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Most of us struggle to do the right thing where our health is concerned. We know what to do, we know we should exercise, take our vitamins, avoid those sugary snacks and eat only when we’re really hungry… but we don’t. It is hard. The stress of our daily lives is tough: no matter our age, our social and financial status, whether we’re single or married. It pales to insignificance, though, when we take on the burden of caring for a loved one.
Given that we’re all getting older, and so are our parents, grandparents, parents-in-law, and various uncles and aunts that see us as their support system, this is a responsibility that will be upon us, if it isn’t already. So, how do we do it right? Information, information, information. The more we know, the more we’ll see, and the quicker we will respond to situations. Time is always of the essence.
As potential caregivers, one disease we must all be fluent in, is diabetes. Diabetes and it’s related complications result in millions of deaths each year: according to the International Diabetes Federation Atlas 2019, that number reached 4.2 million in 2019. Diabetes, singly, or when combined with hypertension, causes 80% of end-stage renal disease globally. Both diabetes and chronic kidney disease are strongly associated with cardiovascular diseases1. Diabetic foot and lower limb complications affect 40 to 60 million people with diabetes worldwide1. Chronic ulcers and amputations result in a significant reduction in the quality of life and increase the risk of early death1.
If you have people with diabetes in your family and social circle, begin reading and learning about these complications today. As with all complications related to diabetes, an early diagnosis results in the best chances for recovery.
One of the lesser known, but possibly the most frightening, complications of diabetes is vision loss. Diabetes related eye complications are made up predominantly of Diabetic Retinopathy, Diabetic Macular Edema, Cataract and Glaucoma, along with double vision and inability to focus1. Of these, Diabetic Retinopathy is acknowledged to be one of the leading causes of blindness in the working age population with devastating personal and socio economic consequences1. It is also the sneakiest of them all, because in the early stages of the disease, it is completely asymptomatic. This means that by the time you begin to see symptoms, irreversible damage to vision has already occurred.
Here are a few symptoms you should be on the lookout for, both as a caregiver, and a well-wisher.
Difficulty in reading
This is a tricky one because common wisdom says that our eyes weaken with age. However, when we read, we use a part of the eye called the Macula – the area dedicated to sharp vision2. This is the same part of the eye we use when we drive and when we focus on faces. Diabetes can lead to swelling in the macula – a condition called Diabetic Macular Edema, which is part of the Diabetic Retinopathy cluster3.
If you notice that there is difficulty reading even after a change of spectacles, don’t ignore it. According to Dr Manisha Agarwal, Joint Secretary, Retina Society of India, this is one of the earliest signs of Diabetic Retinopathy, and can escalate to clouds of black or red spots in the field of vision, or even sudden blackouts due to hemorrhages in the eye.
Insist on a visit to the eye doctor, and keep a log of any other symptoms related to vision till you meet the doctor. When it comes to the eye, all details are relevant.
Cloudy vision can show up in various ways – some people complain of a general dullness of colors, they might be unable to differentiate between variations in colors (like being unable to see a white lamp set against a white wall), they might struggle to see at night, and of course, the most telling sign – fuzzy, filmy, or foggy vision, as if seeing the world through a veil. That is, in fact, exactly what may be happening4.
Cataracts affect the lens of the eye, creating a layer of deposits on the lens itself. People with diabetes are more likely to develop these cloudy lenses called cataracts. People with diabetes can develop cataracts at an earlier age than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses5.
A feeling of pressure in the eye
Watch for complaints of swelling in the eye – oftentimes, the sufferer feels the swelling long before the enlargement becomes visible. While a number of eye diseases and disorders can cause swelling, people with diabetes always need to be on the lookout for Glaucoma6.
Diabetes doubles the chances of having glaucoma3,6, which can lead to vision loss and blindness if not treated early. Risk also increases with age6.
Glaucoma occurs when pressure builds up in the eye. The pressure pinches the blood vessels that carry blood to the retina and optic nerve. Vision is gradually lost because the retina and nerve are damaged6.
Floaters that are dark in color
We all get floaters in our eyes from time to time – those interesting, transparent little loops you only notice when you look at a solid colored wall, or at the sky. Those are completely normal. However, should you hear complaints about thick floaters, or floaters that seem dark in color, you should take this very seriously7.
Often, this symptom is so fleeting that you may never hear of floaters. So, ask. Particularly if you’re also hearing about trouble reading, or difficulty driving or seeing faces. In later stages of Diabetic Retinopathy, blood vessels leak into the vitreous fluid in the eye, causing these floaters and dark patches8. Trouble is that they resolve on their own8, and don’t become a problem. So the chances that they will be mentioned to you, the caregiver, are small. It’s best to bring this to the person’s attention, so they know this is something they should complain to you about!
Of all the eye disorders people with diabetes can have, Diabetic Retinopathy is the one that poses the greatest risk1. In most countries, DR is acknowledged to be one of the leading causes of blindness in the working age population with devastating personal and socioeconomic consequences, despite being potentially preventable and treatable1.
However, what makes this even more tragic is the fact that Diabetic Retinopathy is preventable! In countries like the UK, where a policy of eye screening was introduced, Diabetic Retinopathy stopped being the leading cause of blindness in the working population. In fact, in Wales, they saw a 40-50% reduction in the incidence of new visual impairment and blindness certifications – in just 8 years1.
What does this prove? A simple, routine and painless eye test, performed at your eye doctor (not at the spectacle shop!) can stop Diabetic Retinopathy in its tracks! Since this is a disease that is asymptomatic in the early stages, catching it at that stage means that no vision loss has occurred, and patients can, by following their doctor’s recommendations, keep the disease from progressing.
This is why Network18 has launched the ‘Netra Suraksha’ – India Against Diabetes initiative, in association with Novartis: to spread awareness about Diabetic Retinopathy to the people most likely to be affected by it. The initiative brings together the best minds in medicine and policy making, along with think tanks, to come up with real world solutions that will work for India. The initiative also aims to raise awareness about Diabetic Retinopathy through round table discussions, explainer videos and articles, all of which, you can access at the Netra Suraksha initiative page on News18.com
As potential caregivers ourselves, it is also critical that we watch for our own health. We recommend that everyone take our online Diabetic Retinopathy Self Check Up to assess their own risk and that of their loved ones. Then, we recommend making annual eye tests routine, like a habit. Bundle this test with other wellness actions like annual blood tests, and other proactive screenings. After all, can you think of a disease where you wished you’d find out later rather than sooner?
IDF Atlas, International Diabetes Federation, 9th edition, 2019https://socaleye.com/understanding-the-eye/ 18 Dec, 2021https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease 18 Dec, 2021https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790 18 Dec 2021https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589218/ 18 Dec, 2021https://my.clevelandclinic.org/health/diseases/4212-glaucoma 19 Dec, 2021https://www.medicalnewstoday.com/articles/325781#causes 29 Dec, 2021https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611 18 Dec, 2021