Understanding the Challenges of High Blood Glucose for Diabetics with Vision Issues

Managing diabetes effectively involves keeping blood glucose levels within a target range. However, for individuals with diabetic retinopathy or other vision impairments, recognizing the symptoms of hyperglycemia (high blood sugar) can be particularly challenging. Standard indicators like blurred vision may be harder to detect, as these patients might already experience fluctuating visual clarity due to their pre-existing condition. It is crucial to be aware of alternative signs and use a combination of methods for glucose level monitoring.

Why Early Recognition Matters: Ignoring prolonged high blood glucose can lead to severe complications, including ketoacidosis, increased risk of infection, and worsening of diabetic retinopathy itself, which can lead to significant vision loss or blindness. In the table below, we show the potential risks associated with unchecked hyperglycemia:

Complication	Description	Impact on Diabetics
Ketoacidosis	The body produces excess blood acids (ketones) due to insufficient insulin.	Life-threatening; can lead to coma and organ damage.
Increased Infection Risk	High blood glucose creates an ideal environment for bacteria and viruses to multiply and flourish.	Higher susceptibility to infections; can slow the healing process for existing infections or injuries.
Worsening Retinopathy	Damage to the blood vessels in the retina due to chronically high blood glucose.	Progressive vision loss, increasing the risk of blindness, floaters and blurry vision.

Recognizing Non-Visual Symptoms of Hyperglycemia

Since visual cues may be unreliable for this demographic, diabetic individuals with vision problems need to be especially attuned to other potential symptoms of high blood sugar. These can include both acute (sudden and intense) and chronic (long-term) symptoms. Below are the key non-visual symptoms to watch out for:

Acute Symptoms:

Increased Thirst (Polydipsia): One of the body's first responses to high blood glucose is increased thirst as it tries to dilute the excess glucose in the bloodstream.
Frequent Urination (Polyuria): Increased thirst leads to frequent trips to the bathroom. The kidneys are working overtime to flush out excess glucose through urine.
Extreme Fatigue or Weakness: High blood sugar can interfere with the body's ability to utilize energy efficiently, causing extreme fatigue and feelings of weakness.
Unexplained Weight Loss: This can occur despite increased appetite, as the body loses calories through frequent urination.
Increased Hunger: Cells may not receive enough energy despite high blood sugar, leading to increased hunger.

Chronic Symptoms:

Dry, Itchy Skin: Prolonged high blood sugar can lead to dry, itchy skin as the body draws moisture to dilute blood glucose.
Numbness or Tingling in Hands and Feet (Neuropathy): Over time, hyperglycemia can damage nerves, resulting in peripheral neuropathy which manifests as pain or a numb/tingling sensation in the extremities. This can make it difficult to discern other diabetic health conditions and potential complications, like wound healing issues.
Slow-Healing Cuts or Sores: High blood sugar impairs blood flow, making it harder for wounds to heal.
Frequent Infections: Due to high blood sugar environments, those with frequent infections should always be concerned that the root cause could be diabetes, even when there is an existing diagnosis.
Increased Headaches: Blood sugar fluctuations, both high and low, can trigger or worsen headaches.

Example Scenario: If someone with a pre-existing condition of diabetic retinopathy begins to experience sudden and increased thirst, coupled with a strong urge to urinate, extreme fatigue, they should suspect hyperglycemia even if their vision doesn't seem to be experiencing a sudden change.

Practical Strategies for Monitoring Blood Glucose When Vision Is Impaired

Effective management of blood glucose for individuals with vision challenges requires implementing additional measures:

Regular Blood Glucose Monitoring:
- Talking Blood Glucose Meters: Utilize blood glucose meters that have auditory functions for results, rather than relying only on visual readings. Many of these devices announce test results and menu selections to improve ease of use.
- Consistent Testing: Create a routine to test blood glucose at regular intervals throughout the day, including before meals, 2 hours after meals, and at bedtime, or as directed by their healthcare provider. Consider keeping a written record of daily readings and also making use of digital logbooks through apps or technology.
- Assistance if needed: Have a family member, caregiver, or healthcare professional assist with testing, where feasible. Ensure that they are aware of the need for precision and accuracy in blood glucose measurements.
Medication Management:
- Insulin Delivery Devices: Opt for devices with features that can reduce dosing errors or which have specific audible or tactile cues to minimize medication errors due to vision impairment. Devices can include automated insulin pumps or injectors with pre-set doses and other safeguards.
- Pill organizers and dispensers: These will help you sort medication intake, reducing the chance of accidental errors.
- Clearly Label Medications: Have prescription labels that are larger, use high-contrast print, or use tactile labels for each medication.
Establish Dietary Habits:
- Consistent Meal Timing: Avoid large meal fluctuations which can lead to swings in blood sugar levels. Consistently follow a meal schedule and portion controls based on the guidance provided by your healthcare team.
- Consult a Registered Dietician: A registered dietician will develop a personalized meal plan that focuses on stabilizing glucose levels, reducing insulin fluctuations and incorporating food choices and portion controls that fit your preferences and capabilities.
- Meal Planning and Food Prep: Plan meals in advance and involve family or caregiver to prepare nutritious food choices that also stabilize glucose levels.
Collaboration with a Healthcare Team:
- Regular Checkups: Regular appointments with endocrinologists and ophthalmologists to monitor and manage diabetes as a condition, and also to monitor potential risks related to vision. Discuss treatment options, such as medication changes or specialized therapeutic modalities.
- Diabetes Education Programs: Participate in education programs tailored to diabetes patients with visual impairments.
Leveraging Technology:
- Continuous Glucose Monitoring (CGM): Consider a CGM system that provides real-time glucose readings and alarms when levels are too high or too low. Some devices connect with smartphones for easier access.
- Health Apps and Devices: There are a wide range of applications that include blood glucose logbooks, medication reminders, access to relevant diabetes educational materials and tracking capabilities that fit varying needs.

