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Imagine for a moment that there exists a disease that could potentially take 15 years off your lifespan. Let’s say, for the sake of this discussion, that this same disease could also significantly increase your risk of heart attack, stroke, kidney disease, and blindness. And now, let’s say that almost one third of the entire Canadian population either has this disease or is on the verge of acquiring it. Would this disease be something worth speaking about? Where would you rank this disease on your list of health concerns? What would a disease with such significant and wide-reaching effects be called?

Well, it turns out we already have a name for it; we call it diabetes.

Yes, diabetes. The same diabetes that seems to have nonchalantly found its way into the lives of so many Canadian families. The same one that, all too often, is spoken about like it’s a minor nuisance rather than a potentially serious illness. As if having high blood sugar is some sort of innocuous topic of discussion instead of a truly ominous indicator of poor health.

This same disease is the leading cause of acquired blindness in Canadians under the age of 50. It contributes to 30% of strokes, 40% of heart attacks, and 70% of non-traumatic limb amputations. In fact, the effects of diabetes on the public health care system have been so dramatic, it has officials at Diabetes Canada pleading with the federal government to develop a national strategy for intervention, calling it an epidemic. There are currently over 3.5 million Canadians living with Type 1 and Type 2 diabetes. It is projected that number will reach over 4.6 million by 2028. That is a 32% increase in one decade.

However, what is more concerning about diabetes is the insidious nature of its onset. It is well documented that, by the time a patient with type 2 diabetes is officially diagnosed, they have likely already had the disease for about 5 years. According to Diabetes Canada, it is estimated that there are currently over 7 million Canadians who are either undiagnosed or pre-diabetics. That means that, all together, there are over 10 million people (28% of the population) who are potentially at risk of suffering from the negative effects of diabetes.

What is diabetes?

Diabetes is a chronic disease that occurs when the body either does not produce enough insulin or cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. The increase in blood sugar that occurs due to the lack of insulin (or the ineffective use of it) is called hyperglycemia. Over time, hyperglycemia can lead to serious damage to many of the body’s tissues.

Diabetes and the eye

Diabetes is a leading cause of vision loss in Canada. The risk of blindness is 25 times higher for patients with diabetes compared to those without diabetes.

The primary condition that is related to this vision loss is called diabetic retinopathy. Over time, increased levels of glucose in the bloodstream cause damage to the small blood vessels in the back of the eye (retina). Eventually, this can lead to weakening of the blood vessel walls, which leads to leakage of blood and fluid into the retina. Diabetic retinopathy can have consequences of varying degrees. Patient symptoms can range from mild blurriness to severe vision loss due to conditions like retinal detachments and large hemorrhages. Diabetes can also increase a person’s risk of developing other ocular conditions such as glaucoma and cataracts.

The most reliable way to confirm the presence and the degree of diabetic retinopathy is to have comprehensive eye exam. During this examination, doctors will often use drops to dilate the patient’s pupils allowing them to take a more detailed look at the retina.

Studies have shown that signs of diabetic retinopathy in type 2 diabetics can often be detected even before blood sugar levels reach diagnostic levels. This means that regular eye exams can be vital in early diagnosis of the disease.

As an optometrist, over the years, I have seen patients on both ends of the diabetic retinopathy spectrum. On one end, I have seen the devastating long-term vision loss that can result from uncontrolled hyperglycemia, along with the decreased quality of life and the loss of hope that come with losing one’s eyesight. However, on the other hand, I have seen the incredible rejuvenation of patients who were once on the verge on significant ocular disease. I have had the pleasure of witnessing patients turn their lives around by making the necessary changes in their lifestyle that have led to weight loss, improved vision, and overall better lives.

Finding a solution to the greater problem of the diabetes epidemic seems like a daunting task. With one third of an entire nation at risk of acquiring this potentially devastating disease, it’s hard to fathom where to even start. Without doubt, it will require a complicated and multi-factorial approach by the government, the health care system, and the public. However, if we narrow our focus, we will find that the starting point is actually quite clear. Start with you. Make the changes that you know are necessary to live a full, healthy life. Eat well, get some exercise, and talk to your doctor. It can be done. I’ve seen it with my own eyes.


Written by Dr. Harbir Sian

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