Type 1 diabetes, known as insulin dependent, and type 2 diabetes, known as noninsulin dependent, are variations of a tumultuous disorder that does not spare any organ or body system. Even when blood-sugar levels are managed adequately, there are ultimately far-reaching consequences to a multiyear exposure of the mechanisms of this disease.
The unifying pathology responsible for the late manifestations of the disease is related to the cardiovascular sequelae that are all too frequently associated with diabetes. The diabetic is the first to have a heart attack, stroke, and kidney disease that frequently leads to dialysis and transplantation.
The diabetic is almost exclusively in that group of patients who develops wounds in the extremities, especially in the feet, that do not heal. The ultimate consequence is to develop a gangrenous extremity that requires amputation to spare the life of the patient.
Accumulation of plaque in the arteries is accelerated in the diabetic, but the plaque-deposition process is certainly not unique to diabetes. What is unique is that the most devastating consequence of diabetes is found in the microvasculature. These diseased microscopic arterial blood vessels are truly only found in diabetes. It is because of these deranged vascular structures that a normal blood supply to the tissues cannot be established to provide the nutrients and oxygen to the cells, so they cannot function normally.
It should come as no surprise that diabetes has serious implications with respect to the eye and to the retina in particular. It is said that it is impossible for a patient to suffer from diabetes for greater than thirty years without the retina being substantially involved. The conditions that result are together as a group known as diabetic retinopathy, which is associated with resultant loss of vision that can lead to total blindness.
A special mention should be made about the diabetic with retinal involvement in keeping with the Three-Step Program that is being discussed:
- Diabetic retinopathy is no different from any other retinal disease in how it responds to modalities that are used in the Three-Step Program. We continue to observe substantial improvement in vision in as short a period of time as three days.
- It was previously pointed out that diabetic retinopathy is a consequence to the pervasive manifestations of a diseased microvasculature. The diseased blood vessels leak fluid and bleed. As was pointed out during the discussion of wet ARMD, the same diseased retinal blood vessels also bleed. It is because of this that retinal specialists will recommend the same anti-VEGF injections to the patient with diabetic retinopathy that they did with the patients with wet ARMD.
The same plan that was suggested during that discussion is operational here. Go back and read it again. The three-pronged plan to avoid injections, in brief, is as follows:
- Receive an evaluation from another eye doctor.
- Complete a three-step and/or three-day treatment program.
- Return to be reevaluated to see if your improvements permit you to avoid any invasive treatment at all.