Diabetes “Sight for Life” This presentation was made possible through production funding from the The purpose of this program is to help you learn about your vision as a person with diabetes. It is presented as a public service from the American Optometric Association. Sponsored in part by a grant from Roche Diagnostics

17 million Americans have diabetes. About half of those people don’t know they have diabetes. Diabetes is the major cause of blindness among working age Americans. Over 17 million Americans have diabetes. The American Diabetes Association estimates that almost half of those people don’t know they have diabetes. That means that about one in 14 persons (possibly one or two people in this room) could have diabetes. Diabetes is also the major cause of blindness among working age Americans. No matter what you have heard, any of us can get diabetes. That’s why it’s important to learn about this disease and know the signs.

DIABETES is a serious DISEASE! Diabetes can be a very serious disease if not controlled. Diabetes is the third leading cause of death. An epidemic! Diabetes can be a very serious disease if not controlled, just like heart disese or high blood pressure. High levels of glucose in the blood can cause serious complications. Diabetes and it’s complications are the third leading cause of death in the United States. The Centers for Disease Control (CDC) considers diabetes to be an epidemic!

What is Diabetes? What is diabetes? The medical term is DIABETES MELLITUS. You may have heard diabetes called “high blood sugar” or “sugar diabetes” and some people think diabetes is caused by eating too much sugar. Diabetes is not caused by eating too much sugar, although it does involve the foods we eat and eating too much can be part of the problem. So what is diabetes? Diabetes is a disease that affects our body’s ability to use food energy. Diabetes usually does not interfere with digestion, but it does prevent a person’s body from using glucose. Glucose is produced from the food we eat. It circulates in the body to provide us with energy. Persons with diabetes are not able to make use of the glucose they produce. There are 2 major types of diabetes…... Diabetes affects the ability of our body to convert the food we eat into energy.

Type 1 (Insulin-Dependent) Diabetes Type I or Insulin-Dependent Diabetes. Requires insulin shots to live. Usually starts under age 20. Insulin dependent diabetes (or type I diabetes) means that people who are affected must have insulin shots to stay alive. This form of diabetes usually starts during childhood and occurs most frequently in people under age 20.

Type 2 (Non-Insulin Dependent) Diabetes Can often control their diabetes without using insulin. Adults over age 40 who are overweight and have a family history of diabetes. Now occurring more frequently in children and adolescents. Non-insulin dependent diabetes (or type II diabetes) occurs in people who frequently can control their diabetes without using insulin. This form of diabetes usually starts in adults over age 40 who are overweight and have a family history of diabetes. However, this form of diabetes is now occuring more frequently in children and adolescents. We’ll talk more about these two kinds of diabetes later.

When We Eat Food Food is converted into glucose. Stomach Liver Pancreas Intestines Food is converted into glucose. Glucose enters the bloodstream. Insulin helps to move glucose into cells. To understand diabetes, let’s look at what happens in our body when we eat food. All the foods we eat are classified as either carbohydrates (bread,vegetable,fruits,cereals), proteins (meat & dairy products), or fats (butter, oils margarine, bacon & salad dressings). After we eat these foods, they are digested and and broken down into glucose. Glucose is a form of sugar-so that’s why you may hear people call diabetes a sugar disease. After these foods are moved into the intestines, the glucose is absorbed into the bloodstream and carried to al parts of the body to be used for energy. But before glucose can be used by the body’s cells, a hormone called insulin must be present to help the glucose enter the cells. Insulin is produced by the pancreas. When food enters our body, the pancreas releases insulin into the bloodstream.

Insulin allows glucose to enter the cell. How Our Body Uses Food The Cell Glucose Molecules Insulin A simple way to understand this is to think of insulin as the “key” that “unlocks the door” to our cells and allows the glucose to get inside. Once glucose is inside the cell, it can be used for energy. Insulin allows glucose to enter the cell.

Type 1 Diabetes The Cell Glucose Molecules When a person has diabetes, glucose still enters the bloodstream in the normal manner. However, in a person with insulin-dependent diabetes (IDDM), the pancreas does not produce enough insulin to allow the glucose to enter the cells. There is no “key” to unlock the cell to let the glucose molecules in. That is why a person with IDDM must take insulin shots to stay alive. Without insulin, glucose cannot enter the cell. This person is “insulin-dependent”.

Type 2 Diabetes Glucose Insulin Insulin does not work properly. The Cell In a person with non-insulin dependent diabetes (NIDDM), the pancreas usually produces some insulin. However, the insulin does not work properly, just like a key that won’t open the door. Therefore, in either case, glucose builds up in the blood and eventually may spill over into the urine. This buildup of excess glucose in the blood is referred to as hyperglycemia or high blood suger. Insulin Insulin does not work properly. Glucose buildup - “hyperglycemia”.

