1.Some patients have been tested for diabetic retinopathy, but their blood glucose is normal on annual physical exams and they deny having diabetes, why? Answer:I have encountered several patients like this in the clinic. The manifestation of diabetic retinopathy (glucose retinopathy) can be seen on fundus examination, but the patients refuse to admit that they have diabetes. Because the unit organizes physical examination every year, and the blood sugar is normal every year. In fact, the general physical examination does not completely exclude diabetes because the physical examination measures fasting blood sugar. Some diabetic patients have normal fasting blood sugar, but only high postprandial blood sugar. Moreover, most medical checkups are only done once a year, and a normal blood sugar this time does not indicate a big problem. In order to clarify whether you have diabetes, you can consider checking random blood glucose. Patients who are suspicious or have family history also need to continue to do glucose tolerance test. 2. Some patients who have been found to have diabetes for only a few months come to the ophthalmology department for fundus examination and are found to have diabetic retinopathy. Is it possible to tell that the patient has actually had the disease for a long time? Is the duration of diabetes a risk factor? A: Generally speaking, diabetic retinopathy is not present when you first get diabetes. However, as the duration of the disease increases, usually after 7-8 years, diabetic retinopathy slowly starts to appear, and as the duration of the disease increases, the lesions will become more severe. More than 70% of patients with a disease duration greater than 10 years will develop varying degrees of glycogen retinal, and the percentage will exceed 90% in patients with a disease duration greater than 20 years. In addition, diabetic retinopathy occurs early and severely in type 1 diabetes, while retinopathy occurs relatively later in type 2 diabetes. 3. Some patients say that their recent blood glucose control is quite good, around 6-7 mmol/L, but the diabetic retinopathy in the eye fundus is very heavy. Does this situation indicate that the short-term good blood sugar control has no practical significance? A: The occurrence of diabetic retinopathy is a long-term chronic process, which requires long-term glycemic control to show the effect. Some data show that for every 1% reduction in glycosylated hemoglobin HbA1C, the risk of glucose retinal development will be reduced by 21% and the risk of progression will be reduced by 43%. The development of diabetic retinopathy is an irreversible process, and with the occurrence of glucose retinopathy already, no amount of short-term glycemic control can make the lesion better, and it can only be stabilized or improved by appropriate treatment. Even so, good glycemic control can prevent the lesions from worsening too quickly. In addition, blood glucose fluctuation is also a factor in the aggravation of diabetic retinopathy. It is important not to emphasize blood glucose control and lead to too much blood glucose fluctuation, or even hypoglycemia. 4. Is diabetes combined with hypertension, hyperlipidemia and pregnancy a risk factor for diabetic retinopathy? A: There are some risk factors that can increase the chance of occurrence or severity of lesions in the glycoplegia, such as hypertension, hyperlipidemia, anemia, renal insufficiency, pregnancy, poor lifestyle habits and so on. These risk factors tend to affect the blood vessels, leading to vascular sclerosis, increased capillary leakage, etc. If blood glucose, blood pressure, and lipids are well controlled, with a healthy lifestyle and a good mindset, diabetic retinopathy may occur later and the lesions may be less severe. A person’s high metabolism and increased secretion of various growth factors during pregnancy may cause diabetic retinopathy to develop dramatically, even to the point of requiring surgery soon. Individual differences are also an important factor. Some patients develop diabetic retinopathy severely despite good blood sugar control. Some patients have not been diabetic retinopathy despite good glycemic control. Of course such patients are only a very small minority and cannot be a reason for not controlling blood sugar well. 5.What principles should diabetic patients follow in their daily life to prevent diabetic retinopathy? A: First of all, prevention should be the main focus. It is far more important to prevent the occurrence of glucose network than to treat it after it appears. Secondly, we should adjust our mindset. Diabetes is a chronic, lifelong disease, we must face the reality and learn to live with diabetes. Thirdly, we must be confident. Correct and timely intervention can make more than 90% of diabetic patients avoid blindness, and new treatment methods are emerging, as long as actively cooperate with treatment, it is completely possible to protect their vision. The fourth is perseverance. The treatment of diabetes is a long-term process, and one cannot expect to get well after a few visits to the doctor. You have to treat the control of diabetes and other related factors as part of your life, and walk and cherish it, in order to achieve good results and protect your eyesight.