Diabetes mellitus (DM) is a disease that affects a person's ability to metabolize sugars. A patient with diabetes will experience many symptoms, including hyperglycemia, polyuria, polydipsia, polyphagia, and blurred vision. Patients also generally suffer from yeast infections more often than patients without diabetes. Although patients may experience all or just a few of these symptoms, they are often unaware of their illness until diagnosed by a doctor. If a patient's blood sugar remains high for a long time, due to poor compliance with prescribed medications and diet, he or she may experience complications such as diabetic retinopathy, hypertension, neuropathy, and increased foot infections. It is therefore extremely important for patients to monitor their blood sugar levels at home. This provides patients with key information to adjust their medication levels and restrict their diet based on their most recent readings. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay DM consists of two main types: type 1 and type 2. Type 1 is caused by the destruction of the beta cells of the pancreas, which produce insulin. It accounts for approximately 10% of diabetes and is thought to be an autoimmune process. Type 2 is caused by a combination of insulin resistance and insufficient insulin production by the pancreas. It represents approximately 90% of the dry matter. Diabetes is diagnosed if one of the following conditions is met: an HbA1c of 6.5% or more, a fasting blood sugar of 126 mg/dl or more, a 2-hour blood sugar of 200 mg/dl or more, or random blood sugar levels. reading of 200 mg/dl or more. HbA1c measures a patient's blood sugar by measuring the percentage of hemoglobin that binds glucose. Typically, glucose does not bind to hemoglobin, but when a patient has hyperglycemia, more glucose binds to hemoglobin. This measurement is preferable because it is an average measurement over a period of a few months rather than a one-time measurement like other diagnostic tests. According to the American Diabetes Association, in 2015, 9.4% (30.3 million) of people in the United States population had diabetes. Of these 9.4%, approximately 24% (12 million) of patients were undiagnosed. Around 25.2% of people over the age of 65 have diabetes, while only 0.24% of people under the age of 20 have diabetes. Diabetes is more common among American Indians, Blacks, and Hispanics in the United States. Globally, approximately 422 million people have diabetes. This equates to an increase of almost 4% since 1980. The prevalence of diabetes varies widely around the world, but higher rates of type 1 diabetes appear in European countries, followed closely by Canada and the United States. United. Type 2 diabetes has higher rates among the previously discussed groups in the United States, as well as in Fiji, China and South Africa. Patients are at higher risk of developing diabetes if they have any of the following characteristics: they are overweight, age 45, are Native American, black, Hispanic, or Pacific Islander, have high blood pressure, are not not physically active, have a family history of diabetes, etc. Diabetes rates are increasing rapidly in countries that adopt a lifestyle similar to this. of the United States. More and more people are becoming obese, leading to a diagnosis of type 2 diabetes. A person's BMI is used as an indicatorto determine if a patient is overweight or obese. BMI stands for body mass index and it is equal to the patient's weight in kilograms divided by their height in meters squared. A BMI of 27.3 or higher is considered overweight, while a BMI of 30 or higher is considered obese. Although some muscular patients may have a superficially high BMI, it is still considered a good indicator of a person's healthy weight. One of the biggest concerns among long-term diabetic patients is the development of diabetic retinopathy (DR). Around 93 million people worldwide suffer from DR. The incidence of DR varies widely across the world, but on average 30-40% of patients with diabetes will develop DR. There are many risk factors for developing DR, including: length of time the patient has had diabetes, men are more at risk than women, hypertension, high HbA1c levels, smoking, puberty increases rates in patients with type 1 diabetes, pregnancy, as well as kidney damage can all lead to an increased risk of developing DR.DR occurs due to various pathways in the body that are affected by the increase glucose levels. The polyol pathway reduces excess glucose in the retina to sorbitol and then to fructose. The conversion of sorbitol to fructose is slow, resulting in sorbitol being trapped in the cells of the retina. This creates osmotic damage in the retinal cells as water follows its concentration gradient. It may also produce myopic shift due to the lens becoming less flexible in young patients or leading to a higher refractive index in patients without accommodation. Since water regulation is affected, patients may often also experience dry eye symptoms. This pathway has also been associated with increased thickness of the basement membrane of retinal capillaries. Hyperglycemia also results in increased activation of protein kinase C, leading to changes in retinal hemodynamics, vascular endothelial growth factor (VEGF) expression, and endothelial permeability. This can lead to oxidative stress as well as macular edema. Macular edema causes photoreceptors to misorient, leading to poor vision. Ischemia leads to the recruitment of VEGF which causes neovascularization in order to provide more oxygen to the hypoxic zone. Neovascularization leads to the formation of fragile and leaky blood vessels. VEGF is also thought to control the actions of insulin growth factor 1 (IGF1); however, the role of IGF1 in DR is not fully understood at present. When vessel contents leak into the vitreous body, vision is negatively affected. Neovascularization of the iris can also lead to open-angle glaucoma due to hypoxic conditions created by changes in the vascular system. Hypertension also causes endothelial damage. Thus, many pathways contribute to the development of DR and a cure would be very difficult to obtain. The two main types of DR are proliferative DR (PDR) and non-proliferative DR (NPDR), which can then be broken down into mild, moderate, and severe categories. In cases of mild NPDR, microaneurysms occur. Microaneurysms are small areas of blood vessels that become weakened due to loss of pericytes and bloating outward. In cases of moderate NPDR, microaneurysms, pinpoint hemorrhages and scattered exudates occur. In cases of severe NPDR, bleeding throughSpotting and flaming, cotton