June 18, 2025 • 27 mins
Diabetes can silently damage your eyes long before you notice any vision changes. In this episode, ophthalmologist Dr. Evans explains how high blood sugar affects the tiny vessels in your retina—and how early detection can help prevent permanent vision loss.
With clear analogies and expert insight, Dr. Evans walks us through the stages of diabetic eye disease, why the brain might hide signs of vision loss, and how lifestyle changes can help your body heal.
Whether you're managing diabetes or supporting someone who is, this episode offers essential, hopeful information to help protect your sight.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the MedLink Health Connections
podcast.
Today we're talking aboutsomething that often goes
overlooked how diabetes affectsyour eyes.
Diabetic eye disease can creepin without warning and it's one
of the leading causes of visionloss in adults.
What should you be watching for?
When does eye damage actuallybegin, and can it be stopped or
even reversed?
When does eye damage actuallybegin, and can it be stopped or
even reversed?
To help us understand all ofthis, we're joined by Dr Evans,
(00:27):
a leading ophthalmologist atGeorgia Eye Care, located in
Athens, georgia, who works withpatients every day to protect
and preserve their vision.
Whether you're managingdiabetes yourself or supporting
someone who is, this episode isfull of insight that could make
a big difference.
Dr Evans, we know diabetes canaffect many parts of the body,
but a lot of people may notrealize the eyes are one of them
(00:49):
.
To start things off, can youexplain what exactly is diabetic
eye disease and how is itconnected to diabetes?
Speaker 2 (00:56):
Yeah, absolutely.
I'd love to chat a little bitabout that, but first I just
want to say thank you so muchfor having me out.
This is a great honor and it'sa lot of fun to talk about the
eyes, and I could be here allday.
We'll try to keep it short andsweet.
So what is diabetic eye diseaseand how is it connected to
diabetes?
Well, you know, diabetes ingeneral is a disease of the
(01:16):
entire body, so anything thathas blood supply is going to be
affected by diabetes.
Essentially, you have all thissugar floating around in your
blood and and typically thebody's way of processing that
sugar is by releasing insulin.
That sugar is then taken upinto the tissues, such as the
muscle, and places where it'suseful, and the body tries to
(01:38):
get rid of that sugar as quicklyas possible.
Because if the sugar stayswithin the bloodstream too long,
eventually it'll start to makechanges, and a lot of these
changes are not great.
And in fact, one of the waysthat we check for diabetes in
patients is we check your A1Cand basically that is a marker
of how long sugar has been inyour bloodstream and the changes
(02:02):
that the sugar actually makesto the red blood cells.
And so, because we know thatblood cells last for about 90
days within the body, that's agood marker to determine how
much blood has been in there andhow many changes have occurred
to these individual blood cells.
And so when we check your A1cwe can tell, basically over
about a three month period, howhigh your sugars have been.
So that just goes to show thatsugar hanging out in the
(02:24):
bloodstream is not a good thing.
Well, if you can imagine,obviously there's blood flow all
throughout our body, butthere's some tissues and some
organs that require more bloodflow.
So heart, kidneys, liver, brainand actually a lot of people
don't know this but for its size, the eye actually demands
probably the highest flow orhighest what's the word?
(02:48):
Concentration, I guess of bloodfrom the body.
So in terms of its size and howmuch tissue it has, the amount
of blood flow that's going tothe choroid, which is one
portion of the eye, istremendously high.
So you can imagine it goingback to sort of the eye is
tremendously high.
So you can imagine going backto sort of the process of this
disease, all this sugar in thebloodstream going to an organ
(03:09):
that has a lot of blood flow.
You're going to notice somechanges very, very often, and so
that's why a lot of yourprimary care doctors are going
to say every year, our diabeticsneed to have an eye exam
because this is the only placein the body that we can actually
visualize the blood cells orthe blood vessels.
So you know, I don't reallyknow what's going on in your
(03:31):
heart.
I can do some tests and I canmaybe do some imaging to take a
look inside your body, but withthe eyes, I can literally look
in with my own eyes and seewhat's going on at the cellular
level.
And so when I look in there,typically and I'm hoping to see
nothing I'm hoping to seehealthy blood vessels and a
healthy retina.
(03:51):
But typically what happens withdiabetics, specifically ones
that are uncontrolled, is, overtime, the diabetes and the sugar
inside the bloodstream startsto affect the blood vessels and
it starts to affect theirability to hold in, basically,
the blood.
And the way that I explain thisto patients is you know those
garden hoses that you have thatare like black and they seep
(04:13):
fluid.
You know you turn them on andit's like a way to water your
garden, it's like a trickle typeof thing.
Well, think of it.
Sort of like that You've gotyour blood vessel and blood is
starting to kind of leak out ofthe blood vessels.
And that's kind of anotherthing about the body.
The body doesn't really likefor blood to be in the tissues,
it likes it for all of it to beinside the blood vessels.
(04:35):
And so when the blood vesselsthemselves start to become kind
of leaky and it leaks blood intothe tissue, it becomes
inflammatory and the bodyamounts a little bit of an
inflammatory response to it.
And so it's a combination ofthis blood starting to seep out
of the blood vessels into thesurrounding tissue and in this
case we're talking about theretina, because that's the
(04:55):
portions that we can see easilywhen we look inside the eye.
The blood starts to kind of seepand trickle into the retina and
it starts causing inflammation.
Seep and trickle into theretina and it starts causing
inflammation, and thatinflammation can then lead to
scarring and then scarring canlead to severe vision loss.
And so essentially, with thescarring inside the eye, scars
and I don't know if you have anyscars or you've ever seen
(05:17):
anybody with scars but scarswhen they first grow it's this
body's attempt to repair itself.
But then what happens is thescar starts to contract a little
bit.
And so if you've ever seensomeone with a scar, you can
sometimes see the tissue aroundit kind of contracting a little
bit and when that happens in theeye it actually contracts and
kind of pulls on the retinaslightly and the retina at that
point can then detach from theeye.
(05:39):
So basically the progression.
I know this is a very longwinded answer, sorry it's okay.
But it's nice to have a littlebit of background and kind of
understanding of, like, what'sthe deal with all this sugar and
how does it affect us?
Right, but essentially you havesugar in the blood that causes
damage to the blood cell I'msorry, the the blood vessels and
that causes the blood vesselsnot, it's not able to do its job
(06:01):
very well.
So blood starts to seep intothe tissue and that causes
inflammation.
