Diabetes Mellitus Is A Disorder Of The

Diabetes Mellitus Is A Disorder Of The. All forms of diabetes is a very critical illness and overwhelming illness. This article will present you with several diabetes fully grasp and handle their condition.

- did you know that diabetesis the most common cause of blindness in individualsfrom the ages of 25 to 65? and blindness can be caused by multiple different complicationsassociated with diabetes including glaucoma and cataracts, however

in this tutorial, let'sdiscuss the most common cause of blindness due to diabetes which is a condition knownas diabetic retinopathy. and if we break down the term,

we can receive generally, an understanding of what this disease is,so you have retino here meaning the retina, andpathy meaning disease. so, diabetic retinopathyis a disease of the retina that's caused by diabetes. and to describe what the retina is, let's bring in a diagram of the eye and go through some of the structures as it will help us as we learnmore about this condition.

over here on the left, we havea cross-section of the eye and there's a few importantstructures to note. so this is the front of the eye here, and this is the back of the eye, and this part right hereis known as the cornea. and it is where lightinitially passes through as it goes through theeye, and then it hits this structure right here,which is known as the lens. and the lens focuses thelight on this structure

in the back of the eye, thiskind of brownish structure, and this is the retina. and then exiting the back of the eye here, this is the optic nerve. then, you can also seeall of these blood vessels that are traveling through the retina and then exit the back of the eye in the middle of the optic nerve. so if you look over here on the right,

this is a front view of the eye. so this is kind of what it looks like when a doctor looks in to your eye. so here, right here we have what's called the optic disc, and theoptic disc is really just the convergence of the retina and where it exits theeye, so this is really actually the optic nerveexiting the back of the eye. and then over here, you have a structure

called the fovea. and the fovea is the portion of the retina with the highest density of cones which are the nervous receptors that correspond with colorand more high resolution. so this is the portion of the retina that produces thehighest resolution image. so, in a sense, you cankind of think of the fovea as producing an hd or a highdefinition quality image

whereas kind of the moreperiphery of the retina on the outside will producea much lower quality image. now that we have a verybasic general orientation to the eye and the retina,let's use this drawing to discuss the three stagesof diabetic retinopathy. and they are, diabeteswithout retinopathy, non or pre-proliferativediabetic retinopathy, and proliferative diabetic retinopathy. and one thing that's important to note

is that these stagesof diabetic retinopathy are defined by their pathology. not by the clinical presentation or their symptoms. but before we dive into the pathology here, what are some of the common symptoms of diabetic retinopathy? well, since it's a disease of the retina caused by diabetes, it makessense that the symptoms

are typically visual. and most of the symptoms tend to be fairly mild initially. they are things like blurry vision, or seeing dark spots or floaters. however, sometimes thesymptoms can be very serious. such as sudden onset of blindness. all right, so now let's get back to these stages of diabetic retinopathy.

so the first stage i'm mentioned is diabetes without retinopathy. so why do we considerdiabetes without retinopathy a stage of diabetic retinopathy? it doesn't quite make sense. and this is because the stages are dictated by the underlying pathology. and so, long before someone with diabetes develops vision changes,the underlying hyperglycemia

or high blood sugar levels in their blood causes damage to cells knownas pericytes within the retina. so these retinal pericytes arespecialized contractile cells that surround theretinal vasculature here. and they're very importantfor helping regulate blood flow throughout the retina. and the damage to these pericytes is believed to be caused by an inability to properly metabolize the glucose

within these cells. and then this results in osmotic damage. now this damage to the retinal pericytes is the earliest stageof diabetic retinopathy and it's likely present inmany, if not most individuals who have had diabetesfor at least a few years, however, unfortunately thisdamage is only detectable under a microscope andtherefore the retina on opthamologic or on aneye exam looks normal.

it looks something like this. so therefore, early inthe course of diabetes individuals will not necessarilyhave visual disturbances or signs of disease on exam, however this does not necessarily mean that the damage is not occurring, it's just not detectable. and the next stage of diabetic retinopathy is that of the non

or pre-proliferative diabetic retinopathy. so recall that i just mentionedthat these retinal pericytes help regulate bloodflow through the vessels throughout the retina,and when they're damaged this results in the weakeningof the capillary walls, as well as increased blood flow. what happens when thesecapillaries are damaged, it allows for theformation of microaneurysms which are focal dilationsof weakened vessel walls

and since these aneurysms occur in the microvasculature of the retina the vessels themselves are very small and not visible on opthamologic exam however, the microaneurysms are. and so they kind oflook like these red dots that just appear kind of randomly throughout the retina. and if we bring in an actualpicture here of the retina

you can see that this is actually what they look like under examination. so they're a little bit harder to see, but they're these dots right here, right here, and here, which are typically the first clinical signof diabetic retinopathy. however, this isn't theonly clinical finding for this non or pre-proliferative diabetic retinopathy stage.