Symptoms of Diabetes Unusual Thirst Blurred Vision Frequent Urination When glucose starts spilling over into our urine, this produces the symptoms of diabetes. Usually the first sign of diabetes is frequent urination, especially at night. This is followed by unusual thirst-that feeling that you just can’t get enough to drink. Another important symptom of diabetes is fatigue-just feeling like you don’t have enough energy. The person feels tired because the body isn’t burning enogh glucose for energy. A person may also notice blurred vision that comes and goes. This happens when the excess glucose causes the lens in our eye to swell. Other symptoms of diabetes might include sudden weight loss-even when the person is eating the same amount. A person may also notice that wounds or infections are slow to heal. Some persons with these symptoms may not have diabetes. But, if you or someone you know has these complaints, see your doctor. Fatigue

Who Develops Type 1 Diabetes? Also called “Juvenile Diabetes”. Begins suddenly in persons under age 20. 10% of diabetes patients. Let’s look at who gets diabetes. Insulin-dependent diabetes (IDDM), or type I diabetes, is called that because these patients must take insulin to stay alive. You may have heard this called juvenille diabetes, because it usually starts in children under the age of 20. The symptoms come on very suddenly. Adults are unlikely to develop this type of diabetes. This form of diabetes accounts for only 10% of the diabetes patients in the United States.

Who Develops Type 2 Diabetes? Usually occurs after age 40. Gradual appearance of signs and symptoms. Occurring more frequently in children. Half are unaware they have diabetes. 90% of diabetes patients. Non-insulin-dependent diabetes (NIDDM), or type II diabetes, occurs in people who can usually control their diabetes without taking insulin. You may have heard this called maturity onset diabetes because it usually occurs after the age of 40. It has a gradual onset often over many years. This type accounts for 90% of all diabetes in the United States. Alarmingly, this form of diabetes is also occuring more frequently in children. This is especially true for Native American, Hispanic American and African American children. As we have said, half of these people don’t know they have diabetes. The signs and symptoms may not be recognized in the early stages. That’s why we are learning about diabetes today. We need to know the sign and symptoms if we want to get prompt diagnosis and treatment. If you have any of these sign and symptoms (frequent urination, unusual thirst, fatigue, blurred vision), you should be checked for diabetes. It’s very important to catch diabetes early so it can be controlled and a person can live a normal, healthy life.

Who Is Likely To Develop Diabetes? Overweight Sedentary Family history of diabetes Advancing age Ethnic origin We don’t know exactly why people get diabetes. Scientists all around the world are working hard to find a cure, but the exact cause is still not clear. We do know that you can’t catch diabetes from someone else. Eating a lot of sugar does not in itself cause diabetes. But eating too much and being overweight does have a major effect on the disease. One of the most important things to recognize is that being overweight and not getting enough exercise really does increase your chance of getting non-insulin-dependent diabetes. 80% of adults are overweight when they find out that they have diabetes. If the disease “runs in your family”, this will increase your chance of developing diabetes. Also, as we get older, our likelihood of developing diabetes increases. We can’t do much about that, but we can be aware of the risk. Another important thing that has become evident recently is that non-insulin-dependent diabetes occurs much more often in African Americans, Hispanic Americans and Native Americans. This is also occuring among children with these ethnic origins.

How Does My Optometrist Detect Diabetes? Symptoms Blurred Vision Vision that Changes “Double Vision” Frequent Urination Thirst Fatigue Your optometrist may suspect diabetes is you have symptoms of blurred vision, vision that changes over time (as blurred one day and clear some time later) or if you have double visoin. He or she may ask if you have any other syptoms of diabetes. Your optometrist may want to know more about your personal and family history. He/she will perform tests to determine what your visual acuity is, how well coordinated your eye movements are, if your refractive condition (the strength of your glasses) has changed over time, a test to determine your eye pressure (tonometry) and perhaps a visual field test. It is likely that he/she will dilate your pupils with eyedrops to examine your retina for early signs of diabetes . He/ she may even order a blood test to measure the amount of glucose in your blood. If your optometrist is concerned that you may have diabetes, he will refer you to your family physician for more tests. Your regular eye exam may be the first opportunity to detect diabetes!

