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Diabetic retinopathy

GEROPHARM pays considerable attention to the regulation of drug safety. Currently, the company has the pharmacovigilance system which functions in accordance with international requirements and regulatory requirements for the Russian Federation. Employees collect data on the found adverse reactions that occur when taking medicinal preparations, the marketing authorization holder of which is GEROPHARM.

What is diabetic retinopathy?

Diabetic retinopathy (DR) is a change in the vessels and tissues of the retina and optic nerve resulting from diabetes mellitus (DM). It can lead to vision impairment and blindness.
The probability of DR occurrence depends on DM duration. It is most commonly met (87-99%) when diabetes mellitus persists for 15 years and over.

What is the cause of diabetic retinopathy?

In diabetes mellitus, glucose absorption is reduced due to failure to produce enough insulin or insufficient sensitivity to insulin. It causes your blood sugar to rise. Hyperglycemia may develop. Taking medicinal agents in diabetes does not always keep blood sugar levels within a normal range. Hyperglycemia disturbs vascular wall permeability and trophism in the tissues of the whole body. When these vascular disturbances are manifested on the retina, it’s called diabetic retinopathy.

What types of diabetic retinopathy are known?

DR is divided into 3 stages depending on the intensity of changes in the fundus of the eye. In nonproliferative retinopathy, microaneurysms (small outpouchings of the vessel lumens), lipid deposits in the form of yellow foci, and haemorrhages are formed in the retina. In preproliferative retinopathy (next stage) these changes are more pronounced. Their number is increased as well. Edema of the central retina is possible. In 3rd proliferative stage of DR, newly formed vessels, extensive haemorrhages and fibrous commissures and films appear in the retina or optic disk.

The changes can result in retinal detachment, hemorrhages in the vitreous body (intraocular hemorrhage), non-vascular glaucoma.

How is diabetic retinopathy manifested?

In DR, visual functions mainly depend on the condition of the retinal central area (macula/macular area). Initially, vision can be slightly reduced or be normal, especially if the macula is not damaged. Later, edema of the macular area, hemorrhages, neovascular glaucoma or retinal detachment can be developed leading to complete blindness.

How is diabetic retinopathy treated?

Successful treatment od DR mainly depends on DM stable compensation, normalization of arterial pressure and lipid exchange. Treatment of DR includes a combination of drug therapy and laser/surgical treatment.
ACE inhibitors, agents treating the disturbances of lipid and carbohydrate metabolism, antioxidants, vasodilating agents, vasoprotective agents, angiogenesis inhibitors, corticosteroids, and peptide bioregulators are used.

O. V. Zaitseva

Candidate of Medical Sciences, Senior Research Scientist of the Helmholtz Research Institute of Eye Diseases

Patients with diabetes mellitus need strict adherence to doctor’s recommendations related to diet and intake/injection of medicinal agents, and independent control of blood sugar levels using a blood glucose meter.

Diabetes mellitus type 2

Treatment of diabetes mellitus type 2 (especially in patients with obesity) requires normal stereotype (type) of nutrition and physical exercises followed by the use of antihyperglycemic agents. As proper nutrition is an essential part of diabetes treatment, you need to count BU (bread units) daily. A person on insulin therapy needs to know his/her daily need in BE, be able to calculate a daily intake of dietary calories (which is especially important in obesity) and control the caloric content of food.

Regular physical training can help do as follows:

  • reduce blood sugar level;
  • reduce the doses of antihyperglycemic agents (under medical supervision).

If you were not engaged in regular physical activity, consult a specialist in exercise therapy or family doctor. Your doctor will assist you in choosing an individually-tailored set of exercises. The load needs to be increased gradually. 30-minute set of exercises is to be introduced into the regimen.

It is recommended as follows:

  • walking (500 m to 2 km daily);
  • speed walking;
  • bicycle ride;
  • swimming;
  • tennis;
  • skiing;
  • dancing or moderate-intensity aerobic exercise.

Physical load at least 3 times per week (daily is better). Control blood glucose levels before exercises and after them. Physical activity is not recommended if blood glucose level does not exceed 13 mmol/l or when ketone bodies are present in the urine.

In diabetes mellitus type 1, it is necessary to remember as follows:
  • Physical activity increases the rate of insulin absorption and glucose intake without the need in insulin.
  • The risk of hypoglycemia is increased following physical activity as the body has already used the glycogen stores.
  • The changes in glycemia level can be better predicted after regular but not rare physical activity.
  • Independent physical activity without insulin therapy can’t be used to reduce blood glucose levels during treatment of diabetes mellitus type 1. It must be taken into account to avoid hypoglycemia only.
  • The level of hypoglycemia needs to be determined prior to physical activity. You can do physical exercises only if blood sugar level is below 5 mmol/l and not over 15 mmol
  • Short-term physical activity is frequently unplanned. It is not always possible to reduce a dose of insulin beforehand. That’s why it’s better to take 1–2 BU (bread, fruits) prior to it. In some case, you can use easily digested carbohydrates including liquid ones (a glass of juice prior to competition) if the physical activity is very intense.
  • Long-term physical activity usually results in a heavily dropped need in insulin. Thus, it must be planned beforehand. Then a dose of insulin could be reduced. It needs to be taken into account that the effect of long-term physical activity can be observed within the nearest 12–24 hours. Thus, the doses of insulin taken prior to and after the exercises need to be reduced.
  • Do not go in for sports, if you feel sick.
  • Determine the level of glycemia during and after physical exercises as after exercise with diabetes, some people face the risk of blood glucose going too low. Food containing easily digested carbohydrates must be at your disposal.
  • Normal blood glucose levels will maximally postpone vascular and trophic disturbances in the retina and vision impairment.

O. V. Zaitseva

Candidate of Medical Sciences, Senior Research Scientist of the Helmholtz Research Institute of Eye Diseases

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