Inflammation causes contractionand other problems in the eye
which we won't go into right now, and that contraction can
sometimes cause retinal tearsand detachments and things like
that.
So that's sort of the fullprogression of diabetic eye
disease.
Now, of course, going back alittle bit to, you know, blood
(06:25):
seeping into the tissue, we knowthat it's not just red blood
cells, right, there's lots ofother things that are kind of
floating along in ourbloodstream.
Uh, so of course we've gotsugar, you know, we've got blood
cells, we've got white bloodcells, but we also have
cholesterol, we also have a lotof other things that are
necessary for our function, andbut they belong either within
(06:46):
cells or within the bloodvessels themselves.
And so when we have bloodleaking out of the blood vessels
and getting into the tissue,kind of where it's not supposed
to be.
The body tries to repair it,but sometimes there's stuff left
behind, right, and I'm justgoing to call it junk,
whatever's floating around inthe bloodstream, let's say
cholesterol, a little bit ofwaste, you know, because we also
(07:08):
use our blood vessels and ourcells dump waste into it, you
know, to be filtered out throughour kidneys and liver and
whatnot.
So, it's kind of like atransport system, a highway
system, and on the way hereactually, I saw a wreck and you
know they had cleaned it up, butI saw a bunch of junk like
glass and like car parts stilllaying around, you know.
So it's like, even after, likeyou know, something bad happens,
(07:29):
the body tries to fix it, butthere's always some junk left
behind right.
And so a lot of times indiabetic eye disease, a lot of
that junk or that stuff getsleft behind in the tissue and
that's not very conducive toeyesight, if that makes sense.
So you can imagine, your retinais a clear tissue that
intercepts light and sendssignals to our brain and our
(07:49):
brain interprets that as animage.
Now, if you have a bunch ofjunk in your retina that's
blocking that light orreflecting that light and
whatnot, it's going to cause apoor image.
Think of it like you got acamera and your camera's really
dirty.
You know you've got that clearlens up there and you've got a
bunch of junk on that lens andyou're not going to be able to
(08:10):
see very well.
So there's.
It's kind of a multifactorialprocess, but essentially, you
know what is diabetic eyedisease.
Well, it's, it's aninflammatory disease of the
retina and you know how is itconnected Well to diabetes.
The inflammation comes from allthe sugar in the bloodstream.
Speaker 1 (08:34):
What are the most common eye problems caused by
diabetes?
Speaker 2 (08:37):
So I think we need to kind of think about problems.
So there's problems for me, youknow, as your ophthalmologist,
and there's problems for you asthe patient.
Sometimes those sync up.
The unfortunate part aboutdiabetes sometimes is the early
changes that occur in diabetes.
Patients don't often know aboutBecause obviously you can't
(08:59):
look inside your eye and tellthat something's going on right.
But your ophthalmologist canlook in there and can see blood
leakage, like we talked about,and can see a leakage of that
blood into the retina.
We can see some of that junkthat we talked about, the
extracellular material that kindof accumulates after the body's
trying to clean up all of thisblood that's spilling out.
We can see that in the retinaand deposits and typically at
(09:25):
that stage most of the timepatients don't really know
what's going on, for one of tworeasons.
One, if the changes are smallenough, it doesn't create a
significant amount of visionloss where patients don't really
notice.
But also, we were born with aspare eye, right, we all have
two eyes, and so a lot of timesthe brain is very, very good at
ignoring problems that occur inone eye, if that makes sense.
(09:48):
I have patients all the timethat come in who are nearly
blind in one eye.
But they had no idea, becausethe brain is just that good at
helping us adapt.
And you know, because, if youcan imagine, we still have to
function, we still have to liveand survive, and so our brain
just gets us there the mostefficiently possible.
So so that's the difficultyabout diabetes and about
(10:13):
managing eye disease, and that'swhy it's so important to have a
yearly checkup.
So that's what I would considermy problem.
You know, when you come in andI take a look inside the eye and
I can see little spots of bloodand some of the early changes
of diabetes, they're problems,but they're not necessarily
major problems for the patientat that moment, if that makes
(10:34):
sense, because to them it's notgoing to make that much of a
difference.
But that's often the time wherewe can really spend our time
counseling with the patient andtalking about how we can reverse
these changes.
So there are a lot ofreversible changes that occur in
diabetes in the early stages inthe eye, and then eventually,
once it gets into thatinflammatory phase that we
talked about, that's when a lotof irreversible changes start.
(10:57):
So you know, once theinflammation sets in and you
start having scarring andcontraction and other changes.
That's oftentimes irreversible,so let's talk a little bit
about that for a moment.
Irreversible so let's talk alittle bit about that for a
moment.
We talked about howinflammation leads to scarring
(11:17):
and scarring can lead tocontraction, and contraction can
lead to tearing of tissue.
What we haven't talked about isthe fact that, because the sugar
in the bloodstream causes thoseblood vessels not to work very
effectively, the blood vesselsoriginal job, which is
delivering nutrients and oxygento the tissue, is dampened or
(11:38):
hindered, if that makes sense.
And so you have all of thisretinal tissue that's looking
for more blood, but what'shappening is these blood vessels
are not supplying iteffectively because it's leaking
out.
Or, you know, oftentimespatients with diabetes also
suffer from high blood pressureand high cholesterol, and so
you've got these.
You know, oftentimes patientswith diabetes also suffer from
high blood pressure and highcholesterol, and so you've got
these you know, very poor bloodvessels that are not delivering
(11:58):
oxygen very well, not deliveringthe nutrients very well, and so
you've got this tissue outthere that's starving for oxygen
.
Well, when that happens in thebody, tissues activate sort of a
pathway that releases what wecall the vascular endothelial
growth factor, or VEGF, which iswhat we call it, and that
(12:20):
recruits new blood vessels tothat area.
So it's kind of like they sendup a little beacon and blood
vessels start to grow towards it.
Now this can be very importantin some cases.
Within the body I mean, I thinkthat there probably is an
important aspect of this butinside the eye, new blood vessel
(12:40):
growth, or what we callneovascularization, can be a
real problem because often thosenew blood vessels grow in a
very haphazard manner.
It's not very kind of laid out.
Well.
You know, when we're growing asa fetus, there's kind of like a
plan.
You know, our DNA sort of putsout this master plan and it
tells like where the bloodvessels to grow and everything
grows according to how, like it,best functions.
(13:02):
But when the body is in thissort of repair mode, it tries to
do things as quickly andquickly as possible.
It's just like I don't carewhere the blood comes from, I
just need it.
