supposed to be the windows of the soul. You may have to talk with a therapist to deal with this situation. Your family doctor will refer you to one. Also there are support groups around. It helps to be with people who are experiencing the same situation. Ask your doctor for any support groups near your residence.

There are also products and services that can make living a lot easier. There are magnifiers and special lenses available. Video magnifiers may also help.

standard treatment 2. Must-Reads from Around the Web

Eyes Q - Problems on the Rise: Don’t Let This Be You

Protect Your Eyes

Protect Your Eyes and Vision

Diabetic Retinopathy and Diabetic Eye Problems

Diabetic Eye Problems

3. “Alerts I Can’t Resist To Send You

You Can Get Answers Here to a Lot of Your Questions< Prevent Diabetes Problems: Keep Your Eyes Healthy

Most Americans Are Not Aware of Eye Health Dangers From Diabetes Diabetic Retinopathy News

The Ophthalmologists Are Given an Alert on the Early Treatment Diabetic Retinopathy Study. Clinical Alert for Ophthalmologist


Here are the Most Frequently Asked Questions about Diabetic Eye Care Questions about Diabetic Eye Care

4. A Success Quotation of the Month“

"'If you don't take care of your body, where are you going to live?" - Unknown

5. Dessert Recipe”

Watermelon-Cranberry Agua Fresca

6. Some Humour - Let's laugh together at the joke below even if it's not funny. It is really good to try having a good laugh. And I like you to laugh so much because research has found it effective in treating diabetes, stress and chronic pain. In fact as I write this, scientists are studying how much more laughter can help.

The Lawyer and His Creative Defense

Defense: My client did not do that burglary.

State Lawyer: How can you say that when he was caught in the act?

Defense: I repeat, he did not burglarize.

State Lawyer: Then prove it.

Defense: He just inserted his arm into the window and removed a few items.

State Lawyer: How is that not burglary?

Defense: Don’t punish the whole man by the offense committed by the arm.

Judge: Well put, I sentence the man to one year in jail.

State Lawyer: That’s good, the client can choose to accompany it or not.

The defendant smiled while his lawyer helped him detach the artificial limb. Then he laid it on the bench and walked out.

7. Do you have a question or comment for the team?

Drop us a line at Put on the subject line “Diabetes Positive Approach” so no one can mistake it as spam. Write your questions or comment there.

You may see your question answered in an upcoming issue of Diabetes Positive Approach like this one below.

7. Q&A: What is macular edema, or diabetic macular edema?"

Answer: Consistently high blood sugar levels can damage the blood vessels in the eyes. When this happens, the blood vessels begin to leak fluid into the retina. This leads to the vision becoming blurry. And the vision can become distorted, too.

8. Got something to say? Please write down your questions and comments in Facebook.

Just go to the Just copy and paste that on your browser. Facebook will want you to join me first before you can send me a message.

My! All that reading tired me out. Truth be told though, I feel great after reading all these. It is only at the start that I feel, “Yikes, not again! Why do I have to do this? But then comes the end of the session and I feel like I can do anything. I can even look at Prime Minister Harper in the eye.

When you look at the mirror and saying those positive qualities about yourself, did you concentrate on your thoughtfulness and cooperation? That's good. Now we can look at the children in the eye and they will love you more. Then it is the next stage which is looking at your peers and co-workers in the eye.

Don't you find sometimes it is hard to look at other people in the eye? There are some people who cannot look directly at someone they are having conversation with. Some have such low self-image they feel they are not worthy to look at some people directly. Well, we are not like these people because we have been developing our self-image. And lastly, we can look at everyone we meet in the eye. Hey, we did it, let’s give ourselves a high five! Yay!


Now, what can we take away from all of these? Just take care of your eyes by keeping your blood glucose within the target level, eating healthy, moving more and getting that annual eye exam?

How about you? What have you been doing to take care of your eyes? Please share them with us at the email address below the authors’ names so we can help all the others.

Warm Regards,

Roger and Evelyn Guzman

Try this Natural Clear Vision !which is guaranteed for 60 days. If you’re not satisfied you get a full refund.

Did you like this newsletter? If so, please recommend it to your friends. If you have any questions or tips, please leave a comment at Just copy and paste that on your browser. Facebook will want you to join me first before you can send me a message.

This newsletter is copyright 2014 Roger Guzman, M.D.

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