EP #9: Unveiling the Connection: Diabetes and Eye Health with Dr. Falco

Do you know that diabetes goes beyond blood sugar levels? Wondering how your eyesight can be impacted by diabetes? Tune into our enlightening episode of the Jazzy Eyes podcast where your hosts, Dr. Laura Falco and Jeremy Wolfe, delve into the crucial link between diabetes and eyesight. Dr. Falco unravels the mystery around hemoglobin A1C, the red flags that your fluctuating blood sugar levels might be indicating about your vision, and the latest diabetic research that’s shaking up the medical world.

We don’t stop at the theory, as Dr. Falco walks us through the severity of diabetic retinopathy - a condition that could lead to permanent vision loss if not managed properly. Discover the importance of adopting a team approach in managing diabetes, involving not just your ophthalmologist but also endocrinologists, nutritionists, and more. Get a glimpse into innovative technologies such as continuous glucose monitoring that are aiding patients in keeping their diabetes under control. This episode is a must-listen for everyone as it emphasizes the power of regular monitoring, lifestyle alterations, and open communication with your healthcare team in ensuring the best outcomes for diabetic patients. So, grab your headphones and join us on this journey of exploring the indispensable connection between diabetes and your vision health.

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Episode Transcript

Speaker 1 (00:03):
Welcome to the Jazzy Eyes Podcast.
Taking care of your vision withexpert precision.
Here's your host, dr LauraFalco.

Jeremy (00:16):
Hello everyone and welcome to the Jazzy Eyes
Podcast.
I'm your co-host, jeremy Wolfe,and I'm here with the host, dr
Laura Falco.
Dr Falco, we were just talkingabout diabetes.
It is upcoming DiabetesAwareness Month and we're
talking a little bit about theillness and as it pertains to
your eyesight.
But something I didn't ask onthe last segment that I think we

(00:38):
should clarify right now forlisteners can you just give a
basic definition for those thatmaybe don't know as to what
diabetes is in the first place?

Dr. Falco (00:47):
So diabetes is diagnosed by your blood sugar
level, right?
So patients will typically haveblood work done fasting in the
morning and there are certainreadings.
If you're over, say, 120 in themorning, you're going to be
diagnosed fasting, you know, asa diabetic, because you could

(01:10):
should be 100 or less, right?
There are other tests and I'mactually glad you asked this I
was going to talk about this.
It's called a hemoglobin A1C,so it's a percentage.
Now hemoglobin A1C is basicallygiving you an idea of, over the

(01:30):
course of the life cycle of ared blood cell, which is about
90 days, how high and low yourblood sugar fluctuates because
diabetics tend to peak high andthen come down.
So they're these huge swings intheir blood sugar level and
that can also go along with likefrequent urination, frequent

(01:53):
thirst, like their symptoms thatpatients can have or sometimes
they really don't know they haveany symptoms.
So the higher the highs, thelower the lows, the bigger, like
the peak to the trough you knowlike is up and down, the larger
the number will be the percent.
So if somebody has a numberthat's say 8, 9, 10%, they're

(02:15):
definitely a diabetic.
You know you're looking to havea number under 6%.
Some people want it under 5.5%.
So this is basically tellingyou over the span of 90 days if
your blood sugar, if your body'sregulating in a tight zone or
if your body's having troubleand it's going up, down, up down
.
And these peaks and valleys arequite far from one another.

(02:37):
The further they're apart, thehigher their percentage the
number will be.
So that kind of like ties intothe newest research is showing
that the HbA1c everyone thoughtwas like the, the, the answer is
kind of not the best prognosticindicator for us to see what

(02:59):
you know, how much damage wemight see in the back of the eye
.
We used to think if we heard anA1c level was like 12 or 13%,
we were going to see a disasterin the back of the eye, all
these bleeds and stuff.
And now we're we're kind of notand and they're tying it in eye
signs at least, andmicrovascular blood vessels to

(03:19):
more of.
Is the patient on insulin or notversus A1c?
Because typically the harderthe diabetes gets to control
they end up on insulin and thatseems to correlate more with
changes in the back of the eye.
But just to name a couple ofsymptoms a patient might have.

(03:40):
Who's diabetic eye wise?
There is a.
Your prescription can changequite a bit and you're not sure
why.
So your glasses that worked allof a sudden don't work.
These can actually change yourglasses prescription because it
changes the physiology of thelens in the eye and that changes

(04:04):
the prescription Fascinating.
Yeah, so sometimes we actuallywon't prescribe glasses until
somebody's stabilized, becausewhat I see one day isn't going
to work three months later.
If they're A1C, or ifeverything gets vastly changed,
you can have patients with moredry eye than typically, because

(04:25):
diabetes and dry eye are linkedtogether.
Can you back up?

Jeremy (04:28):
a second there.
What's the A1C again?