By employing these strategies, individuals with diabetes and vision issues can proactively manage their blood sugar, minimizing risks and improving overall quality of life. The table below highlights technology to assist in glucose management.

Technology	Function	Benefit for Visual Impairments
Talking Blood Glucose Meters	Audibly communicates test results and menu navigation	Reduces reliance on visual cues.
Continuous Glucose Monitors (CGM)	Real-time glucose readings and alarms for high/low levels	Provides timely alerts even if vision is a factor.
Health Apps with Accessibility Features	Digital logging, medication reminders, access to educational content with larger fonts, voice over features	Helps monitor blood sugar trends and medication intake efficiently.

The Importance of Support and Education

The impact of vision loss with diabetes can be difficult both physically and mentally. Individuals with diabetes and vision issues should build a support system composed of healthcare providers, friends, and loved ones. Being properly educated and equipped can allow for diabetes patients with impaired vision to live independently while also actively managing health through collaborative efforts with all healthcare providers.

Support System: Having an active support network will improve management and reduce the mental stress related to coping with both diabetes and vision issues. Friends, loved ones, and also relevant support groups can empower individuals with diabetes to live comfortably and safely. These support systems may include:

Family members and friends: Family and loved ones can help the patient with testing, medication and food management, driving for medical appointments, and also acting as a communication liaison with healthcare providers.
Diabetes support groups: Support groups are excellent platforms to share, connect, and support others who face similar challenges. They can offer support through understanding the patient's needs.
Healthcare providers: Regular consultations with healthcare providers should include open and transparent discussions on challenges, concerns, and any potential adjustments needed to their care plan. This may include consultation with ophthalmologists, endocrinologists, nurse practitioners, certified diabetes educators, registered dieticians and other specialists.

Educational Programs: Participating in education programs specific for diabetes patients with vision impairment will provide you with information on practical strategies and techniques on managing care and living life independently and to the fullest.

Workshops on diabetes education programs may include workshops for diabetes education, insulin administration, proper testing and record keeping, diet management and food safety, and resources available to those with vision issues.
These workshops will not only provide you with educational tools, but they also connect you with other individuals in similar circumstances to improve the feelings of empowerment and also to know that they are not alone.
Ensure that the programs being provided have features that are specific and suitable for their visual needs, as some generic workshops can cause accessibility barriers to this community.

By ensuring appropriate methods are used, all those with both diabetes and vision impairments will live happier and healthier lives, empowering themselves through education and collaboration. This, in turn, will minimize the risks and associated long-term complications associated with uncontrolled high blood glucose.

Levels Chief Medical Officer, Dr. Casey Means, chatted with our advisor, Dr. David Perlmutter on the discovery of how the elevation of uric acid in the body is a causative mechanism in the development of metabolic diseases, and one of the key links between obesity, blood sugar 220 2 hours after eating diabetes, heart disease, neurologic diseases like dementia, ADHD, fatty liver disease, and more. Sign Up to Get Your Ultimate Guide to Glucose: They also covered: - The several mechanisms of how uric acid causes cellular dysfunction and insulin resistance, including oxidative stress, inflammation, and even preventing insulin from getting out of the blood stream effectively. - The evolutionary reasons why the metabolic dysfunction and weight gain caused by uric acid would have benefitted us historically in terms of low access to food and water, by letting us more easily pack on weight and raise blood pressure. And how we now live in an evolutionary-environmental mismatch where this survival mechanism is now hurting us in the face of caloric abundance. - The different dietary and environmental factors that generate uric acid, including fructose, purine rich foods and umami foods, dehydration, alcohol, and more. - The optimal levels for uric acid. - How uric acid impairs our hunger signals, drives us to eat, and even promotes risk taking behavior. We talked about how to reverse high uric acid levels as a way to unlock optimal health. 00:00 - Intro 03:12 - More than just gout 05:06 - A causative what supplements lower blood sugar levels role 07:44 - The number one normal blood sugar levels for diabetics type 2 cause of death 15:24 - Evolutionary environmental mismatch 16:58 - High fructose corn syrup 22:27 - The dangers of uric acid 23:38 - Uric acid and dementia 30:33 - Too much fructose 41:32 - Erectile dysfunction and cardiovascular risk 01:03:17 - No need to eat sugar Transcript & Show notes:

Uric Acid: A KEY Cause Of Weight Gain, Diabetes, Heart Disease & Dementia | Dr. David Perlmutter [d803d3]