Dr Paula Diab advocates the need to move away from a curative, rehabilitative model of treating diabetes and invest time and money into preventing the complications, such as eye disease, by early detection, timeous treatment where necessary and appropriate follow-up.

It’s probably fairly common knowledge that diabetes can affect your eyes and, in some cases, even cause people to lose their sight completely. It’s estimated that over 7 million people over the age of 40 have some degree of diabetic retinopathy and that this number will increase to 11 million by 2030. The good news though is that it’s estimated that 95% of severe visual loss from diabetic retinopathy can be prevented.

Who is at risk?

All people with diabetes, be it Type 1 or Type 2 diabetes, are at risk. Complications are more common in those people who have had diabetes for longer or whose diabetes has been uncontrolled, but that doesn’t mean that everyone else is safe.

Anyone who already has another form of vascular disease is already at high-risk of developing eye disease. The blood vessels in the eyes are obviously much smaller than those in the heart, brain and limbs so we can often pick up early vascular disease much earlier by shining a light in the eye than we can on an angiogram. Anyone who already has heart disease, suffered from a stroke or heart attack or poor limb perfusion is most certainly already at high-risk.

Because the eyes also have multiple vessels that supply them, the clinical signs of poor vision don’t always correlate with the pathological decline. In other words, it’s not reliable to wait until you experience visual loss or a deterioration in your vision before getting your eyes examined.

How is it detected?

The only way of detecting diabetic eye disease is by regular screening by an optometrist or ophthalmologist. This is not the same as your annual update of your glasses or contact lenses. This is a comprehensive examination where the optometrist or ophthalmologist is specifically looking for complications related to diabetes.

When we renew our script for glasses or contact lenses, we are concentrating mainly on the lenses, the windows of the eye through which we see. In diabetes, we need to assess the blood supply and the potential damage to the retina of the eye which often requires a more sophisticated examination and photographs to be taken. Current South African guidelines recommend that every person with diabetes has their eyes screened at least annually from the time of diagnosis of diabetes, even in childhood.

As mentioned above, please don’t wait for deterioration in your vision before you seek help; at this stage it’s often too late. Regular monitoring and documentation of declining eye function often encourages a diabetologist to enhance medical therapy and prevent the decline in vision before it becomes noticeable. This is why comprehensive care and good communication amongst the various specialists is vital.

How can eye disease be treated?

Firstly, and most importantly, addressing any additional risk factors is very important.

• Stop smoking.
• Ensure that your blood glucose levels, blood pressure and cholesterol levels are well within target and that you’re taking all the correct medication.
• Maintaining a healthy diet and regular physical exercise will also go a long way to ensuring good cardiovascular health.

Some eye conditions can be treated with eye drops and topical medications whilst others may need surgical intervention. Eye surgery and treatment has progressed at a rapid rate over the last few years and many procedures are extremely safe, quick and have remarkable outcomes. However, the longer that these diseases are left before treatment is commenced, the more difficult it becomes and the more the prognosis deteriorates.

What type of damage can occur?

Diabetic retinopathy is a general term for all disorders that affect the retina caused by diabetes. The retina is the back surface of the eye where all the blood vessels are found and where the images we see are imprinted onto the retinal cells. It stands to reason that if these blood vessels are blocked or leaking in any way, that the images we see may not be correct.

Proliferative retinopathy refers to the new vessels that are formed when older vessels become damaged or obstructed. These new vessels are often fragile or weak and can leak into the vitreous humour (jelly-like substance at the back of the eyeball) causing haemorrhages, scar tissue and even retinal detachment.

Non-proliferative retinopathy refers to the phenomenon where capillaries in the back of the eye balloon and form pouches. As the condition worsens, more blood vessels become blocked depriving areas of the retina from their blood supply. This results in new but weaker vessel formation.

Maculopathy is when fluid leaks into the centre of the macula, causing the macula to swell and blur the vision. The macula is the central area of the retina where colour vision is perceived and where the image is the most focussed.

Cataracts may also be found as a result of diabetes although they may also occur independently of blood glucose levels. These cause cloudy vision and difficulty with night vision.

Glaucoma (damage to the optic nerve) caused by an increased pressure build-up within the eye can also be a consequence of diabetes and may occur quickly or over a longer period of time but can also have a severe impact on vision.

What should you do? 

Talk to your doctor today and ask for a referral to get your eyes tested as soon as possible. South African guidelines recommend that you get your eyes checked annually regardless of what visual symptoms you may have.