And so when these new bloodvessels grow, like I said,
usually it's kind of haphazard.
Usually they're not formed verywell and often those new blood
(13:26):
vessels themselves will clot andkind of stop functioning for
whatever reason, and sometimesbecause this chemical is being
released.
The VEGF that we talked about isbeing released all throughout
the retina and the vitreous,which is like the center part of
the eye.
Blood vessels start to groweverywhere.
You know, not only are theygrowing into the retina, they
start growing into the center ofthe eye and it becomes a major
(13:49):
issue because those bloodvessels themselves then cause
scarring and inflammation.
They're not functioning verywell either because there's
blood in them with sugar and sothey start to contract and it
further pulls on the retina andso it causes lots of problems.
Sometimes you can see thoseblood vessels grow into the
drain of the eye.
(14:09):
Okay, we have a drain which iscalled the trabecular meshwork
and that drain is responsiblefor all of the eye.
Okay, we have a drain which iscalled the trabecular meshwork
and that drain is responsiblefor all of the fluid that's
produced in the eye.
It drains it back into the body, basically back into the
bloodstream, and so you canimagine, if all of these little
blood vessels are growing intothe drain of the eye, then that
drain is not going to functionwell and that leads to high
(14:30):
pressures in the eye, just likeif you put a bunch of spaghetti
in the kitchen sink and you turnthe water on, that water level
is going to rise, and that'swhat happens in the eye, and
that will lead to something elsewe could talk about, which is
glaucoma.
So there's something calledneovascular glaucoma, which is
because of, if you break it down, neovascular new blood vessels
(14:51):
glaucoma, which is an opticneuropathy often associated with
high pressures in the eye.
So you have that's a majorproblem in some of my end-stage
diabetic retinopathy patients,where blood vessels are growing
and causing high pressures inthe eye, and all that pressure
is causing severe trauma to theoptic nerve, and so that's just
(15:14):
one of the ways that pressure iscausing severe trauma to the
optic nerve, and so that's justone of the ways that diabetic
retinopathy can lead toblindness.
We talked a little bit aboutretinal tears and detachments
that occur due to scarring andinflammation.
Sometimes, and most often, weactually I don't know why I
forgot about this, but a lot oftimes I'll be called to the
emergency room because there's adiabetic patient who's
uncontrolled and their sugarshave been kind of high and all
(15:38):
of a sudden they just went blindin one eye and in my mind
there's a lot of differentthings that could be happening.
You can still get blood clotsand just you know, standard sort
of things that happen, you know, but most commonly in my
uncontrolled diabetics is goingback to that leakage of blood.
And so what happens is theseblood vessels, they, they break
(16:01):
open and blood starts flowinginto the center of the eye.
And if you, if you kind ofthink of the eye as like a globe
or a snow globe, there's a lotof fluid in the middle and you
release a little bit of blood inthere and all of a sudden it's
going to look like you justshook up that snow globe and
you're not going to be able tosee through it, and so that's a
very common thing.
We call it a vitreoushemorrhage, and that is one of
(16:25):
the most common reasons for anuncontrolled diabetic to have
sudden vision loss diabetic tohave sudden vision loss.
So lots of problems Typically,you know, typically your
ophthalmologist can detect thesethings early on if you're
getting kind of routine care andyour ophthalmologist will work
really closely with your primarydoctor to kind of help you kind
(16:49):
of manage this.
You know, because the thingthat people don't understand is
that because we can see insidethe eye and I can actually
visualize your blood vessels, ifeverything's looking good
inside the eye, then chances areit's looking good elsewhere,
right?
So the places that I can't see,such as your heart, kidneys,
you know, lungs, whatever, theyall have blood vessels and those
(17:11):
blood vessels are the same asthe ones in the eye.
So this is just kind of likeyou know you're trying to
diagnose a problem with your car.
You just got to pop the hood,you know, look under there, see
what you see.
And that's kind of what we doin ophthalmology, and so that's
why it's so important to get aneye exam once a year.
Speaker 1 (17:27):
Are these hemorrhages reversible?
Speaker 2 (17:34):
So, yeah, typically hemorrhages in the eye.
So so, yes, right, the body isvery good at cleaning up its
mess.
Um, what the body's not greatat is if the original factor,
the original thing that causedthat mess, keeps going on, right
.
So that's why you see patientsthat have, like, let's say, a
stroke, and sometimes you knowthings don't get better, but
sometimes they do.
Sometimes you know things don'tget better, but sometimes they
(17:56):
do.
Sure, right, and it's just thebody's way of repairing itself.
And but you know, of course, if, whatever reason, you had that
stroke let's say your bloodpressure was crazy high If you
don't fix that problem, well,guess what?
The body's not going to begreat at repairing itself.
Sure, you know, you have tokind of get rid of that original
sort of what we call theetiology or the cause of that
problem.
And so a lot of times we seepatients that come in with early
(18:18):
changes in their eye and justsome hemorrhages and blood
leaking into the retina.
As long as we can get thatsugar under control and get that
information to your primarydoctor so they can better
closely manage it.
And you know the patients,there's a lot of work to do.
You know, it's not just on thedoctors, right?
I mean, the patients have toeat right and exercise and
really change their lifestyle toget back to a point where their
(18:38):
body is better able to repairitself.
It is a lot, well, you know,and it's I think of things often
.
I try to break it down and makeit simple.
But one of the biggest thingswe say as doctors, we're always
talking about a healthy diet andexercise.
Um, and it really is the key toeverything, Um, you, you always
(19:03):
hear, like, for example,patients go to physical therapy
after they have, like, a kneereplacement or something like
that.
It's just work, it's exerciseright, you're trying to get the
body moving again, you're tryingto strengthen your muscles and
you're trying to put yourself inthe best possible position to
get healthy again.
Okay, well, guess what?
Your body is better able to dothat when you are healthy.
You know what I mean.
So if you, if you take twopeople, one, one person who is
(19:26):
very unhealthy, very poorlifestyle, the, the level of
nutrients that they're takinginto their body are very poor,
the level of nutrients thatthey're taking into their body
are very poor, okay, versussomeone who's active and healthy
, that's eating a high level ofnutrition and you give them the
same injury.
Well, guess who's going to healfaster?
Obviously, it's going to be thehealthy person, and it's easy
(19:47):
for us to visualize that.
But think about your body, allthe healing that it's doing on
its own.
So you get a little hemorrhagein your retina, okay.
But I've got a super healthyperson over here and I've got a
very unhealthy person over here.
