“Diabetic eye disease is, often goes unrecognized”
Yumlish sits down with Lisa Golden a certified diabetes care educator. Lisa explains the role of a CDCES, the importance of regular eye exams for someone with diabetes, and the signs and symptoms of diabetic eye disease.
Lisa Golden is a diabetes care and education specialist. She specializes in working with people with disabilities such as people living with vision impairments.
Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions Like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions.
Shireen: In today’s episode, we sit down with Lisa Golden, who is a certified, diabetes care and education specialist. We’ll be discussing the role of a diabetes care educator, the importance of regular eye exams for someone with diabetes, and [the] signs and symptoms of diabetic eye disease. Stay tuned.
Shireen: Lisa Golden is a diabetes care and education specialist. She specializes in working with people with disabilities, such as people living with vision impairments. Welcome, Lisa.
Lisa: Thank you. I’m excited to be here
Shireen: and that’s so pleasure having you on. Lisa, we wanna learn a little bit more about why you decided to become a diabetes care and education specialist. What was it, within your world that drove you to that?
Lisa: Well, I’ve actually been in diabetes, as a career since 1995. I was excited. I wanted in the healthcare industry and my mother had diabetes, I thought I knew something about it, and then I learned there was so much more to know, but what really made me become a Certified Diabetes Care and Education Specialist was because just over 12 years ago, I started working with people with disabilities, specifically with people with who are blind or deaf, blind. And, there was so much more that I wanted to be able to show that I could help them with. And I felt that it was a good specialty. It was taking all the knowledge that I already had about diabetes and being able to look at things a little bit differently so that I could provide some better solutions for those individuals.
Shireen: Was interesting to come from a, from a personal, like that’s, that’s how you got into it, right? Can you help our listeners understand, the complications of diabetes? Let’s start with diabetic eye disease. That’s a big one that we’re here to talk about. What is it and how is it diagnosed?
Lisa: Well, diabetic eye disease is, often goes unrecognized. A lot of people, Type two diabetes upon diagnosis with type two, have some kind of diabetic retinopathy going on and with type one, it may take a couple of years, but then that’s the importance of annual exams. But basically, it is damaged to the retina, it, or any place in the eye. Now there are several types of diabetic eye diseases. There is diabetic retinopathy and that is like bleeding in the back of the eye or forming some, extra blood vessels in order to feed the back of the eye because it’s not getting well fed, because there’s been damage from glucose to that area. I would say that anywhere glucose, anywhere your blood flows, you could have damage from diabetes. And the back of the eye is very sensitive to that. That’s where diabetic retinopathy comes in. The macular edema is the big bleeding. It’s when it really burst and you’ve got some blood in the back of the eye, but you could also have some, cataracts can be an issue, for people with diabetes.
There [are] some other things that could happen. And it’s really important that you see your eye doctor as recommended by the American Diabetes Association, annually and see something and, you know, worst case scenario, nothing’s wrong with the back of your eye. And, they can give you a good exam. And I think, you know, anytime you get any labs that are all in the normal range, that’s a good thing.
Shireen: Help us understand how, how it is diagnosed. Like, what should someone do?
Lisa: A lot of times people will have blurry vision. Sometimes they don’t recognize that they have a problem until they go and see their eye doctor because they’re really, it’s easy for us both with the symptoms of diabetes and with the symptoms of diabetic eye disease to just think about ’em as being, Well, I’m tired. I’m getting older you know, I just, I’m expecting to have this kind of blurry vision, or I think my blurry vision is just because my blood sugar is not normal and not really realizing that there’s actually some damage to the eye. It is often a silent thing that happens and many people don’t realize that there’s a problem until they go in for that exam.
Shireen: It is usually going to the eye doctor and getting that exam.
Shireen: Especially if you, if you are someone that has diabetes, letting the eye doctor know and have them screen for that.
Lisa: Yes, because by the time it gets to be something. You are really recognizing with signs and symptoms. It usually has extensive damage having been done. You don’t wanna find out because you’ve actually lost vision. And I do hear in my work a lot of stories of that, that they, were out doing something and all of a sudden their vision, they just went blind suddenly. And sometimes they’re able to, recover from that and sometimes, it can be a permanent condition.