Dr. Falco (04:31):
It's the hemoglobin A1C.
That's that percentage test.
That gives you an idea becauseit follows the life of that red
blood cell.
The hemoglobin on the red bloodcell is a 90-day life.
Whether or not the patient isagain the peaks and valleys, if
they are far apart or if theyare close together, that will
affect the result.
So your percentage will be highor low and you really want a

(04:53):
lower number for that.
You don't want big peaks andvalleys.

Jeremy (04:57):
Thanks for clarifying.
It's Monday and I'm slowprocessing things.
I need to hear things twicesometimes.

Dr. Falco (05:03):
Yeah, no, the other big.
You know there's cataracts thatalso can come earlier with
diabetics than non-diabetics,and all of those are pretty
treatable.
The one that is that you reallyhave to look out for is called
diabetic retinopathy.
So the eyes are amazing.
It's like one of the few placesyou dilate the pupils, you look

(05:25):
at the back and you're lookingat the microvascular.
You're able to visualizearteries and veins in basic in
their natural habitat withoutbeing very invasive.
And whatever you're seeing inthe back of the eye you have to
understand is what the rest ofthe body is looking like.
You just can't see it.
But we get a window in,literally through the pupil and

(05:48):
we examine the back of the eyeand patients who have
uncontrolled diabetes and havediabetic retinopathy have a lot
of changes back there.
And then we sometimes that'show they're diagnosed because
they don't even know they haveit.
But it's very important becausethat's where you can really
have permanent vision loss.

(06:09):
That's not correctable anymore.
So you know, just to like kindof summarize, diabetes
management for the patients isdefinitely a team approach.
It's not just me, it's not justan ophthalmologist, it's not
just an endocrinologist, it's comanaging these patients with
the primary, if that's, you know, to keep them abreast the

(06:30):
endocrinologist, a nutritionist,for a lot of patients because
the root cause is being obese,and then the ophthalmologist,
when it's getting to a pointwhere they need treatment
because of what we're seeing inthe back of the eye for the
diabetes, and it is, it'sbasically communication.

(06:50):
The patient has to understand.
The patient has to come in, youknow, and and realize that this
is there's a group of us whocan manage, you know.
There's wound care also, to behonest, podiatry and wound care,
because they can have, they canhave um sores, you know, and
and neuropathy.
So it's a big issue.
It's affecting a ton of people.

(07:10):
There are newer technologiesthat patients are using to keep
it under control, because ifyour diabetes is under control,
then all these other sideeffects, you know, all these
other sequela they don't happenas frequent or as severe.
So there's something calledcontinuous glucose monitoring.
So a lot of people are nowwearing glucose monitors, which

(07:34):
is a huge improvement, and ontheir smartphone there's an app,
so they're not guessing.
If their blood sugar is inrange, they know, and they can
keep it in range and take theirmedication when needed, or if
their blood sugar is going toolow.
That can actually be moredangerous than blood sugar going
too high for a lot of patients.

(07:55):
And they can make.
They can have a little orangejuice, they can have a little
candy just to make sure theirsugar is staying in the right
zone.
So there's a ton of um.
There's a ton of thingspatients you know can do, but
they have to come in, be seen,be monitored and everybody has

(08:16):
to have open communication toall the doctors who are managing
these patients for thesepatients to have the best
outcome.

Jeremy (08:23):
Absolutely, and I think the one message I'd like to give
everybody out there is takecare of yourself right.
Exercise, eat well, get seenfrequently, monitor your
condition, because it's so mucheasier to address a lot of these
issues before they become majorissues.

Dr. Falco (08:42):
Exactly.
I mean, like you said, the bestthing you could do is move.
The best thing you could do iswatch what you eat and move your
body.
I know that these newmedications that a lot of
patients are using that's goingto be approved for obesity in
addition to diabetes are workfor some patients and they're

(09:03):
helping people lose the weight.
But the reality is you have tochange your lifestyle, because
when you're no longer on thosemedications, how are you going
to prevent that from happeningagain?
And so it's hard.
We've been conditioned to takea pill and just continue to do
what we want to do, but thereality is, with this condition,
that's not a great plan.

(09:24):
It's a lifestyle and it'schanging eating habits and it's
moving physically.

Jeremy (09:31):
Yeah, for sure.

Dr. Falco (09:32):
Yeah.

Jeremy (09:34):
Right, very interesting stuff.
We could probably talk forhours upon end about this topic,
but we'll get into a little bitmore with Dr Nguyen, 100%.

Dr. Falco (09:44):
Right Dr.

Jeremy (09:45):
Falco always a pleasure.

Dr. Falco (09:47):
Good to see you.

Jeremy (09:49):
All right.
Likewise, and thanks to ourlisteners for tuning in and we
will catch you on the nextepisode of the Jazzy Eyes
Podcast.
Everyone, have a great day.

Speaker 1 (10:00):
Thank you for listening to the Jazzy Eyes
Podcast.
For more information, visitjazzyeyescom or contact
954-473-0100.