Diabetic Eyes

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

This week I shared a personal and eye-opening experience that brings the reality of diabetic complications into sharp focus—literally. After nearly four decades of caring for thousands of diabetic patients and raising two type 1 diabetic children, I found myself in an all-too-familiar but deeply unsettling situation when my daughter Kelli (Type 1 for almost 30 years) suddenly lost vision in one eye. Despite being diligent with regular checkups and solid diabetes management, she was stricken overnight with a vitreous hemorrhage—bleeding inside the eye—due to diabetic retinopathy. This experience underscored how relentless diabetes can be, and how its complications don’t discriminate, regardless of our best efforts.

We talked through the reasons why this happens, digging into the biochemistry of how high blood sugar levels damage blood vessels everywhere, but especially the smallest, most delicate ones in the eyes. Ischemia caused by blocked, leaky vessels triggers the release of VEGF, a growth factor that stimulates new vessel formation. Unfortunately, these new vessels are weak and prone to bleeding and scarring. The path to treatment now involves Anti-VEGF injections, laser therapy, and careful follow-up, with the hope that Kelli’s vision will recover. The takeaway for all of us is clear: diabetic eye disease can strike anyone with diabetes, sometimes swiftly and without warning, making strong blood sugar control, regular eye checks, and monitoring for glucose spikes absolutely critical to prevention.

PODCAST NOTES 

• Diabetes is notorious for silently causing damage to blood vessels throughout the body, but the eyes are particularly vulnerable. The retina’s fine blood vessels are often the first to show signs of trouble—even before any symptoms appear—making regular eye exams a must for all diabetics.

• The effects of diabetes extend beyond just high blood sugar readings. It’s the constant wear and tear from glucose fluctuations and spikes that accelerate damage. Hemoglobin A1C gives an average, but those hidden highs are especially destructive to small blood vessels in the retina.

• Diabetic retinopathy is the leading cause of blindness among working-age adults (ages 20–74) in America. Often, patients don’t notice vision changes until the disease is advanced, underscoring the importance of early detection and routine monitoring.

• In this real-life example, my daughter Kelli experienced sudden, complete vision loss in one eye due to a vitreous hemorrhage—a serious complication where fragile blood vessels bleed into the eye’s interior, blocking the retina and causing rapid vision changes. Diagnosis by a retinal specialist was both immediate and crucial.

• The underlying cause in Kelli’s case was ischemia—the lack of blood flow and oxygen caused by damaged, leaky retinal vessels. This prompts the release of vascular endothelial growth factor (VEGF), which signals the body to grow new blood vessels. These new vessels are weak, abnormal, and highly likely to bleed or scar the retina.

• Modern treatment protocols for proliferative diabetic retinopathy include intravitreal injections of anti-VEGF medications, laser therapy to shrink and prevent further growth of abnormal vessels, and, in advanced cases, surgery. These therapies can often restore or preserve sight if used promptly, but prevention remains the best strategy.

• Continuous glucose monitoring (CGM) is one of the most powerful tools for managing diabetes today. By tracking blood sugar levels in real time, CGMs help identify damaging spikes and fluctuations that might be missed with traditional finger-stick tests or three-month averages. Personal experience has shown how unpredictable these spikes can be, varying from person to person.

• Alarmingly, up to 25% of people with diabetes in the USA, and 44% worldwide, don’t even know they have the disease—putting them at further risk of developing complications like diabetic retinopathy. Raising awareness, early detection, and proactive management are critical to preventing blindness and other diabetes-related problems.

My hope is that this story serves as a wake-up call for everyone living with diabetes, as well as their loved ones. The fight against diabetic complications starts with you. Prioritize yearly eye exams, take full advantage of modern glucose monitoring tools, and treat every blood sugar spike seriously—not just the averages.

Remember, prevention is always easier and more effective than treatment. If sharing Kelli’s experience helps even one person act to protect their eyesight or take diabetes management seriously, we’ve made a difference. Don’t wait until problems arise—schedule your eye exam, assess your diabetes management plan, and invest in your long-term health.

Stay educated. Stay healthy. 

Till next week.