They both have hemorrhages intheir retina.
Who's going to be able to clearand clean up that hemorrhage
better?
It's going to be the healthyperson, right?
And so I think sometimes wethink of healing and reversible
(20:10):
damage and all of this at moreof a sort of meta level, like,
oh, I hurt my knee, I need toheal, but your body's doing a
lot of this at a cellular leveltoo, right?
And so that's really where thework happens.
And if your body is notequipped to do that because of
poor nutrition and poor healthand all of that, then the same
(20:30):
problem is going to keephappening.
But you're also never going toget over that first insult.
That makes sense.
Speaker 1 (20:36):
What are some of these like lifestyle changes
that you can kind of do to helpwith that?
Speaker 2 (20:43):
Yeah, no, well.
So this is kind of like theSunday school answers, you know,
like there's always answersthat you can give when someone
asks you a question, you caninstantly like be right, right.
So whenever someone asks methat question, I'm always going
to say, well, okay.
Well, you know, eat better,right, that's always going to be
the answer, no matter what.
So when I was in medical school, that was an easy one.
(21:03):
Like doctors would always tryto ask me super difficult
questions.
I'm like, well, you know, let'sfocus on eating healthy, and
it's like my turn's over nextguy.
But so lifestyle changes.
So, number one absolutelynutrition, that's all it is
right.
A Absolutely nutrition, that'sall it is right.
A lot of times in diabetics anddiabetes, we're just overloading
(21:25):
the body's capacity to dealwith all the sugar, and so and
sugar is not just, you know,cakes and bonbons and stuff like
that you know our body breaksdown a lot of food into sugar,
and so and this is somethingthat you know I won't get into
because I'm not the nutritionistand I'm, you know, I don't know
(21:47):
all about that but there arecertain foods that will raise
your blood sugar a lot higher,and patients often know what.
They are right.
They know what spikes theirblood sugar and it's not always
the same for everyone.
It's not always the same foreveryone.
Funny enough, but, um, but weneed to give the body a break
and and try to allow it time torepair itself and eat better,
(22:09):
right?
Um, exercise.
So we know for a fact that whenwe exercise, it makes it much
easier for our muscles and othertissues to take in that sugar
from the bloodstream, and sowe're getting that sugar out of
the bloodstream into thesurrounding tissues to lower our
blood sugar levels as quicklyas possible.
And so every moment and youknow, the more that you are
(22:32):
working out and using yourmuscles, the lower your blood
sugar is going to be.
That's great.
And so those are like the twomain things, right?
And then, of course, you know,there's patients who are in
transition, who are workingreally hard to get their blood
sugars under control.
They're working really hard totake their medications and to
exercise and to eat, right?
(22:54):
One simple thing and again, Iknow this is self-serving
because I'm an ophthalmologistbut just go see your doctor,
right?
That's a lifestyle change,right?
Because there's so many peoplewho don't want to go see doctors
at all and we can't help if wedon't see you.
And a lot of times, you know,burying our head in the sand and
(23:14):
saying I don't have anyproblems and I don't see any
doctors, I don't take anymedicines like, doesn't
necessarily mean that you'rehealthy.
Whether or not you're healthyis really just an objective fact
.
You know it's there or not.
Seeing your doctor can justkind of help you manage those
issues.
Speaker 1 (23:30):
Okay, and so, with that being said, what are some
ways that you work with otherhealthcare providers to support
patients with diabetes?
Speaker 2 (23:40):
Well, the biggest thing is a patient will come
into the office and say, hey, myprimary doctor said I needed to
see you, and so there I'lltypically kind of take a few
moments to sort of talk aboutdiabetes in the eye sort of what
we did here, but just a littlebit more abbreviated and talk
about why it's important.
And then the biggest thing isjust communicating with the
(24:02):
primary care doctor, lettingthem know that, hey, this is
what I saw, and not every littlechange inside the eye requires
a whole lot of intervention onmy part.
Sometimes, you know, if I seejust a couple little hemorrhages
, that's something that I canjust manage and watch,
especially if that patient isbeing taken care of by a primary
(24:24):
doctor who's following themclosely to make sure that their
blood sugars are headed in theright direction, then I feel a
little bit more comfortable,kind of letting them go for a
while and just monitoring things.
But certainly if it's a patientwhom I feel like is maybe not
managing their disease very well, then that's something I'm
going to communicate to theirprimary doctor so they can be a
(24:46):
little bit more aggressive ingetting those sugars under
control.
Speaker 1 (24:51):
Do you have any final words to say?
Anything we might have missed.
Speaker 2 (24:56):
I think that I always have more to say.
That's my problem, you know.
I think that you know diabetes.
When I was, when I was inmedical school, I remember being
in a room full of doctors andwe all always talked about like
(25:19):
what's the one disease thatwould be the most challenging
for you to get.
And we're talking about doctorswho have managed some of the
most challenging things.
You know, inner city, Atlanta,Just very, very challenging
things, and almost alwaysdiabetes.
You know, kind of rose to thetop.
It is just such a verydifficult disease to manage.
It's just such a very difficultdisease to manage.
(25:43):
But I think the final wordwould be to help empower
patients to know that there areso many tools out there that can
help you.
There's a lot of doctors whowant to help you and this can be
something that can be managed,you know, and just sort of take
the take back that control ofyour life and and make these
(26:04):
decisions to help improve youroutcomes and your life and your
quality of life, you know.
So that's the biggest thing isthat you can do it and it's not
the end.
Speaker 1 (26:16):
You know this diagnosis of yours, you know
there's so much more that wrapsup our conversation on diabetic
eye disease, a condition thataffects millions, but with the
right care and early action, itdoesn't have to steal your sight
.
A big thank you to Dr Evans forjoining us and helping shed
light on how diabetes can impactvision and what you can do to
protect it.
If you or someone you love hasdiabetes, don't wait to schedule
(26:39):
that annual eye exam.
It's a simple but powerful stepin protecting your long-term
health.
And if you need supportmanaging your diabetes, medlink
Georgia is here to help.
Our diabetes education programoffers personalized guidance on
nutrition, blood sugarmanagement and healthy lifestyle
changes.
Visit MedLinkGAorg to learnmore or schedule an appointment.
(27:01):
Thanks for tuning in to theMedLink Health Connections
podcast.
We'll see you next time.
Thank you for tuning in to theMedLink Health Connections
podcast.
We hope you found today'sepisode informative and
inspiring.
If you enjoyed the show, pleasesubscribe, rate and leave a
review on your favorite podcastplatform.
