Eyes, Feet, Retinas and Toes, Retinas and Toes

Helpful Highlights

• When diabetes is present, the organs and areas of the body with microvasculature (tiny blood vessels) are especially vulnerable to damage. These include the eyes, kidneys, toes and feet.

• Diabetic retinopathy often does not have symptoms until late in the disease progression and can result in irreversible blindness.

• People with diabetes frequently lose sensation in their feet and hot and cold temperatures; therefore, knicks, cuts, scrapes, punctures, or other wounds can go undetected, leading to infection and limb-threatening conditions.

• Your loved one must have an annual eye exam that includes evaluation for diabetic retinopathy, as well as frequent self and professional foot exams.

Diabetic retinopathy

Diabetes can make your loved one more likely to develop other eye conditions such as cataracts and open-angle glaucoma; however, diabetic retinopathy is a serious complication of diabetes and the most common cause of vision loss for people with diabetes.

It occurs when high blood sugar levels affect the blood vessels in the retina - the light-sensitive layer of tissue at the back of the eye - causing them to swell (aneurysm) and leak (hemorrhage), or shut off blood flow completely. Damaged blood vessels and an abnormal growth of new ones steal your loved one's vision.

Your loved one must get an annual eye exam that includes evaluation for diabetic retinopathy.

TWO MAIN STAGES

Non-proliferative diabetic retinopathy (NPDR). Tiny blood vessels leak, causing the retina to swell. When the center of the retina (called the macula) swells, the resulting macular edema contributes to vision loss. The tiny blood vessels may also close off, causing macular ischemia, and creating tiny particles (exudates) to form in the retina that can affect vision, too.

Proliferative diabetic retinopathy (PDR). This is the more advanced stage. It happens when the retina starts growing new blood vessels (called neurovascularization). While this may seem like a good thing, as new vessels promote blood flow, these new vessels are fragile and often bleed into the chamber of the eye. A little blood may cause dark "floaters" in the visual field, while large bleeds can block most or all vision.

Diabetic foot care

Diabetes can cause nerve damage (neuropathy), reducing sensation and blood flow to the feet, especially the toes. If your loved one cannot feel pain in their feet, they may not know when they are injured and injuries may go untreated for a long time.

This can lead to serious foot problems like dry, cracked, and infected skin, sores and wounds that heal very slowly or don't heal at all, and dramatic changes in the shape of the foot.

It can also lead to a condition called diabetic foot syndrome (DFS). This condition causes ulcers on the foot, bringing different levels of infection and loss of blood flow. DFS often leads to amputation of the toes, part of the foot, or the whole foot. (Amputation is when parts of the body must be surgically cut off.)

Your loved one must get, at minimum, an annual foot exam by their healthcare provider, though they should learn to conduct self-exams on a much more frequent basis (such as every other week or at least every month). They should also make every effort to protect their feet from discomfort and injury.

Your loved one's provider may refer them to a podiatrist for ongoing foot care.