in addition to damagingthe retinal capillaries this loss or damage tothe retinal pericytes also results in increasedvascular permeability. and basically what this means is that the capillaries become leaky. now this leakiness allowsfor large molecules such as proteins andlipids that are normally retained within the vessels to leak out in to this retinaltissue, and unfortunately,

there isn't a normal mechanism to allow these to be reabsorbed. so as you can imagine,if proteins and lipids were to leak out, they get trapped. and this also can be seenunder a dilated eye exam and it kind of appears as these yellow-white flecks on theretina, as you can see here. and this finding isknown as a hard exudate. and, once again, even though this is just

a drawing of the retina, it'sactually fairly representative of what actual hard exudates look like. so you can see once againall of these microhemorrhages or microaneurysms in the retina, and then these white-yellowflecks all over and that's the proteins and lipids that have leaked out to form these hard exudates in the retina. so these two clinical findingsare very characteristic

of this second stage or thenon or pre-proliferative stage of diabetic retinopathy. and because diabetic retinopathy is categorized by the pathologic findings and not necessarily theclinical presentation, this stage of diabetic retinopathy may or may not be symptomatic, so it usually begins about 15 to 25 years after someone's initiallydiagnosed with diabetes

and it can last for manyyears before it progresses to the next stage which is proliferative diabetic retinopathy. now, proliferative diabetic retinopathy can be asymptomatic,however, it's pretty uncommon so most individuals that reach usually will have at least blurry vision or the presence of floaters. and as its name suggests,

proliferative diabeticretinopathy is characterized by vascular proliferation within the retina. and the reason for this is that all of the microvasculardamage that occurs in these first two stagesof diabetic retinopathy results in something called ischemia. and what ischemia is, isa lack of oxygen supply to the cells of the retina. so, what the retina will do is it tries

to compensate for this ischemia by producing a growth factor known as vegf which stands for vascularendothelial growth factor. and vegf does exactlywhat its name suggests. it produces new blood vessels. however, these blood vessels in diabetic retinopathy are abnormal, and the retina is not able to compensate for the ischemia.

so it looks something like this over time. so you can see there's all of these new blood vessels that have formed within the retina and similar to the microaneurysms and the hard exudites, this vascular proliferationcan also be identified on a dilated eye exam. and it looks something like this. so you can see some maybea little bit more normal,

larger vessels in the retina, but then throughout here, are these little bit lighter kind of squiggly looking newer vessels. so this is that vascular proliferation that is indicative of the and unfortunately, oncediabetic retinopathy hits this third stageand becomes proliferative the clinical course ispretty unpredictable

and it can actually be fairly severe, resulting in potentially visionthreatening complications such as vitreous hemorrhageor retinal detachment. so now that we have a better understanding of the pathological mechanisms of diabetic retinopathy, howcan we use this information to learn how the condition is treated? well, first off the treatmentsare aimed at halting the underlying pathologic mechanisms

of diabetic retinopathy, however their use is more commonly dictatedby the severity of symptoms. so we'll start with the first stage the diabetes without retinopathy, and since the pathologic mechanism of diabetic retinopathyis directly related to the underlying hyperglycemia associated with diabetes,the best way to prevent or delay the progressionof diabetic retinopathy

is early and aggressivecontrol of one's blood sugar with lifestyle modificationsand anti-diabetic medications. however, oftentimes this is not enough, and over time even individuals with very well controlled diabetes may develop diabetic retinopathy. so because these early stagesare often asymptomatic, it's also important for allindividuals with diabetes to have a yearly dilated eye exam

performed by an ophthalmologist to look for the signsof diabetic retinopathy. now once an individual hassigns of diabetic retinopathy such as the microhemorrhagesor the microaneurysms and these hard exudites, and they move in to that second stageof diabetic retinopathy and now the treatment isdependent on symptoms. so if that individualis, say, asymptomatic their only treatment isstill to just maintain

proper blood glucose regulation and the yearly eye exam. however, as soon as symptoms such as blurry vision or floaters develop, then an individual withdiabetic retinopathy should be placed on anti-vegf medications. and these medications will prevent the proliferation of newblood vessels in the retina and therefore help prevent the progression

to proliferative diabetic retinopathy. now, unfortunately oncesomeone has evidence of proliferative diabeticretinopathy with this vascular proliferation of the retina, the clinical course is actuallypretty difficult to predict. so for this reason,anyone in this stage of diabetic retinopathy isrecommended to undergo a procedure known aslaser photocoagulation. and this is a process by whichvery precisely focused lasers

are used to stop thegrowth of these vessels on the retina, and unfortunately this treatment is not necessarily curative it's more aimed at preventingserious complications of diabetic retinopathysuch as retinal detachment where, as its name suggests, the retina can become detached from the posterior wall of the eye, or vitreous hemorrhage wherethese new blood vessels

actually burst and bleed into the inside of the eye. and both of these conditions,may potentially result in permanent blindness, therefore anyone with diabetes who develops sudden onset visionloss should be evaluated emergently to rule outthese complications. so diabetic retinopathyis a disease of the retina that's caused by diabetesand it tends to be a slow progressivecomplication of diabetes

that eventually affectsnearly all individuals with diabetes maladies. however, the underlying mechanism of diabetic retinopathyis directly associated with glycemic control orblood glucose regulation.

Diabetes Mellitus Is A Disorder Of The,therefore, like many of thecomplications of diabetes, proper treatment of theunderlying condition can prevent or at least slow the progression of diabetic retinopathy.

Now you understand how to control your trouble, you happen to be much better able to create the correct selections and changes in your life. Understand that these pointers are only relevant if you are using as many of them as is possible, and thus you must start off right now to see quick results.