Managing Diabetes-Related Symptoms: Eye Issues and Digestive Discomfort

Q: Managing Diabetes-Related Symptoms: Eye Issues and Digestive Discomfort

Dear Miss Zhu Zhu：<br>1. <br>The acute complications of type 2 diabetes primarily include diabetic ketoacidosis and non-ketotic hyperosmolar hyperglycemia; if treatment and dietary management are not optimal, hypoglycemia may also occur.<br>2. <br>The chronic complications of typ

Symptoms such as discomfort in the stomach associated with diabetes?

Hello Doctor, my mother is 57 years old.
Last year, she was diagnosed with diabetes and has been taking insulin every morning.
Earlier this year, she developed diabetic retinopathy, which required surgery.
Recently, she has been experiencing some troubling symptoms that I would like to discuss.

She has noticed that when her eyes are exposed to light, she sees a flashing white circle in front of her eyes.
If she blinks continuously for a few minutes, the white light disappears, and she feels fine.
However, if the white light persists, she starts to feel unwell and experiences dizziness.

Additionally, she has been complaining of pain in her shoulder blades, which seems to make her feel unwell throughout her body.
She visited a neurologist in September, who found everything to be normal but advised her to avoid overexertion and to apply heat to the area.

Moreover, my mother has been eating small, frequent meals, but sometimes she feels discomfort shortly after eating.
Her blood sugar levels have been in the sixties and have not dropped below 60.
She feels better after vomiting and finds relief after passing gas or having a bowel movement.
Last year, she underwent an endoscopy, which showed no significant issues.

What tests should she undergo now? Thank you.

Zhu Zhu, 20~29 year old female. Ask Date: 2016/12/13

Dr. Xiao Yongxun reply Internal Medicine

Dear Miss Zhu Zhu:
1.
The acute complications of type 2 diabetes primarily include diabetic ketoacidosis and non-ketotic hyperosmolar hyperglycemia; if treatment and dietary management are not optimal, hypoglycemia may also occur.
2.
The chronic complications of type 2 diabetes mainly involve macrovascular and microvascular complications.
The former includes cardiovascular diseases, cerebrovascular diseases, and peripheral artery disease, while the latter includes retinal disease, neuropathy, and nephropathy.
In fact, the vascular system of the human body is widespread, so the complications caused by hyperglycemia are systemic and nearly ubiquitous.
3.
Based on the above principles, prolonged hyperglycemia or poor glycemic control can lead to changes in the autonomic nervous system and gastrointestinal system, resulting in bloating and gastroparesis.
The discomfort caused by your mother's diabetes is understandable; her struggles are not easily comprehensible to others.
4.
I cannot recommend any specific tests; I only hope that you and your mother will have a thorough discussion with your attending physician to consider how to halt the progression of the disease and even explore ways to attempt to reverse it.

Reply Date: 2016/12/13

More Info

Managing diabetes-related symptoms, particularly those affecting the eyes and digestive system, requires a comprehensive approach that includes proper monitoring, timely medical evaluations, and appropriate treatment strategies. Your mother's situation, involving both visual disturbances and gastrointestinal discomfort, is not uncommon among individuals with diabetes, especially those who have experienced complications such as diabetic retinopathy and gastroparesis.

Eye Issues
The visual symptoms your mother is experiencing, such as seeing flashes of white light and subsequent dizziness, can be attributed to several factors related to her diabetes and recent eye surgery. Diabetic retinopathy can lead to changes in the retina that may cause visual disturbances. The presence of "floaters" or flashes of light can indicate changes in the vitreous gel of the eye or retinal issues. It is crucial for her to have regular follow-ups with her ophthalmologist to monitor her eye health, especially after surgery for diabetic retinopathy.
Additionally, the dizziness she experiences when the visual disturbances occur could be related to the brain's response to sudden changes in visual input. This phenomenon, known as visual vertigo, can occur when the brain receives conflicting signals from the eyes and the vestibular system. It is essential to discuss these symptoms with her healthcare provider to rule out any serious underlying conditions.

Digestive Discomfort
Regarding her gastrointestinal symptoms, the discomfort after eating, along with the need to vomit for relief, suggests the possibility of gastroparesis, a condition where the stomach takes longer to empty its contents. This is a common complication of diabetes due to nerve damage (diabetic neuropathy) affecting the stomach's motility. The fact that her blood sugar levels remain stable (above 60) is a positive sign, but it does not rule out the presence of gastroparesis.

To manage these symptoms, it is advisable for her to consider the following:
1. Dietary Modifications: Eating smaller, more frequent meals can help manage symptoms of gastroparesis. Foods that are easier to digest, such as pureed or soft foods, may also be beneficial.

2. Medication: There are medications available that can help stimulate gastric motility. Discussing this option with her primary care physician or a gastroenterologist would be prudent.

3. Monitoring: Keeping a food diary to track what she eats and her symptoms can help identify specific triggers and patterns.

Recommended Evaluations
Given the complexity of her symptoms, the following evaluations may be beneficial:
1. Ophthalmologic Follow-Up: Regular eye exams to monitor for any progression of diabetic retinopathy or other ocular complications.

2. Gastroenterology Consultation: A referral to a gastroenterologist for further evaluation of her digestive symptoms, including possible gastric emptying studies to assess for gastroparesis.

3. Neurological Assessment: Since she has experienced shoulder pain and systemic discomfort, a follow-up with a neurologist may be warranted to explore any potential neuropathic pain or other neurological issues.

4. Blood Tests: Regular monitoring of HbA1c levels and other metabolic parameters to ensure her diabetes is well-controlled, as poor glycemic control can exacerbate both eye and digestive issues.

In conclusion, managing diabetes-related symptoms requires a multidisciplinary approach that includes regular monitoring and collaboration between various healthcare providers. It is essential for your mother to maintain open communication with her healthcare team to address her symptoms effectively and improve her quality of life.

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