Remember, the informationshared in this podcast is for
(27:22):
educational purposes only andshould not replace professional
medical advice.
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website at medlinkgaorg for moreresources and updates.
Until next time, stay healthyand take care.
Welcome to the MedLink Health Connections
podcast.
Today we're talking aboutsomething that often goes
overlooked how diabetes affectsyour eyes.
Diabetic eye disease can creepin without warning and it's one
of the leading causes of visionloss in adults.
What should you be watching for?
When does eye damage actuallybegin, and can it be stopped or
even reversed?
When does eye damage actuallybegin, and can it be stopped or
even reversed?
To help us understand all ofthis, we're joined by Dr Evans,
(00:27):
a leading ophthalmologist atGeorgia Eye Care, located in
Athens, georgia, who works withpatients every day to protect
and preserve their vision.
Whether you're managingdiabetes yourself or supporting
someone who is, this episode isfull of insight that could make
a big difference.
Dr Evans, we know diabetes canaffect many parts of the body,
but a lot of people may notrealize the eyes are one of them
(00:49):
.
To start things off, can youexplain what exactly is diabetic
eye disease and how is itconnected to diabetes?
Speaker 2 (00:56):
Yeah, absolutely.
I'd love to chat a little bitabout that, but first I just
want to say thank you so muchfor having me out.
This is a great honor and it'sa lot of fun to talk about the
eyes, and I could be here allday.
We'll try to keep it short andsweet.
So what is diabetic eye diseaseand how is it connected to
diabetes?
Well, you know, diabetes ingeneral is a disease of the
(01:16):
entire body, so anything thathas blood supply is going to be
affected by diabetes.
Essentially, you have all thissugar floating around in your
blood and and typically thebody's way of processing that
sugar is by releasing insulin.
That sugar is then taken upinto the tissues, such as the
muscle, and places where it'suseful, and the body tries to
(01:38):
get rid of that sugar as quicklyas possible.
Because if the sugar stayswithin the bloodstream too long,
eventually it'll start to makechanges, and a lot of these
changes are not great.
And in fact, one of the waysthat we check for diabetes in
patients is we check your A1Cand basically that is a marker
of how long sugar has been inyour bloodstream and the changes
(02:02):
that the sugar actually makesto the red blood cells.
And so, because we know thatblood cells last for about 90
days within the body, that's agood marker to determine how
much blood has been in there andhow many changes have occurred
to these individual blood cells.
And so when we check your A1cwe can tell, basically over
about a three month period, howhigh your sugars have been.
So that just goes to show thatsugar hanging out in the
(02:24):
bloodstream is not a good thing.
Well, if you can imagine,obviously there's blood flow all
throughout our body, butthere's some tissues and some
organs that require more bloodflow.
So heart, kidneys, liver, brainand actually a lot of people
don't know this but for its size, the eye actually demands
probably the highest flow orhighest what's the word?
(02:48):
Concentration, I guess of bloodfrom the body.
So in terms of its size and howmuch tissue it has, the amount
of blood flow that's going tothe choroid, which is one
portion of the eye, istremendously high.
So you can imagine it goingback to sort of the eye is
tremendously high.
So you can imagine going backto sort of the process of this
disease, all this sugar in thebloodstream going to an organ
(03:09):
that has a lot of blood flow.
You're going to notice somechanges very, very often, and so
that's why a lot of yourprimary care doctors are going
to say every year, our diabeticsneed to have an eye exam
because this is the only placein the body that we can actually
visualize the blood cells orthe blood vessels.
So you know, I don't reallyknow what's going on in your
(03:31):
heart.
I can do some tests and I canmaybe do some imaging to take a
look inside your body, but withthe eyes, I can literally look
in with my own eyes and seewhat's going on at the cellular
level.
And so when I look in there,typically and I'm hoping to see
nothing I'm hoping to seehealthy blood vessels and a
healthy retina.
(03:51):
But typically what happens withdiabetics, specifically ones
that are uncontrolled, is, overtime, the diabetes and the sugar
inside the bloodstream startsto affect the blood vessels and
it starts to affect theirability to hold in, basically,
the blood.
And the way that I explain thisto patients is you know those
garden hoses that you have thatare like black and they seep
(04:13):
fluid.
You know you turn them on andit's like a way to water your
garden, it's like a trickle typeof thing.
Well, think of it.
Sort of like that You've gotyour blood vessel and blood is
starting to kind of leak out ofthe blood vessels.
And that's kind of anotherthing about the body.
The body doesn't really likefor blood to be in the tissues,
it likes it for all of it to beinside the blood vessels.
(04:35):
And so when the blood vesselsthemselves start to become kind
of leaky and it leaks blood intothe tissue, it becomes
inflammatory and the bodyamounts a little bit of an
inflammatory response to it.
And so it's a combination ofthis blood starting to seep out
of the blood vessels into thesurrounding tissue and in this
case we're talking about theretina, because that's the
(04:55):
portions that we can see easilywhen we look inside the eye.
The blood starts to kind of seepand trickle into the retina and
it starts causing inflammation.
Seep and trickle into theretina and it starts causing
inflammation, and thatinflammation can then lead to
scarring and then scarring canlead to severe vision loss.
And so essentially, with thescarring inside the eye, scars
and I don't know if you have anyscars or you've ever seen
(05:17):
anybody with scars but scarswhen they first grow it's this
body's attempt to repair itself.
But then what happens is thescar starts to contract a little
bit.
And so if you've ever seensomeone with a scar, you can
sometimes see the tissue aroundit kind of contracting a little
bit and when that happens in theeye it actually contracts and
kind of pulls on the retinaslightly and the retina at that
point can then detach from theeye.
(05:39):
So basically the progression.
I know this is a very longwinded answer, sorry it's okay.
But it's nice to have a littlebit of background and kind of
understanding of, like, what'sthe deal with all this sugar and
how does it affect us?
Right, but essentially you havesugar in the blood that causes
damage to the blood cell I'msorry, the the blood vessels and
that causes the blood vesselsnot, it's not able to do its job
(06:01):
very well.
So blood starts to seep intothe tissue and that causes
inflammation.
Inflammation causes contractionand other problems in the eye
which we won't go into right now, and that contraction can
sometimes cause retinal tearsand detachments and things like
that.
So that's sort of the fullprogression of diabetic eye
disease.
Now, of course, going back alittle bit to, you know, blood
(06:25):
seeping into the tissue, we knowthat it's not just red blood
cells, right, there's lots ofother things that are kind of
floating along in ourbloodstream.