How Does My Optometrist Detect Diabetes? Tests History Visual Acuity Eye Movements Refraction Your optometrist may suspect diabetes is you have symptoms of blurred vision, vision that changes over time (as blurred one day and clear some time later) or if you have double visoin. He or she may ask if you have any other syptoms of diabetes. Your optometrist may want to know more about your personal and family history. He/she will perform tests to determine what your visual acuity is, how well coordinated your eye movements are, if your refractive condition (the strength of your glasses) has changed over time, a test to determine your eye pressure (tonometry) and perhaps a visual field test. It is likely that he/she will dilate your pupils with eyedrops to examine your retina for early signs of diabetes . He/ she may even order a blood test to measure the amount of glucose in your blood. If your optometrist is concerned that you may have diabetes, he will refer you to your family physician for more tests. Your regular eye exam may be the first opportunity to detect diabetes!

How Does My Optometrist Detect Diabetes? Tonometry Retinal Exam through a Dilated Pupil Visual Field Test Blood Test for Glucose Your optometrist may suspect diabetes is you have symptoms of blurred vision, vision that changes over time (as blurred one day and clear some time later) or if you have double visoin. He or she may ask if you have any other syptoms of diabetes. Your optometrist may want to know more about your personal and family history. He/she will perform tests to determine what your visual acuity is, how well coordinated your eye movements are, if your refractive condition (the strength of your glasses) has changed over time, a test to determine your eye pressure (tonometry) and perhaps a visual field test. It is likely that he/she will dilate your pupils with eyedrops to examine your retina for early signs of diabetes . He/ she may even order a blood test to measure the amount of glucose in your blood. If your optometrist is concerned that you may have diabetes, he will refer you to your family physician for more tests. Your regular eye exam may be the first opportunity to detect diabetes!

Complications of Diabetes #1 Cause of BLINDNESS #1 Cause of AMPUTATION #1 Cause of KIDNEY FAILURE Twice as many HEART ATTACKS Three times as many STROKES Diabetes is: - the #1 cause of new cases of blindness in working age adults (under 65). Ther are 5,000 new cases of blindness each year caused by diabetes. Most of this can be prevented by early diagnosis and treatment. - the #1 cause of amputaiton in the United States. Diabetes is responsible for almost 50% of all lower-extremity amputations. - the #1 cause of new cases of kidney failure requiring dialysis or transplant. - People with diabetes have twice as many heart attacks and three times as many strokes. Most of these “complications” of diabetes are preventable. So you can see why you need to know the early warning signs of diabetes!

Benefits of Preventing & Treating Diabetes Feel better. Fewer symptoms. Longer, healthier life. Decrease the risk for complications of eye, foot, kidney, heart and nerve diseases. A lifetime of good vision! It is important to treat diabetes even if you think you may only have “a little sugar in the blood”. A person will usually feel better, have fewer symptoms and be more active when their blood sugar is in “good control”. The chances of long-term complications are drastically reduced. People with diabetes can lead a normal, healthy lives. Most importantly, persons with diabetes can have a lifetime of good vision. Controlling blood sugar reduces the risk of bad vision by at least 60%. Coupled with an annual eye exam, you can reduce the risk of blindness to almost nothing!

Diabetes Can be Treated & Controlled Your Diabetes Team: Optometrist Family Physician Podiatrist Dentist Diabetes Educator Retinal Specialist Dietitian If you have diabetes, you can control it. Your optometrist and the medical professionals who work with him or her can help you understand diabetes. Learn how you can control it in order to live a long and healthy life.

Points to Remember If you or someone you know: has symptoms of diabetes. is overweight or sedentary. is over age 40. has a family history of diabetes. Call the Doctor! Schedule a Checkup! Remember, if you or someone you know: has symptoms of diabetes (frequent urination, excessive thirst, fatigue or blurred vision). is overweight or sedentary. is over age 40 has a family history of diabetes. Call your doctor to schedule a checkup for diabetes. Have regular eye exams as part of a complete physical.

How to find an Optometrist To find a local Optometrist go to www.aoa.org home page. Click onto "Doctor Locator". Medicare beneficiaries can receive assistance in getting an eye exam by calling the “Diabetes Hotline” at 800-262-3947. Find more information on the American Optometric Association website: www.aoa.org. November is National Diabetes Month. But you don’t have to wait until November to schedule an eye exam! Members of the American Optometric Association are joining with members of other health care organizations in an effort to prevent blindness in Americans with diabetes. If you or a member of your family have not received a dilated eye examination in the past year, you should contact your local optometrist for an appointment. If you do not have an optometrist, you can go to the AOA website to find a doctor near you. If you are a Medicare beneficiary you may call the “Diabetes Hotline” at 1-800-262-3947 to get assistance in receiving an eye exam. Medicare will pay a portion of your annual dilated eye exam. More information can be found on the American Optometric Association website at www.aoa.org.