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What is diabetic retinopathy?

Diabetic retinopathy is damage to the eye that results from chronically untreated or inadequately treated high blood sugar. In its more advanced form, it can result in severe visual loss or blindness if untreated, and this can occur suddenly without warning. It is the leading cause of blindness in working age adults in the United States and more than 20,000 people become blind as a result of diabetes each year. In order to prevent this, all people with diabetes should periodically be screened with an eye exam or photography of the inner lining of the eye (retina). Because it is often not possible to pinpoint precisely when type 2 diabetes actually develops, as it may be silent and unrecognized for months or even years, people with type 2 diabetes should be examined for retinopathy at the time of diagnosis, while those with type 1 diabetes should be examined between 3 and 5 years after the diagnosis has been made. The frequency with which follow-up visits is recommended will depend upon the findings and the measures taken to address them. For example, if no retinopathy is detected, follow-up examination in 2 years may be recommended, whereas in the case of serious findings requiring active treatment, follow-up in 3 months or fewer may be required.

Although it has clearly been shown that the rate of progression of diabetic retinopathy is related to the control of the blood sugar, there are several other factors involved. There is a hereditary tendency, so that if a close relative with diabetes developed retinopathy, you are more likely to do so. You should inform your eye doctor, who will be especially vigilant. Control of blood pressure has been shown to delay worsening of retinopathy and control of cholesterol abnormalities also plays a role in preventing progression. Quitting smoking can slow the progression of diabetic retinopathy. Therefore, all of these factors must be carefully addressed to prevent retinopathy successfully. Finally, it is important to note that retinopathy is not the only form of eye damage that can occur in diabetes. Other disorders, including glaucoma (increased pressure inside the eye) and cataracts (opacity of the lens of the eye), are more common in diabetes. Therefore, a comprehensive specialist eye exam is periodically needed and retinal photographs alone are not adequate.

Retina

The inner lining of the eye.

Glaucoma

Increased pressure inside the eye.

Cataracts

Opacity of the lens of the eye.

Diabetic nephropathy is the term used to describe kidney damage that occurs in diabetes.

Hemodialysis

Blood filtering and removal of wastes through a machine.

Peritoneal dialysis

A process whereby wastes are exchanged Into fluids Introduced Into the abdominal cavity.

What is diabetic nephropathy?

Diabetic nephropathy is the term used to describe kidney damage that occurs in diabetes, usually of longstanding. The damage to the kidney in diabetes can result from the high blood sugar itself, which leads to an expansion of certain types of material in the filtering mechanism of the kidney. This expansion damages the delicate cells responsible for filtering waste materials through the kidney. Eventually, there are abnormal pressures and changes in the important electrical balance in this complex structure. These changes lead to leakage of proteins that are usually either retained or reabsorbed by the kidney. The blood pressure can rise due to overload of fluid and constriction of small blood vessels. The rise in blood pressure further damages the kidney if not treated. If there is an excessive leak of protein, the body becomes protein deficient, which can lead to generalized puffiness and swelling. Eventually, the kidneys can fail and their functions must be replaced by the processes of either hemodialysis (blood filtering and removal of wastes through a machine) or peritoneal dialysis (a simpler process whereby wastes are exchanged into fluids introduced into the abdominal cavity), or a kidney transplant is required.

Although complete kidney failure is not a common outcome in diabetes in percentage terms, diabetes is the most common cause of kidney failure in working- age adults and occurs in more than 25,000 people each year in the United States. Kidney failure is extremely disruptive to the sufferer's life and is very expensive to treat. The tendency to get diabetic kidney damage has an inherited component, so that if a close relative with diabetes suffers from it, an individual is more likely to experience it. However, it can be delayed or even prevented. Good control of blood sugar and blood pressure, together with use of certain types of drugs known as ACE-inhibitors or ARBs, has been shown to markedly slow progression of diabetic kidney damage. Moreover, it can be detected very early by sensitive tests in common use.

 
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