Karl, 16, is seen for the first time in my optometry office. He was referred to me for a fluctuating vision problem. During his examination, I saw signs suggesting that he might have diabetes, which could have explained the fluctuating vision. This suspicion became reality when her family doctor confirmed the diagnosis. Karl’s world has been turned upside down.
As an optometrist, I invite you to dive into a reality that should concern us all.
What is diabetes ?
Diabetes is an insidious disease. His symptoms (thirst, need to urinate often, fatigue, weight loss, darker areas of skin on the neck and armpits) often go unnoticed, at least in the early stages of the disease.
Diabetes affects the lives of one in 14 people in Canada (7%) and one in 10 in North America (10%).
Two types of diabetes can be diagnosed:
-
Type 1which is insulin-dependent and develops when the body cannot produce the insulin needed to metabolize the sugars we ingest and which fuel our tissues
-
Type 2, which develops during the production of insulin, but in insufficient quantities. Sometimes the insulin produced is ineffective in doing its job.
Type 1 diabetes is generally associated with the development of the disease during childhood and adolescence. Type 2, the most common, usually develops later in life, often after 50.
A counter-intuitive diagnosis, but not uncommon
From this definition, it would have been logical to conclude that Karl had type 1 diabetes, the course and treatment of which are well understood by doctors. However, in his case, and after the required tests, his doctor identified type 2 diabetes. This diagnosis is counter-intuitive and poses significant challenges. The rapidity of onset, the initial severity of the disease and the mechanisms of resistance, or of reduced insulin secretion, may be different in patients who develop the disease at a younger age. than in adults.
Additionally, treatment options, involving trial and error, become more complex due to the much longer duration of this type of disease when it begins at a young age. Major and minor changes that affect blood vessels in type 2 diabetic patients can have serious and difficult to predict consequences since the duration of treatment can last from 40 to 60 years.
However, Karl’s situation is not exceptional. More and more young people and adolescentsespecially those who are overweight, obese and sedentaryare affected by type 2. Nearly 75 percent of them have parents or siblings with diabetes.
If at first glance this confirms genetics as a risk factor for developing the disease, in this specific case it is rather a consequence of poor lifestyle habits, especially dietary habits, and lack of physical activitywhich are often shared by the whole family.
Impact on vision
The fact that Karl developed type 2 diabetes earlier, rather than later in life, also puts him at higher risk of developing eye complications. A article on this subject recently caught my attention. This study looked at the records of 1,362 people with diabetes living in Minnesota, so in North America, and then extrapolated to Canada. The data was compiled between 1970 and 2019, which also makes it possible to measure the evolution of the situation in recent decades.
The results are astonishing: young people with type 2 diabetes (compared to type 1 diabetics of the same age) are 88 times more likely to develop retinopathy (abnormal blood vessels and/or retinal hemorrhages). In addition, the risk of this retinopathy becoming “proliferative”, and therefore vision threatening, is multiplied by 230. There is also a 49-fold increase in the risk of fluid accumulation in the retina (macular oedema) and a 243-fold increase in risk of developing mature cataracts at a young age. The latter requires a riskier surgical intervention in young people than in the case of age-related senile cataracts.
What should be remembered? That major problems, which often require surgery to save sight, occur much more quickly in young people with type 2 diabetes than in those with type 1. These patients therefore need to be monitored more closely. Indeed, nearly one in two type 2 patients will develop some form of retinopathy within one to eight years of diagnosis. In comparison, one in three type 1 diabetics will develop retinopathy between six and 10 years after diagnosis.
Significant repercussions
Having already increased significantly over the past 10 years, the prevalence (number of cases) of type 2 diabetes in young people is expected to quadruple by 2050. This prediction is most alarming for health professionals, but also for decision-makers and managers of public health agencies. The lifetime cost of direct medical care for a single diabetic patient aged 25 to 44 was $125,000 in 2013. These costs have since increased and many more dollars must be added to cover the period between 15 and 25 years, which is not taken into account. Indeed, if 20% of the young population develops diabetes by 2050, millions (perhaps billions?) of healthcare dollars will have to be spent on their care by our governments.
The long-term quality of life of people with diabetes is also reduced. Another study, this time of young people with type 1 diabetes, shows that their disease has a negative impact on their lives. They have to devote a lot of time to their care (lack of activities with their friends). And the burden of their illness on their loved ones weighs heavily on their shoulders. Fear of hypoglycemia (lack of sugar that can lead to coma) or developing serious complications of the disease also affects them. Access to autonomy is more difficult for these adolescents and their quality of life is proportional to the freedom they may or may not exercise.
Eat well, exercise and visit your optometrist
Type 1 diabetes is difficult to prevent, mainly because we don’t know all the reasons why it occurs and to detect it proactively. The situation is different for type 2 diabetes, which is strongly associated with an unhealthy lifestyle in young people. Eating a healthy diet, exercising regularly and fighting a sedentary lifestyle, in particular by limiting free time in front of screens (to less than two hours a day), are good ways to avoid or delay the onset of diabetes in young people. Screen time is also associated with insulin resistance and obesity for young people. In other words, healthy lifestyle habits must be encouraged and above all shared within the family unit.
As for the eyes, regular visits to the optometrist or ophthalmologist can detect early signs of diabetic complications (signs are seen in up to 30% of patients soon after diagnosis). These healthcare professionals can also detect other eye problems arising from the disease, such as loss of ability to focus up close (accommodation), partial paralysis of certain eye muscles causing double vision, delayed healing of surface corneal changes, dry eye or glaucoma. Tests must be done at the time of medical diagnosis of diabetesor in any person with a risk profile (heredity, obesity, sedentary lifestyle).
Since healthy lifestyle habits are an integral part of treating the disease, it’s not too late for Karl to enjoy a happier future. But it is important not to neglect regular follow-ups by your doctor and frequent visits to your family optometrist.
