Local optometrist Dr. John Breiwa considers eyes to be windows. "You can actively see the body functioning," he said.
Sometimes he sees patients with eye diseases that result from diabetes at Drs. Breiwa, Jeskie and Tucker Eyecare. Some patients don't think about how the disease -- where the body does not produce or properly use insulin, a hormone needed to change sugar, starches and other foods to energy -- can affect their vision.
"They think, 'My sugar is high.' The worse-case scenario is that you can go blind," he said. "Diabetes is the third-most common cause of blindness in the nation. Kentucky is one of the top states for diabetes."
There are two types of diabetes. In Type 1 diabetes, the body doesn't produce insulin. In Type 2 diabetes, the body makes insulin but is unable to respond to it, said Megan Givan, a diabetes coordinator at the Warren County Health Department and registered and licensed dietitian. Symptoms include frequent urination, excessive thirst, unexplained tiredness, slow-healing wounds and extreme eating without gaining weight -- which happens more frequently with Type 1, but doesn't happen in Type 2.
"People with Type 1 diabetes use insulin shots or pumps. Some are diagnosed at birth or in their teens or early 20s," she said. "People with Type 2 diabetes can control it with diet and exercise, and then that may lead in to prescriptions. Sometimes they need a combination of pills and insulin."
The risk factors for diabetes include age, ethnicity, family history and weight, Givan said. Older people are more at risk. Pacific Islanders, Native Americans and African-Americans are some of the ethnic groups with the highest risk. Weight plays a part, particularly in Type 2 diabetes. Also at high risk are women with gestational diabetes, which happens during pregnancy, or who give birth to babies weighing more than 9 pounds.
Diabetic eye diseases Breiwa sees include cataracts, which is the clouding of the eye's lens; glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage; and diabetic retinopathy, damage to the blood vessels in the retina that, if left to advance, can turn into proliferative retinopathy, where new blood cells grow on the retina and can bleed into the eye.
"The walls bulge out and eventually pop. We see them as large blood vessels in the eye," he said. "There can be blood floating around in the eye. It's hard to see through that." Laser treatment can be done on the retina to stop the growth of the blood vessel. There is also an injection in the eye that can reduce fluid retention. "The blood is reabsorbed back in the body," he said.
If things are bad, Breiwa sends patients to a different type of doctor. "When we're seeing a lot of little hemorrhages, a retina care specialist gets a hold of them," he said.
Breiwa recommends that diabetics have a dilated eye exam a minimum of once a year and, in some cases, every six months.
"There can be changes in vision," he said. "They tend to become nearsighted, but I have seen people go the other way." Regular exams can help detect the diabetic eye diseases earlier and prevent more eye damage.
"We generally don't find (more severe) problems unless they've been diabetic for a while," he said.
Other complications that can be caused by diabetes include heart disease, stroke, heart attack, kidney disease and nerve damage. The health department has recently been hosting free diabetes self-management classes that discuss complications that can be caused by diabetes, sick day management and treatments, nutrition, medication and exercise.
"We talk about when to call the doctor and what foods you can eat if you can eat," she said of the sick day plan. "We talk about counting carbohydrates." Exercise helps with weight control and blood sugar control.
"The body will be more insulin sensitive if you exercise every 24 hours or so," Givan said. Breiwa urges diabetic patients to take of their overall health as well as their eyes, which includes getting a proper diet and doing things in moderation. "People shouldn't blow that off," he said.
©2011 the Daily News (Bowling Green, Ky.)