Into the fray of diabetes |14 February 2022
In Seychelles, poor vision and even blindness from poorly treated diabetes is a huge problem. Diabetic care and routine eye checks are simply not good enough. This is the responsibility of both the government (Public Health Care) and the individual. Repeated public awareness campaigns on risks, dangers and prevention through proper nutrition among other things needs to be stepped up and incorporated in a regular programme of public health education. The responsibility of the individual in the prevention of diabetes and/or its management cannot be overemphasised.
The leading causes of blindness and low vision are primarily age-related eye diseases such as age-related macular degeneration, diabetic retinopathy (damage to the retina at the back of the eyes from diabetes), glaucoma and cataracts. In people of working age, diabetes is the most common preventable cause of blindness. After 44 years of independence, it is rather appalling that we do not have a single qualified Seychellois physician (internal medicine specialist) in the Ministry of Health and not a single qualified diabetic specialist.
Some immediate action can be taken.
1. Training: Far more training of doctors and nurses is needed as a matter of priority, and training has to be repeated in order to ensure inclusion of maximum health staff and regular updates.
2. Checks on quality of care: there is a need to carry out regular clinical quality audits in every clinic, government and private, to check that the management of diabetes and hypertension is good enough; that guidelines are being implemented.
Severe diabetes or badly managed diabetes can lead to diabetic retinopathy. This is a condition where the high levels of sugar in the blood causes damage to the blood vessels in the retina (a membrane at the back of the eye) and lead to vision impairment and, if left unchecked, to blindness. It takes several years though for diabetic retinopathy to threaten your sight giving a window of opportunity for preventive action. The longer you've had diabetes, the more likely you are to have diabetic eye damage (retinopathy).
- Risk factors for diabetic eye damage include:
- Poor control of blood sugar levels
- Poor control of high blood pressure
- Poor control of raised cholesterol
- Kidney damage from diabetes
- Pregnancy: during pregnancy diabetes can severely damage the eyes.
If diabetic, how can you prevent eye complications and blindness?
- Good sugar control: Regular monitoring and keeping blood sugar levels under control over time is very important. You may ask the doctor for a HbA1c blood test (glycated haemoglobin-haemoglobin is the protein in the blood responsible for carrying oxygen to all parts of the body. In situations of high sugar content in the blood over a prolonged period, the sugar can become attached to the haemoglobin) every 3-6 months. This test gives a good picture of the blood sugar levels over a prolonged period of time, the preceding weeks or even months. If your HbA1c result is 7% or less, sugar control is good. If more than 7.5%, your sugar control is not good enough. In addition, your fasting blood sugar and blood sugar levels just before meals should be less than 7 or 8.
- Good systolic blood pressure control: keep it to less than 130 mmHg. It should be possible today to buy your own BP machine (such as an OMRON) from a pharmacy.
3. See an optometrist once a year for your diabetic eye check
- Take your glaucoma eye drops and/or tablets, and see your eye specialist regularly.
- Do not smoke
- Good control of blood cholesterol levels (a type of fat found in your blood).
In all cases, make sure you take your medications as directed, every day.
Prevention by annual screening for diabetic eye complications
It is recommended that diabetics be offered annual eye checks (or every two years if eyes are normal). The aim is to detect eye damage early and to treat early, so as to prevent loss of vision. A diabetic person may have good vision (be asymptomatic) in spite of the presence of severe and dangerous retinopathy.
During the annual eye check, (1) a photo of the retina at the back of the eye will be taken using a special eye camera, (2) a test of your vision (visual acuity test) is done, (3) An eye examination is carried out using an ophthalmoscope, to make sure you don’t have cataracts and glaucoma, and (4) a measurement of pressure in the eyes is also done to detect raised pressure (glaucoma).
These tests are important because your retina can be badly damaged before you notice any change in your ability to see.
Other severe complications in diabetics, requiring immediate treatment
Detachment of the retina and bleeding into the eye. These are caused by weakening of blood vessels in the eyes due to the disease progression and build-up of scar tissue.
Treatment of severe retinopathy
The main treatments are:
• laser treatment
• injections of medication into your eyes
• removal of blood or scar tissue from your eyes
The impact of an increasingly sedentary lifestyle and poor diet cannot be overlooked. The pace of life has become more frenetic; most people prefer to drive or take public transport instead of walking. Children are nurtured on television and video games instead of playing outdoors; their snacks are reduced to carbohydrate high packed snacks and sweetened fizzy drinks instead of fruit and plain drinking water. These changes can lead to obesity, childhood obesity and all its implications for the health and welfare of the individuals, not to mention the financial impact on the public health system. Walking and physical activities have become a luxury, an exception. This is a matter of personal responsibility and is central to prevention and to proper management in disease, in this case, diabetes, for the best outcome. Nutrition, exercise, quality of sleep and avoiding stress together contribute to better health.
Join the Seychelles Association of the Blind and Visually Impaired (Sabvi), and register as blind
Support is available out there for those who have already lost their sight.
SABVI has begun several initiatives to enable people with vision impairment. Through this Association:
You may be taught how to walk safely, using a special stick, a white cane.
You may be assisted to get and use special visual and home aids.
You may be taught Braille.
As a registered blind or severely visually impaired person suffering from diabetic retinopathy, you may be eligible to certain assistance:
You may need preset insulin syringes
You may need help from an occupational therapist to adapt your home
Should you require it, you will receive financial help from government for home or other assistance.
If diabetes and hypertension are well treated, most diabetic people may only have minor eye disorders during their life. It is up to you to take your responsibility seriously, to find a good diabetic doctor, a trained diabetic nurse, a good optometrist, to follow any advice including a healthy diet, daily exercise, and weight control), to take your medications as advised, (tablets, eye drops, insulin injections) and to attend follow ups. Get advice on nutrition and weight control from a nutritionist or diet trained nurse.
Dr Guy Ahmoye MD, MRCP
Personal statement at the request of Sabvi
Dr Ahmoye qualified from St Bartholomew’s Hospital in London. He is a Member of the Royal College of Physicians (MRCP). He worked both in Seychelles and the United Kingdom during his long career. For many years he was a member of the top Joint Diabetic Committee at St Thomas Hospital and King’s College Hospital, London.
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