Diabetic retinopathy

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.

• 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