Shireen: If this is something that has [been] caught ideally early enough, what are some of the treatments used to help people with, eye disease, diabetic eye disease?
Lisa: Well, the most important thing to prevent diabetic eye disease is managing your diabetes. When our blood sugars are as normal as possible, then you’re going to not have the complications of diabetes, or it’s much less likely that you’ll have the complications of diabetes. We know that from the diabetes control and complications trial. That would be my first point of view, is find out how to manage your blood sugars, whether that’s going to a diabetes care and education specialist such as I am or you know, just working with your doctor to find what the right treatment is for your diabetes.
Now, once you have some eye conditions, some of the most common things, I mean, cataracts, obviously cataract surgery, but, sometimes there [are] eye drops that can be prescribed and they don’t necessarily improve your vision, but, can keep some things from happening to your eyes. It’s important that even though, you’re not seeing [an] improved vision from it, that you’re taking those so that they, keep off further damage from happening. There’s also some laser surgeries where they can go in and actually laser the parts of the eyes that are damaged. Unfortunately, when they laser it, all it does, it’s keep it from continuing to bleed or grow blood vessels in that area.
And again, it doesn’t improve vision but recently there’s been, recently, in the past decade, there’s been a lot of anti-VEGF medications. Now, these are actually injections that go directly into the eyeball and, they can improve vision to a certain extent. Maybe not get you back to 20/20 but can really stop and, some of that damage that is happening most often when people start on those anti-VEGF injections. They may have to have an injection in the damaged eye every four to six weeks for so long, and then there’s still going to be some maintenance injections. It’s just maybe that you’re able to go two or three months without having an injection. You’ll wanna be careful and not think, just because my eyesight is improved, I don’t need these injections anymore. You’ll need to still follow up according to [what] the eye doctor is asking of you.
Shireen: Have you had instances where patients, where your patients have ever been able to reverse diabetic retinopathy, at least in the early stages, by reversing their diabetes or controlling their diabetes?
Lisa: I work primarily with people who are in the blind spectrum or low vision, blind spectrum. Sometimes they’re not able to get it reversed. As much as someone with early interventions. Just like there’s a lot we can do with prediabetes in that. If you do those healthy behaviors, then it has more of an effect and the medications have more of an effect. If they can diagnose eye disease when it’s just mild, then a lot of the treatments can be much more effective. Like I said, managing your blood sugars can have a huge effect on that as well. It’s not hopeless, there’s a lot that people are able to do and people are very grateful when they have extreme blindness and they’re able to have some residual vision. People often think of blindness as being you have, you can see nothing. It’s just the vision that you have is not very functional. When you have more functional vision rather than less, people appreciate those improvements even though it’s not 2020.
Shireen: Interesting. And, in your work when you’re working with people who have visual impairments like that is largely brought on, or at least the people that you’re talking to is largely brought on, by diabetes, by having it sort of go so far that it leads to that vision impairment?
Lisa: Yes. A lot of people assume that people with diabetes get diabetes education, but often at their doctors, their physician’s office, they’re just provided a meter in medication and told to use these and they really don’t know how to use them, in the moment because I really believe blood sugar management is best done in the moment.
The individual who has diabetes has is able to respond to whatever that number happens to be. I mean, you are not your blood sugar number. It is important that you’re able to use that number and know how to use that number to make little changes or make decisions on what’s good, for you and what’s, not working for you. What I recommend is if you have an opportunity, go seek diabetes education so that you can have that information. The doctor often only has 10, 15 minutes with you, they’re doing the best they can to point you in the right direction. Versus someone like me who’s a diabetes care and education specialist, can spend time with you getting to know you for your lifestyle, and I always tell my customers that, please let me know if this isn’t going to work for you because what we need is for you to be able to change your diabetes management over time to prevent either fur, further damage to your eye, or getting other complications of diabetes.
If this doesn’t work in your life, then I need to know and we’ll talk about other solutions. It may not have been my first choice for you because I’m gonna always offer what I think is the best solution for that moment. But if it’s not working in your life, then it’s not gonna work in the long term. I also tell people to seek out diabetes education multiple times throughout the time that they have diabetes. You can never remember everything that you heard in one educational session. It helps to build and you may, something may pop out and grab your attention, but just life is different when you’re in your twenties versus when you’re married versus when you have young kids and teenagers and you’re an empty nester or you’re retired. Llife just changes naturally and at each of those stages, we need to find right way for you to best manage your health.
Shireen: The reason why that is important, so let’s say you are someone who gets diagnosed with that. Ask your physician, ask your clinicians in your network to connect you to a diabetes care and education specialist, to learn about those types of things. Then coming, coming back to the, the, the diabetic eye disease, real quickly. Lisa ,when we’re, when we’re sort of talking about that, what sort of impact does a diabetes care and education specialist like yourself have on the patients that you’re working with, is it about reversal of the condition? Is it, is it managing it? Is it, where do you focus and how do you empower your patients to make strong choices for themselves?
Lisa: For most people with diabetes, we are trying to keep them from having an eye condition. It’s preventative care, and by doing that, by managing your blood sugar. Once, because I specialize in people with disability once they come to me, I try to work with them from a point of view of what can they do to best manage their diabetes and therefore their eye conditions, their eye health, how do they manage their diabetes well enough that, when they are having these procedures done, that they’re gonna get the full benefit. Remembering that all of these procedures, that’s stress on the body and that’s stress, will raise your blood sugar so quickly. How are we gonna manage this and deal with that. I also, because of working with disability, Try to deal a lot with healthy coping.
Now, every diabetes educator will talk to people about their feelings about diabetes, the way that they, that others work with them, with their diabetes. Not just health professionals, but you know, sometimes the way our family and friends and other social networks, sometimes those situations can be. Supportive of somebody and sometimes they can be, make it even harder to do those healthy things. We talk, I always talk about healthy coping, but when you have lost your vision due to diabetes, then you have a right to be angry at your diabetes. So we have. Deal a lot with depression and, diabetic distress is a very real condition that people deal with.
And that’s something that I work with people about is, what exactly is going on? How do they feel about things? Let’s process those so that we can get back to doing and once we’re doing, you know, ready to get back to doing, then there are talking blood glucose meters. If you wanna be on a continuous glucose meter, there’s gonna be limitations. What are you gonna be able to get off of that and what are you not going to be able to do after that? How can you take your medications and draw your own medications if you’re, drawing insulin or, another, type of device in order to, give your insulin or how do you manage your medications?
How do you know when to refill? All of those kinds of things. There is some specialty stuff that I do for people who are blind just trying to see what are they capable of. Sometimes people have a good method of managing, but they just need to fine-tune and get or get back to what they were doing before they lost their vision and feeling comfortable with doing that and it’s just a really important thing that you allow the individual who is living with diabetes to manage their own diabetes, even though they have a vision loss, I always let them decide. Exactly, you know, what they are going to assign to someone else. Like I understand there’s often in most families the person that cooks and they’re going to eat whatever they cook.
They can often say, Well this is how much of whatever kind of meal, they’re gonna have of that I’m going to eat in order to be healthy with my own diabetes, so I can still, even though somebody else is cooking for me, I can still remain control of the portion sizes and all of those kind of things, what nutrients I’m getting.
Shireen: Lisa, can you talk a little bit about sort of your own journey and how diabetes has influenced that as well as diabetic retinopathy, and then really what advice would you have for someone who’s listening here today, around how to navigate both?
Lisa: Well, my own journey. Again, I came into diabetes as a career about 25 years ago. Knowing that my mother had diabetes and that diabetes is a family, it’s, you know, often genetically, passed on. I knew that I wanted to prevent that, so I worked really hard and considered myself prediabetic from the, you know, just shortly after I started my career in diabetes. Now, like I said, stress will raise your blood sugar and cause problems.
In 2018 is when I actually got Type two diabetes. And I’m not gonna go through all my personal problems that were happening, but it was very, it was multiple deaths. It was very, it was a lot going on during 2018 that led to me actually having diabetes.
And I do recognize now some of the things that people that I worked with prior to that would tell me about their diabetes or about their eyes. I very much understand the blurry vision and how it can vary and sometimes be very blurry and very, or not so blurry. Or you have floaters or, other kinds of, some customers describe it as like spiders in their eye, like covering up their vision, and stuff.
And I have had an occasional episode of that, so I have more understanding of what people describe to me. I just think you, it is very individual and I think it’s important that we don’t dismiss the signs and symptoms that we are receiving because I’m the same way, even though I am a diabetes care education specialist.
When I get a high blood sugar, I’ve had times where I’ve gone to sit down. I think I’m gonna take a break for work, and I’ll go and sit down and the next thing I know, my 15 minutes are up and I haven’t done anything and I can’t even think of what I’ve thought of. And then suddenly as I’m getting up to go back and I’m thinking; diabetes again.
I think why don’t you go in there and test my blood sugar and see what it is and sure enough, something will be off and I was just tired. When you’re [getting] high or extremely low blood sugars, often the symptom is just that you are tired. You just wanna like lay your head there, don’t think, and you’re not motivated to do things.
Some of those are very, asymptomatic. I love the glucose meter because in any kind of testing, whether you’re testing your blood pressure or weight any kind of at-home testing, and then paying attention to your labs at the doctor’s office, cuz those will tell you whether there’s something going on.
You can eliminate if your, all your lab works fine, if your blood sugar’s fine, if your blood pressure is fine, if your weight is not fluctuating. when you know that, it’s something else and you can start looking at other reasons. But I’ve learned to test my own blood sugar as soon as I’m feeling kind of that apathetic, don’t, not motivation, motivated to do what I normally love to do and then act.
And the earlier I act on that, if my blood sugar’s just in the two hundreds and I go ahead and act on that blood sugar, then it’s much easier to get it down into the normal range before it gets into the 300 s. Early intervention is always the best thing. That’s what I would encourage people to do.
Shireen: For everyone listening out there, they should really focus on, communicating to their physicians about getting those checkups done, staying on top of their blood sugars on a day to day basis for, especially for those people who have diabetes sstaying on top of their blood sugars and then getting all these screenings done. Like have your checklist of all of these different screenings, be it an eye exam, like get all of those knocked out. If you are someone that has diabetes, find a diabetes care and education specialist that can walk you. All the different things that you’re at risk of including, including vision impairment.
Lisa: Yes, and I guess one of the things that you asked me that I didn’t answer was, I do have mild diabetic retinopathy. Not to the point that, I mean, I could claim to be visually impaired. I mean, obviously, I wear glasses, but, that’s just something that, because when I’ve had my exams and we’ve noticed that I need to monitor and make sure that I’m going in for those annual comprehensive eye exams, which it’s an hour to get a comprehensive eye exam. Your eyes are dilated and it’s a lot of stuff going on there, but those are really important to be able to see what’s going on.
Shireen: An hour well worth anyone’s time. Yes. Well, with that, Lisa, we are unfortunately toward the end of the episode. At this point in the episode, I’d love for our listeners to. Learn more about how they can connect with you and just stay up to date with your work.
Lisa: Well, I am available on LinkedIn and, I’m also do a lot of work with the Association of Diabetes Care and Education Specialist. probably LinkedIn is probably the best way to reach me, or you can reach me at golden.LM gmail.com.
Shireen: All right. And we’ll, we’ll note all of that in the show notes for this episode. With that, it was such a pleasure having you on. Thank you so much for educating us on this very important topic, on informing us on the importance of this screening, and then more importantly, helping us sort of stay on top of all the different things, that diabetes brings and just being more conscious, about that. Thank you again for your time.
Lisa: Thank you.
Shireen: And to our listeners out there thanks for, listening to this episode and we’ll continue the conversation on Facebook, on Instagram, and answer this quick question. So again, find the podcast post on our social media, Facebook and Instagram. Find this podcast episode.
Post there, and comment below for this quick question. When was the last time you had your eyes checked? That’s right. Be clean, be honest and open on when you got your eye exam done last, and then let us know that you are getting a new exam done pretty quickly if you haven’t done one in a while. So we will see you there after the episode. Head over to our social media, Facebook on Instagram at Yumlish. We will find you there and again with that, Lisa, thank you so much.
Lisa: Take care.
Shireen: Thank you for listening to the YumlisPodcast. Make sure to follow us on social media at Yumlis_ on Instagram and Twitter and atYumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.
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Connect with Lisa:LinkedIn