wool spots, hard exudates, and defined venous beads occur, but no signs of PDR are present. Dot and spot hemorrhages are microaneurysms that have ruptured in the inner and outer plexiform layers. Hard exudates are made up of lipids that have leaked from the retinal capillaries once weakened. These exudates appear yellow and are usually found around the macula, which can lead to visual impairment. Cotton wool spots are caused by ischemia of the retinal vessels leading to infarction of the retinal nerve fiber layer. These spots appear white and fluffy when viewing the retina. In PDR, retinal ischemia leads to the formation of new leaky blood vessels. Patients with ROP may experience vitreous hemorrhages, neovascularization near the optic disc, and beads and curvatures of the vasculature due to hypoxic conditions of the retina. PDR can lead to traction retinal detachments and blindness. This happens when new blood vessels created by VEGF use the vitreous as a scaffold. As the vessels attach to the vitreous body, when the eye moves, the retina experiences traction and retinal detachments can occur. It is important for a diabetic patient to have annual checkups to prevent NPDR from turning into PDR for as long as possible. Many factors in DR cause vision loss, including: macular edema which leads to poor orientation of photoreceptors, leakage of vascular contents into the vitreous due to neovascularization, and hard yellow exudates centered around the macula and optic nerve head. The most likely cause of vision loss in both eyes of this patient would be macular edema. This diagnosis could be confirmed using various imaging techniques and tests such as retinal imaging, fundus photography, and optical coherence tomography (OCT). Retinal imaging simply takes a picture of the retina. Fundus photography requires the patient to be dilated and then the retina can be viewed. OCT can provide cross sections of the retina which can provide information on the exact amount of edema present in a given area, where a detachment has occurred, where a hemorrhage is located retinal, etc. The information from the OCT allows the doctor to determine how aggressive the treatment should be. must be intended for a particular patient. Fluorescein angiography may also be performed to determine the location of blocked or leaking retinal veins or arteries. First, the patient would be dilated and baseline photos of the retina would be taken. Then the NaFl dye is injected into the patient's vein. NaFl dye may have negative side effects such as nausea, vomiting, and flushing. It is therefore best to inform the patient of these potential side effects before starting the procedure. Finally, the examiner should start taking photos. The dye travels from the patient's arm where it is injected to the patient's eye where it first reaches the choriocapillaris vessels. Because the choriocapillaris is fenestrated, the dye is visible as an uneven background glow in the choroidal flushing phase. It only takes 10-15 seconds. Then the central arteries fill rapidly, followed by the peripheral arteries, then the capillaries, then the peripheral veins and finally the central veins. The dye should remain in these vessels, but if the vascular system isdamaged, as in DR, fluorescein can be seen leaking from the vessels. Likewise, if a container is blocked, filling of the containers will not occur as previously described and a blockage will be easily identified using this technique. Finally, in the late phase, the choriocapillaris, arteries and veins all drain the dye. The dye makes the head of the optic nerve glow as it exits the eye. This phase occurs approximately 10 minutes after the injection of the dye. There are several treatment options for DR, including panretinal photocoagulation (PRP). In PRP, an argon laser is used to create 1,200 to 1,800, 200 to 500 micron burns on the retina. These burns cause necrosis by coagulation of leaking blood vessels. Since no oxygen is needed in this area of ​​the retina after being burned, the rest of the retina receives better oxygenation. This treatment has proven to be incredibly effective, but it can also lead to complications such as exudative retinal detachments, macular edema, visual field defects, and night vision abnormalities. Patients should therefore be aware of other treatment options as well as PRP. A somewhat similar treatment, focal laser treatment, exists for macular edema. This laser treatment is used to create 50-100 micron burns on leaking blood vessels. This allows the inner retina to better utilize oxygen in a manner similar to PRP. This treatment has been shown to reduce the risk of visual acuity loss in patients by 50%. Other treatment options are also available for patients with DR. One of these treatment options is Avastin. Avastin is administered by intravitreal injection into the eye and binds to the receptor binding domain of VEGF-A, which prevents VEGF-A from interacting with its receptor; therefore it does not signal the formation of new leaky blood vessels. Similar drugs are also on the market, including Lucentis and Eylea. With VEGF blocked, macular edema would be reduced, leading to better visual acuity for patients. One study found that over a 5-year period, Avastina injections stabilized or improved vision in 70% of cases. PRP should also be considered along with injections as it is more likely to provide better long-term control of the patient's symptoms. Although this treatment has been shown to be very effective, it is important to inform the patient of the possible risks associated with these injections. The greatest risk is the development of infections, including endophthalmitis, which can lead to loss of the patient's eye. In this case, because the patient has blood in the vitreous, ultrasound can be used to determine if there is a retinal detachment or vitreous detachment. B-scan ultrasound is a non-invasive procedure that uses a probe and sound waves to produce a 2D grid of black and white dots. Black dots correspond to areas of low-reflection interfaces while white dots correspond to high-reflection interfaces. If the results show no retinal detachment, but blood is present in the vitreous, a vitrectomy may be necessary. A vitrectomy removes the vitreous gel that new blood vessels have attached to in DR. Removing this gel will prevent further traction forces from acting on the retina and reduce the risk of retinal detachment. Once the vitreous gel is removed, a gas or oil bubble is used to hold the retina in place. Eventually, the body will produce fluids that will replace the bleb and it can be removed with a second surgery.,.