Trials have shown that good glycaemic control, managing other risk factors and regular eye screening can prevent or delay many complications related to diabetic eye disease. Test your glucose levels regularly and understand the fluctuations that occur on a daily basis. Ask your doctor to explain how you can manage your diabetes more effectively and look for complications. Don’t wait for the symptoms before you act.

Finally, please don’t put off these tests because you can see okay or just got new glasses last month. Diabetic eye disease is preventable and treatable if detected early. It’s also an excellent sign of other vascular damage in the body and a skilled clinician will be able to adjust your chronic medication to address these changes and prevent any further damage taking place. There is no need to lose your vision due to diabetes.

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Farhana Cassim, a Cupping therapist, explains the benefits of Cupping therapy, highlighting the good it does for people living with diabetes.

What is Cupping therapy?

Cupping is a safe, non-invasive and inexpensive technique that has been practiced since ancient times. It’s used to alleviate the pain and discomfort arising from disorders of internal organs, and muscle spasms, joint pains, diabetic neuropathy and numerous other conditions. There are three types of Cupping: Dry-, Wet- and Massage Cupping.

After a long period of neglect, Cupping was revived in the Islamic age. Strict adherence to rules of application was demanded, with close attention to timing and patient condition. Traditional healers in many parts of the world use Cupping or versions of it in their healing repertoire. The technique has historically been used by practitioners of conventional medicine for many centuries to treat a range of diseases. It’s also an important aspect of traditional Chinese medicine.

How does it work?

Cupping causes the tissues beneath the cup to be drawn up and swell. This increases blood flow to the affected area. This enhanced blood flow under the cup draws impurities and toxins away from the nearby tissues and organs to the skin.

The release of the vacuum redirects toxic blood that had pooled at the site and redirects it to other areas of the body, thus allowing fresh blood to replace it. This facilitates the healing process. Localised and deep-tissue healing takes place.

Cupping diverts toxins and impurities from important organs, such as the liver or kidney, to the upper surface of the body.
In Dry Cupping, the toxins are brought to the underlying skin. In Wet Cupping, the toxins are brought out of the body, onto the surface of the skin. This process strengthens the immune system, so encouraging the optimum functioning of the body.

The benefits

Cupping assists the liver by increasing blood perfusion, so removing the metabolic load imposed by the disease and perhaps any drugs used to treat the disease. It also supports the immune system, by acting on the reticuloendothelial system to help it in opposing the actions of invading microbes. In addition, Cupping supports the nervous system, by helping to reverse ischaemia (reduced blood flow), which can lead to conditions characterised by cerebral metabolic insufficiency, such as memory disturbances, epilepsy and emotional conditions.

It supports the renal system, by helping to reverse the ischaemia which underlies many disorders. Cupping is also involved in the release of cortisol and serotonin, important mediators in pain and stress. Added to that, it also stimulates meridians, and releases biological opioids called endorphins.

Clinical value

The benefits have been extensively researched and documented. Cupping is recommended for people with recurring, refractory headaches, skin disorders, stomach pain, boils; disorders of the heart and circulation, such as varicose veins and hypertension; joint and neck pains, for example, arthritis and rheumatism; diarrhoea and vomiting; menstrual cramps; bronchitis; colds; asthma; infertility; impotence; and haemorrhoids, amongst other ailments.

The clinical benefits of Cupping continue for several days after the procedure. These are for most ailments that effect a large number of diabetic patients.

The use of whichever form of Cupping is at the discretion of the practitioner.

Studies in people with diabetes

Diabetic patients (Type 2) that were treated with Cupping therapy, the results showed that blood glucose levels were lowered consistently in almost all experimental patients subjected to Cupping, when comparing blood glucose levels before (mean 11.98 ± 10.11SD) and after (9.86 ± 8.93 SD).

On quality of life issues, people with diabetes showed substantial improvement in patient health parameters when the final cupping session was compared to the initial one. The majority of patients showed an increase in energy levels and improvement in sleeping habits.

Although Cupping is not a cure for diabetes, it can assist by detoxing the body and blood by reducing the toxic accumulated waste in the body and improving blood circulation. Cupping also assists in cleansing the blood and cells, resolving stagnation and blood stasis in the body.

Diabetes can make it difficult to control your blood pressure and cholesterol, which can lead to heart attacks, stroke and other serious conditions. Cupping increases blood flow in the body and improves circulation; it also reduces blood pressure and cholesterol when performed regularly.

