National Diabetes Week 2017 kicks off on July 9 in Australia to raise awareness and understanding about this chronic condition. We thought we would do something different on the awareness-raising front with a poem by our UK colleague, Jim Young.
I am not a diabetic.
I have diabetes – you see?
I am not obese,
I do not smoke or drink,
I am a hungry vegetarian,
and I swim in the sea each day.
Then you shouldn’t have diabetes?
But unfortunately, it doesn’t work that way.
My Dad had diabetes and
it was his parting gift to me.
So, I have made friends with my condition,
it calls me Son and I call it Pop,
as I pop another pill.
I treat him with every consideration
and we do love to get it right.
My doctor treats him with reverence
and prescribes only the best wrapped gifts,
to assuage his temper, and hopefully one day
will inject some realism into my insinuation
and oft repeated question,
“Oh why Dad, why? Oh why?”.
Now it ought to be OK? You say.
But these bloody auto-antibodies
go hunting in a pack.
So another pill for cholesterol,
another for BP,
I know these rustling popper packs
will be the life of me.
But I am not a diabetic!
Repeat that after me,
and then maybe you will see,
that whatever my glucose status,
it is me you see – yes me.
So please don’t stick a label
for now you know the truth.
You know that I suffer from diabetes,
as you might do,
Jim Young is Editor-in-chief of Glycosmedia, an independent online newsletter reporting latest developments in diabetes research. You can read more of Jim’s poems here.
Protecting our eyesight is one of the most important things we can do to ensure quality and enjoyment of life. Ophthalmologist Dr Shanel Sharma explains why for anyone with diabetes it’s vital to be vigilant and why the eye is vulnerable to damage from the complications of diabetes.
“Diabetes is the most common cause of blindness for people between 20 and 65 and diabetic eye diseases can affect anyone with diabetes whether type 1 or type 2,” she says. Chronically high blood glucose levels over time damage blood vessels throughout the body. Our small blood vessels are the most vulnerable and are affected first. These include the small blood vessels supplying our eyes, kidneys and our peripheral limbs (toes). People with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels.
What happens in the eye is that the blood vessels become damaged and develop micro-aneurysms, start to bleed causing haemorrhages and stop carrying blood, resulting in retinal ischaemia. Ischaemic retina causes the release of a protein (VEGF – vascular endothelial growth factor), resulting in the development of sick and abnormal blood vessels, which can bleed or cause tractional retinal detachment and loss of vision. The other major way people lose sight is from diabetic macular oedema, from leaking of blood product into the macular. The macular is the part of the eye that allows one to read, look at people’s faces, or do any fine detailed work.
As there is usually a 10–15-year delay in chronically high BGLs and appearance of diabetic eye diseases, it is important to control BGLs well from the start. Although the damage to the eye is irreversible, early detection and treatment can reduce the risk of blindness by up to approximately 95%.
If you are diagnosed with diabetic retinopathy, don’t despair. Good blood glucose control can reduce its progression. Aim for an HbA1c of 6.05% (people with HbA1c levels less than 6.05%, generally develop slowest rate of retinopathy). Studies have shown that with every percentage point reduction in your HbA1c, you can reduce progression of diabetic retinopathy by 33%.
Reducing blood pressure helps too. A 2015 Cochrane review concluded that the available evidence supports ‘a beneficial effect of intervention to reduce blood pressure with respect to preventing diabetic retinopathy for up to 4 to 5 years’.
As diabetic eye diseases most commonly have no symptoms, it is essential to ensure that you are being screened regularly by your GP, optometrist or your ophthalmologist. Symptoms that are associated with diabetic eye diseases can include intermittent blurred vision, difficulty with focusing, loss of contrast, double vision or distortion to your vision. Additionally, diabetes is an independent risk factor for developing other eye diseases such as cataracts and glaucoma.”
- Preventing Diabetic Retinopathy Progression
- Diabetic Retinopathy and Systemic Factors
- Blood pressure control for diabetic retinopathy
- Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus (UK Prospective Diabetes Study)
Diet and diabetic retinopathy
Clinical trials have found that people with diabetes who follow healthy eating principles can reduce their HbA1c levels by 1 to 2 percentage points. If they are also following a low GI diet, they can reduce their HbA1c levels by another 0.5 percentage points. While this may not sound significant, a decrease of just 1 percentage point in HbA1c levels will decrease the common complications of diabetes by 19% to 43%.
Study: Dietary hyperglycemia, glycemic index and metabolic retinal diseases
Diet and AMD
A recent review in Nutrients critically evaluates the evidence about lutein and zeaxanthin (the predominant carotenoids which accumulate in the retina of the eye) intake and age-related macular degeneration. “Current evidence suggests that higher dietary intakes of lutein and zeaxanthin are likely to play an important role in protecting against age-related macular degeneration (AMD)” conclude the authors. “A diet high in a variety of foods is important for achieving adequate dietary levels of lutein and zeaxanthin (as well as other nutrients). Moreover, such a diet should include plenty of leafy green vegetables, in keeping with dietary guidelines. There is also value in including a range of other foods to increase variety and improve the bioavailability of lutein and zeaxanthin, such as eggs and selected nuts,” they say.
Study PDF: Lutein and Zeaxanthin—Food Sources, Bioavailability and Dietary Variety in Age-Related Macular Degeneration Protection
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FRUCTOSE AND BGLS
A new systematic review and meta-analysis in the American Journal of Clinical Nutrition concludes there’s strong evidence that substituting fructose for glucose or sucrose in food or beverages lowers peak postprandial blood glucose and insulin concentrations without a substantial increase in blood triglyceride concentrations. Not so surprising when you look at the GI values of these sweeteners: Fructose (Fruisana brand) = GI 19; Sucrose (table sugar, average) = GI 65; Glucose = GI 100.
Study: Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis