Cataracts

A cataract is a clouding of the lens of the eye so that the person cannot see clearly. The symptoms of cataracts are Gradual blurring of the vision Glare in bright light or sunlight Poor colour vision with fading or yellowing of colours Double or multiple images when one eye is closed

Cataracts occur as part of the natural aging process, but they occur earlier and more often in people with diabetes. It is thought that the high glucose level causes changes in the proteins inside the cells of the lens, altering the optical properties of the lens. The treatment for cataracts is surgery - the cloudy lens is removed and replaced with an artificial lens.

Glaucoma The inside of the eye is filled with fluid. New fluid is constantly being made, and the fluid that is being replaced leaves the eye by entering a drainage meshwork toward the front of the eye. Blockage of the drainage system can lead to increased fluid pressure within the eye - a condition called glaucoma. This pressure increase can damage the nerves going from the back of the eye to the brain and cause vision loss. Like cataracts, glaucoma occurs more frequently in people with diabetes. Glaucoma is treated with eyedrops: Beta-blocker eyedrops such as timolol (Timoptic), levobunolol (Betagan), and betaxolol (Betoptic) reduce the amount of fl uid made.

They are usually quite safe, but they can cause breathing problems in patients with asthma or chronic bronchitis. Miotic eyedrops such as pilocarpine (Isopto Carpine) and carbachol (Isopto Carbachol) contract the iris, opening the drainage channels for the fluid to drain. These drops make the pupil smaller, and initially patients may complain of headache and eyestrain, but both usually get better with time. Carbonic anhydrase inhibitors such as dorzolamide (Trusopt) also reduce the amount of fl uid made. Sometimes people complain of nausea when they use this type of eyedrop.

If the drops do not work, an eye operation to allow the fluid to drain (trabeculectomy) is performed.

Rarely, glaucoma can occur in people with diabetes when there is blood vessel growth in the iris blocking the fl uid drainage channels (a condition called iridis rubeosis). This type of glaucoma is usually treated with lasers. It has recently been reported that bevacizumab might also be effective.

Treating High Blood Pressure Helps the Kidneys Medicines that reduce blood pressure stop the kidney damage from getting worse. Usually your doctor will first prescribe a medicine called angiotensin converting enzyme (ACE) inhibitor. The side effects of ACE inhibitors include an increase in the potassium and creatinine levels in the blood, occasionally a cough, and, rarely, facial swelling.

The rise in potassium can usually be managed by taking a diuretic such as hydrochlorothiazide (HCTZ), a medicine that makes you urinate more, and by avoiding foods high in potassium.

Stopping the medicine gets rid of the cough, and your doctor then may switch you to another group of medicines called angiotensin receptor blockers (ARBs), which have the same beneficial effect on diabetic kidney disease as ACE inhibitors. Quite often, ACE inhibitors and ARBs are prescribed together.