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How delightful would it be to dance into spring with pretty painted toes, soft heels and, more importantly, no foot pain? It’s possible.

“The job of feet is walking, but their hobby is dancing.” Amit Kalantri

First, a little bit more about these two important, yet sadly often neglected parts of your body. The feet really do have a rotten deal. They carry us throughout our lives, get shoved into ill-fitting shoes and are seldom given the praise and recognition they deeply deserve.

As a Pilates instructor and therapeutic reflexologist, I’ve seen 100s of pairs of feet in my studio; all of which tell a tale. Hardly ever have I heard anyone say, “I love my feet.” They are always berated and presented to me with embarrassment and copious apologies for how ugly they are.

The magnificent structures of feet

Each foot consists of 26 bones, 33 joints, over 30 ligaments, 19 muscles and tendons. Don’t forget the 250 000 or so sweat glands in both, or the 7 000 nerves in each.

The feet are the most superb shock absorbers. They cushion up to approximately 454kg of pressure during one hour of strenuous exercise. They provide support of up to 1,2 times our body weight while walking and 2 to 3 times that while running.

The feet are our foundation and keep us balanced. Since 25% of the body’s bones are in our feet, when they are misaligned the implications for our posture are enormous.

What your feet say about you

From a reflexology perspective, the feet can tell a tremendous amount about the state of our mental, emotional, and physical health.

A therapeutic reflexologist can look for signs of disease and pain in the different regions of the foot which have reflexes corresponding to the various organs and systems of the body.  Seldom are these wrong. So, while a reflexologist may not diagnose, they can assuredly suggest where you need to pay attention in your health concerns.

Problems which feet present are many and varied. The most common are:

• Neuropathy – common in diabetes
• Hammertoes
• Bunions
• Cracked, painful heels
• Morton’s neuroma
• Dropped arches
• Plantar fasciitis

These are the tip of the iceberg and all play a significant role in the rest of your body’s health and posture as when your feet are painful, we compensate when we walk, and the quality of life is seriously impacted.

Identifying the culprits

Unfortunately, it’s neglect, lack of awareness, poorly-fitting shoes (the biggest culprit), high heels, cold temperatures and in particular never walking barefoot that contribute to foot pain. Do your feet a favour, take those shoes off and go and walk on the grass. They will love you for it and the health benefits are far-reaching. Watch Earthing Movie for more information on this powerful yet free health supplement right under your toes. (Please note if you have lost sensation in your feet due to neuropathy, it’s advisable to not walk bare feet).

Addressing foot problems

Apart from visiting a podiatrist and taking up Pilates which will teach correct foot placement and how to walk properly, reflexology is a brilliant modality to assist with foot problems.

Remember that reflexology is not simply a foot massage. A properly qualified therapeutic reflexologist has tremendous knowledge of the feet, the reflexes and what they reveal and how to work these reflexes correctly and effectively.

Many health issues can be noted and assisted with reflexology. For example, bunions (those painful bumps that develop on the side of the foot under the big toe) aren’t only due to incorrect foot placement and poorly-fitting shoes but may also indicate blood glucose imbalances or thyroid pathologies.

Constant and painful, deeply cracked heels aren’t only dryness but more often than not a sign of poor gait, as well as lower back problems or issues in the reproductive organs because the heel reflex corresponds to the pelvic and lumbar area of the back. You can go for as many pedis as you like. Until your address the underlying issues, the cracked heels will persist.

Plantar fasciitis which is that horrendous pain in the sole of the foot could relate not only to badly-fitting shoes, but also to tight calf muscles or even a tight lower back. And, from a reflexology perspective, kidney issues.

Neuropathy, the diabetic patient’s nightmare is a numbness of the feet which can be lethal as often pain and injuries can’t be felt and can often lead to more serious symptoms. Reflexology will bring unnoticed injuries to your attention and will also stimulate feeling in the feet.

Awaken the reflexes

Reflexology will awaken these reflexes, bringing energy to the relevant areas encouraging healing to occur. Of course, a session is usually wrapped up with a relaxing foot and calf massage which will loosen tight calves, mobilise immobile ankles, and bring much needed love and relief to sore, tired feet. Reflexology is a many faceted bonus for the body and feet.

Let’s start spring with not only a step but a dance in our feet. Look at your feet with new eyes and thank them for how well they carry you through every moment of your life.

References

•  www.orthopedicassociates.org
•  www.verywellhealth,com/causes-of-foot-pain

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