Uh, so of course we've gotsugar, you know, we've got blood
cells, we've got white bloodcells, but we also have
cholesterol, we also have a lotof other things that are
necessary for our function, andbut they belong either within
(06:46):
cells or within the bloodvessels themselves.
And so when we have bloodleaking out of the blood vessels
and getting into the tissue,kind of where it's not supposed
to be.
The body tries to repair it,but sometimes there's stuff left
behind, right, and I'm justgoing to call it junk,
whatever's floating around inthe bloodstream, let's say
cholesterol, a little bit ofwaste, you know, because we also
(07:08):
use our blood vessels and ourcells dump waste into it, you
know, to be filtered out throughour kidneys and liver and
whatnot.
So, it's kind of like atransport system, a highway
system, and on the way hereactually, I saw a wreck and you
know they had cleaned it up, butI saw a bunch of junk like
glass and like car parts stilllaying around, you know.
So it's like, even after, likeyou know, something bad happens,
(07:29):
the body tries to fix it, butthere's always some junk left
behind right.
And so a lot of times indiabetic eye disease, a lot of
that junk or that stuff getsleft behind in the tissue and
that's not very conducive toeyesight, if that makes sense.
So you can imagine, your retinais a clear tissue that
intercepts light and sendssignals to our brain and our
(07:49):
brain interprets that as animage.
Now, if you have a bunch ofjunk in your retina that's
blocking that light orreflecting that light and
whatnot, it's going to cause apoor image.
Think of it like you got acamera and your camera's really
dirty.
You know you've got that clearlens up there and you've got a
bunch of junk on that lens andyou're not going to be able to
(08:10):
see very well.
So there's.
It's kind of a multifactorialprocess, but essentially, you
know what is diabetic eyedisease.
Well, it's, it's aninflammatory disease of the
retina and you know how is itconnected Well to diabetes.
The inflammation comes from allthe sugar in the bloodstream.
Speaker 1 (08:34):
What are the most common eye problems caused by
diabetes?
Speaker 2 (08:37):
So I think we need to kind of think about problems.
So there's problems for me, youknow, as your ophthalmologist,
and there's problems for you asthe patient.
Sometimes those sync up.
The unfortunate part aboutdiabetes sometimes is the early
changes that occur in diabetes.
Patients don't often know aboutBecause obviously you can't
(08:59):
look inside your eye and tellthat something's going on right.
But your ophthalmologist canlook in there and can see blood
leakage, like we talked about,and can see a leakage of that
blood into the retina.
We can see some of that junkthat we talked about, the
extracellular material that kindof accumulates after the body's
trying to clean up all of thisblood that's spilling out.
We can see that in the retinaand deposits and typically at
(09:25):
that stage most of the timepatients don't really know
what's going on, for one of tworeasons.
One, if the changes are smallenough, it doesn't create a
significant amount of visionloss where patients don't really
notice.
But also, we were born with aspare eye, right, we all have
two eyes, and so a lot of timesthe brain is very, very good at
ignoring problems that occur inone eye, if that makes sense.
(09:48):
I have patients all the timethat come in who are nearly
blind in one eye.
But they had no idea, becausethe brain is just that good at
helping us adapt.
And you know, because, if youcan imagine, we still have to
function, we still have to liveand survive, and so our brain
just gets us there the mostefficiently possible.
So so that's the difficultyabout diabetes and about
(10:13):
managing eye disease, and that'swhy it's so important to have a
yearly checkup.
So that's what I would considermy problem.
You know, when you come in andI take a look inside the eye and
I can see little spots of bloodand some of the early changes
of diabetes, they're problems,but they're not necessarily
major problems for the patientat that moment, if that makes
(10:34):
sense, because to them it's notgoing to make that much of a
difference.
But that's often the time wherewe can really spend our time
counseling with the patient andtalking about how we can reverse
these changes.
So there are a lot ofreversible changes that occur in
diabetes in the early stages inthe eye, and then eventually,
once it gets into thatinflammatory phase that we
talked about, that's when a lotof irreversible changes start.
(10:57):
So you know, once theinflammation sets in and you
start having scarring andcontraction and other changes.
That's oftentimes irreversible,so let's talk a little bit
about that for a moment.
Irreversible so let's talk alittle bit about that for a
moment.
We talked about howinflammation leads to scarring
(11:17):
and scarring can lead tocontraction, and contraction can
lead to tearing of tissue.
What we haven't talked about isthe fact that, because the sugar
in the bloodstream causes thoseblood vessels not to work very
effectively, the blood vesselsoriginal job, which is
delivering nutrients and oxygento the tissue, is dampened or
(11:38):
hindered, if that makes sense.
And so you have all of thisretinal tissue that's looking
for more blood, but what'shappening is these blood vessels
are not supplying iteffectively because it's leaking
out.
Or, you know, oftentimespatients with diabetes also
suffer from high blood pressureand high cholesterol, and so
you've got these.
You know, oftentimes patientswith diabetes also suffer from
high blood pressure and highcholesterol, and so you've got
these you know, very poor bloodvessels that are not delivering
(11:58):
oxygen very well, not deliveringthe nutrients very well, and so
you've got this tissue outthere that's starving for oxygen
.
Well, when that happens in thebody, tissues activate sort of a
pathway that releases what wecall the vascular endothelial
growth factor, or VEGF, which iswhat we call it, and that
(12:20):
recruits new blood vessels tothat area.
So it's kind of like they sendup a little beacon and blood
vessels start to grow towards it.
Now this can be very importantin some cases.
Within the body I mean, I thinkthat there probably is an
important aspect of this butinside the eye, new blood vessel
(12:40):
growth, or what we callneovascularization, can be a
real problem because often thosenew blood vessels grow in a
very haphazard manner.
It's not very kind of laid out.
Well.
You know, when we're growing asa fetus, there's kind of like a
plan.
You know, our DNA sort of putsout this master plan and it
tells like where the bloodvessels to grow and everything
grows according to how, like it,best functions.
(13:02):
But when the body is in thissort of repair mode, it tries to
do things as quickly andquickly as possible.
It's just like I don't carewhere the blood comes from, I
just need it.
And so when these new bloodvessels grow, like I said,
usually it's kind of haphazard.
Usually they're not formed verywell and often those new blood
(13:26):
vessels themselves will clot andkind of stop functioning for
whatever reason, and sometimesbecause this chemical is being
released.
The VEGF that we talked about isbeing released all throughout
the retina and the vitreous,which is like the center part of
the eye.
Blood vessels start to groweverywhere.
You know, not only are theygrowing into the retina, they
start growing into the center ofthe eye and it becomes a major
(13:49):
issue because those bloodvessels themselves then cause
scarring and inflammation.
They're not functioning verywell either because there's
blood in them with sugar and sothey start to contract and it
further pulls on the retina andso it causes lots of problems.
Sometimes you can see thoseblood vessels grow into the
drain of the eye.
(14:09):
Okay, we have a drain which iscalled the trabecular meshwork
and that drain is responsiblefor all of the eye.
Okay, we have a drain which iscalled the trabecular meshwork
and that drain is responsiblefor all of the fluid that's
produced in the eye.
It drains it back into the body, basically back into the
bloodstream, and so you canimagine, if all of these little
blood vessels are growing intothe drain of the eye, then that
drain is not going to functionwell and that leads to high
(14:30):
pressures in the eye, just likeif you put a bunch of spaghetti
in the kitchen sink and you turnthe water on, that water level
is going to rise, and that'swhat happens in the eye, and
that will lead to something elsewe could talk about, which is
glaucoma.
So there's something calledneovascular glaucoma, which is
because of, if you break it down, neovascular new blood vessels
(14:51):
glaucoma, which is an opticneuropathy often associated with
high pressures in the eye.
So you have that's a majorproblem in some of my end-stage
diabetic retinopathy patients,where blood vessels are growing
and causing high pressures inthe eye, and all that pressure
is causing severe trauma to theoptic nerve, and so that's just
(15:14):
one of the ways that pressure iscausing severe trauma to the
optic nerve, and so that's justone of the ways that diabetic
retinopathy can lead toblindness.
We talked a little bit aboutretinal tears and detachments
that occur due to scarring andinflammation.
Sometimes, and most often, weactually I don't know why I
forgot about this, but a lot oftimes I'll be called to the
emergency room because there's adiabetic patient who's
uncontrolled and their sugarshave been kind of high and all
(15:38):
of a sudden they just went blindin one eye and in my mind
there's a lot of differentthings that could be happening.
You can still get blood clotsand just you know, standard sort
of things that happen, you know, but most commonly in my
uncontrolled diabetics is goingback to that leakage of blood.
And so what happens is theseblood vessels, they, they break
(16:01):
open and blood starts flowinginto the center of the eye.
And if you, if you kind ofthink of the eye as like a globe
or a snow globe, there's a lotof fluid in the middle and you
release a little bit of blood inthere and all of a sudden it's
going to look like you justshook up that snow globe and
you're not going to be able tosee through it, and so that's a
very common thing.
We call it a vitreoushemorrhage, and that is one of
(16:25):
the most common reasons for anuncontrolled diabetic to have
sudden vision loss diabetic tohave sudden vision loss.
So lots of problems Typically,you know, typically your
ophthalmologist can detect thesethings early on if you're
getting kind of routine care andyour ophthalmologist will work
really closely with your primarydoctor to kind of help you kind
(16:49):
of manage this.
You know, because the thingthat people don't understand is
that because we can see insidethe eye and I can actually
visualize your blood vessels, ifeverything's looking good
inside the eye, then chances areit's looking good elsewhere,
right?
So the places that I can't see,such as your heart, kidneys,
you know, lungs, whatever, theyall have blood vessels and those
(17:11):
blood vessels are the same asthe ones in the eye.
So this is just kind of likeyou know you're trying to
diagnose a problem with your car.
You just got to pop the hood,you know, look under there, see
what you see.
And that's kind of what we doin ophthalmology, and so that's
why it's so important to get aneye exam once a year.
Speaker 1 (17:27):
Are these hemorrhages reversible?
Speaker 2 (17:34):
So, yeah, typically hemorrhages in the eye.
So so, yes, right, the body isvery good at cleaning up its
mess.
Um, what the body's not greatat is if the original factor,
the original thing that causedthat mess, keeps going on, right
.
So that's why you see patientsthat have, like, let's say, a
stroke, and sometimes you knowthings don't get better, but
sometimes they do.
Sometimes you know things don'tget better, but sometimes they
(17:56):
do.
Sure, right, and it's just thebody's way of repairing itself.
And but you know, of course, if, whatever reason, you had that
stroke let's say your bloodpressure was crazy high If you
don't fix that problem, well,guess what?
The body's not going to begreat at repairing itself.
Sure, you know, you have tokind of get rid of that original
sort of what we call theetiology or the cause of that
problem.
And so a lot of times we seepatients that come in with early
(18:18):
changes in their eye and justsome hemorrhages and blood
leaking into the retina.
As long as we can get thatsugar under control and get that
information to your primarydoctor so they can better
closely manage it.
And you know the patients,there's a lot of work to do.
You know, it's not just on thedoctors, right?
I mean, the patients have toeat right and exercise and
really change their lifestyle toget back to a point where their
(18:38):
body is better able to repairitself.
It is a lot, well, you know,and it's I think of things often
.
I try to break it down and makeit simple.
But one of the biggest thingswe say as doctors, we're always
talking about a healthy diet andexercise.
Um, and it really is the key toeverything, Um, you, you always
(19:03):
hear, like, for example,patients go to physical therapy
after they have, like, a kneereplacement or something like
that.
It's just work, it's exerciseright, you're trying to get the
body moving again, you're tryingto strengthen your muscles and
you're trying to put yourself inthe best possible position to
get healthy again.
Okay, well, guess what?
Your body is better able to dothat when you are healthy.
You know what I mean.
So if you, if you take twopeople, one, one person who is
(19:26):
very unhealthy, very poorlifestyle, the, the level of
nutrients that they're takinginto their body are very poor,
the level of nutrients thatthey're taking into their body
are very poor, okay, versussomeone who's active and healthy
, that's eating a high level ofnutrition and you give them the
same injury.
Well, guess who's going to healfaster?
Obviously, it's going to be thehealthy person, and it's easy
(19:47):
for us to visualize that.
But think about your body, allthe healing that it's doing on
its own.
So you get a little hemorrhagein your retina, okay.
But I've got a super healthyperson over here and I've got a
very unhealthy person over here.
They both have hemorrhages intheir retina.
Who's going to be able to clearand clean up that hemorrhage
better?
It's going to be the healthyperson, right?
And so I think sometimes wethink of healing and reversible
(20:10):
damage and all of this at moreof a sort of meta level, like,
oh, I hurt my knee, I need toheal, but your body's doing a
lot of this at a cellular leveltoo, right?
And so that's really where thework happens.
And if your body is notequipped to do that because of
poor nutrition and poor healthand all of that, then the same
(20:30):
problem is going to keephappening.
But you're also never going toget over that first insult.
That makes sense.
Speaker 1 (20:36):
What are some of these like lifestyle changes
that you can kind of do to helpwith that?
Speaker 2 (20:43):
Yeah, no, well.
So this is kind of like theSunday school answers, you know,
like there's always answersthat you can give when someone
asks you a question, you caninstantly like be right, right.
So whenever someone asks methat question, I'm always going
to say, well, okay.
Well, you know, eat better,right, that's always going to be
the answer, no matter what.
So when I was in medical school, that was an easy one.
(21:03):
Like doctors would always tryto ask me super difficult
questions.
I'm like, well, you know, let'sfocus on eating healthy, and
it's like my turn's over nextguy.
But so lifestyle changes.
So, number one absolutelynutrition, that's all it is
right.
A Absolutely nutrition, that'sall it is right.
A lot of times in diabetics anddiabetes, we're just overloading
(21:25):
the body's capacity to dealwith all the sugar, and so and
sugar is not just, you know,cakes and bonbons and stuff like
that you know our body breaksdown a lot of food into sugar,
and so and this is somethingthat you know I won't get into
because I'm not the nutritionistand I'm, you know, I don't know
(21:47):
all about that but there arecertain foods that will raise
your blood sugar a lot higher,and patients often know what.
They are right.
They know what spikes theirblood sugar and it's not always
the same for everyone.
It's not always the same foreveryone.
Funny enough, but, um, but weneed to give the body a break
and and try to allow it time torepair itself and eat better,
(22:09):
right?
Um, exercise.
So we know for a fact that whenwe exercise, it makes it much
easier for our muscles and othertissues to take in that sugar
from the bloodstream, and sowe're getting that sugar out of
the bloodstream into thesurrounding tissues to lower our
blood sugar levels as quicklyas possible.
And so every moment and youknow, the more that you are
(22:32):
working out and using yourmuscles, the lower your blood
sugar is going to be.
That's great.
And so those are like the twomain things, right?
And then, of course, you know,there's patients who are in
transition, who are workingreally hard to get their blood
sugars under control.
They're working really hard totake their medications and to
exercise and to eat, right?
(22:54):
One simple thing and again, Iknow this is self-serving
because I'm an ophthalmologistbut just go see your doctor,
right?
That's a lifestyle change,right?
Because there's so many peoplewho don't want to go see doctors
at all and we can't help if wedon't see you.
And a lot of times, you know,burying our head in the sand and
(23:14):
saying I don't have anyproblems and I don't see any
doctors, I don't take anymedicines like, doesn't
necessarily mean that you'rehealthy.
Whether or not you're healthyis really just an objective fact
.
You know it's there or not.
Seeing your doctor can justkind of help you manage those
issues.
Speaker 1 (23:30):
Okay, and so, with that being said, what are some
ways that you work with otherhealthcare providers to support
patients with diabetes?
Speaker 2 (23:40):
Well, the biggest thing is a patient will come
into the office and say, hey, myprimary doctor said I needed to
see you, and so there I'lltypically kind of take a few
moments to sort of talk aboutdiabetes in the eye sort of what
we did here, but just a littlebit more abbreviated and talk
about why it's important.
And then the biggest thing isjust communicating with the
(24:02):
primary care doctor, lettingthem know that, hey, this is
what I saw, and not every littlechange inside the eye requires
a whole lot of intervention onmy part.
Sometimes, you know, if I seejust a couple little hemorrhages
, that's something that I canjust manage and watch,
especially if that patient isbeing taken care of by a primary
(24:24):
doctor who's following themclosely to make sure that their
blood sugars are headed in theright direction, then I feel a
little bit more comfortable,kind of letting them go for a
while and just monitoring things.
But certainly if it's a patientwhom I feel like is maybe not
managing their disease very well, then that's something I'm
going to communicate to theirprimary doctor so they can be a
(24:46):
little bit more aggressive ingetting those sugars under
control.
Speaker 1 (24:51):
Do you have any final words to say?
Anything we might have missed.
Speaker 2 (24:56):
I think that I always have more to say.
That's my problem, you know.
I think that you know diabetes.
When I was, when I was inmedical school, I remember being
in a room full of doctors andwe all always talked about like
(25:19):
what's the one disease thatwould be the most challenging
for you to get.
And we're talking about doctorswho have managed some of the
most challenging things.
You know, inner city, Atlanta,Just very, very challenging
things, and almost alwaysdiabetes.
You know, kind of rose to thetop.
It is just such a verydifficult disease to manage.
It's just such a very difficultdisease to manage.
(25:43):
But I think the final wordwould be to help empower
patients to know that there areso many tools out there that can
help you.
There's a lot of doctors whowant to help you and this can be
something that can be managed,you know, and just sort of take
the take back that control ofyour life and and make these
(26:04):
decisions to help improve youroutcomes and your life and your
quality of life, you know.
So that's the biggest thing isthat you can do it and it's not
the end.
Speaker 1 (26:16):
You know this diagnosis of yours, you know
there's so much more that wrapsup our conversation on diabetic
eye disease, a condition thataffects millions, but with the
right care and early action, itdoesn't have to steal your sight
.
A big thank you to Dr Evans forjoining us and helping shed
light on how diabetes can impactvision and what you can do to
protect it.
If you or someone you love hasdiabetes, don't wait to schedule
(26:39):
that annual eye exam.
It's a simple but powerful stepin protecting your long-term
health.
And if you need supportmanaging your diabetes, medlink
Georgia is here to help.
Our diabetes education programoffers personalized guidance on
nutrition, blood sugarmanagement and healthy lifestyle
changes.
Visit MedLinkGAorg to learnmore or schedule an appointment.
(27:01):
Thanks for tuning in to theMedLink Health Connections
podcast.
We'll see you next time.
Thank you for tuning in to theMedLink Health Connections
podcast.
We hope you found today'sepisode informative and
inspiring.
If you enjoyed the show, pleasesubscribe, rate and leave a
review on your favorite podcastplatform.
Remember, the informationshared in this podcast is for
(27:22):
educational purposes only andshould not replace professional
medical advice.
Always consult with yourhealthcare provider for any
medical concerns.
Stay connected with us onsocial media and visit our
website at medlinkgaorg for moreresources and updates.
Until next time, stay healthyand take care.
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