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Article Date: 11/1/2013

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Deficiencies in Diabetics
MEDICAL MODEL
nutrition

Deficiencies in Diabetics

Help identify vitamin shortcomings in diabetic patients.

images

KIMBERLY K. REED, O.D. , F. A. A.O.

Beyond stressing regular eye exams, astute clinical care, reinforcing and supporting medical control and referral to a nutritionist, we must also be mindful of the vitamin deficiencies in our diabetic patients to improve their lives.

Neglected nutrients

Vitamins D3 and B12 are often scant in diabetic patients. One study reveals type II diabetics with very low (<13.9 nmol/L) vitamin D3 levels had an increased risk of all-cause and cardiovascular mortality vs. type II diabetics with high levels. Also, low vitamin D3 (<20 ng/ml) is associated with high blood sugar spikes after meals. Further, overall deregulation in blood sugar modulation is more common in vitamin D3 deficiency, high A1C levels are evident with low D3 levels, and diabetic retinopathy patients have the lowest vitamin D3 levels vs. diabetics without retinopathy and non-diabetics.

Most experts believe adult vitamin D3 levels should be at least 30ng/mL, with 36ng/mL to 48ng/mL preferred. (Consult with a pediatrician regarding child levels.) A recent study reveals nearly half of U.S. obese children were severely vitamin D3 deficient. Finally, magnesium plays a vital role in D3 synthesis and metabolism.

Vitamin B12 plays several important roles in the body, such as energy maintenance. Metformin, a blood glucose controller, creates a risk for B12 deficiency. Although normal levels are 200pg/mL to 900pg/mL, patients with B12 levels below 400pg/mL may experience memory loss, mood and affect disorders, sleep disturbances and obsessive-compulsive disorder. (See “Anti-oxidants,” below.)

Antioxidants

Diabetics tend to have a chronically inflamed vascular system, so they may need high levels of antioxidants of various types, including vitamins C and E, lutein, zeaxanthin, resveratrol, quercetin and others, compared with non-diabetics. Fortunately, most high-quality multivitamin/mineral (MVM) supplements contain the lion’s share of these ingredients and other substances, such as alpha-lipoic acid, that play a significant supportive role in vascular health.
 If there are no contraindications to the use of a daily MVM supplement, educate patients on the potential benefit to taking one.

Your function

Recommend vitamin D3 (25[OH]D3) blood work, especially to diabetics who have not had it in the past six months. A caveat: Educate patients that many health insurance companies do not recognize diabetes as a reimbursable diagnosis for this test, so they may have to pay for it themselves. B12 should be measured at annual preventive care visits and more frequently in metformin users.

If serum D3 levels are low, supplementation with 4000 IU or 5000 IU D3 qd for two or three months is recommended, with follow-up serum level and subsequent intake modification. If vitamin B12 levels are low, supplement through capsule, liquid or weekly intramuscular injection, if absorption from GI is potentially an issue. Dosage varies widely. Advise patients to follow the label’s recommendation. OM

DR. REED IS AN ASSOCIATE PROFESSOR AT THE NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY IN FORT LAUDERDALE, FLA., A MEMBER OF THE OCULAR NUTRITION SOCIETY AND AUTHOR OF NUMEROUS ARTICLES ON OCULAR NUTRITION, DISEASE AND PHARMACOLOGY. SHE IS ALSO A FREQUENT CONTINUING EDUCATION LECTURER. TO COMMENT ON THIS COLUMN, E-MAIL DR. REED AT KIMREED@NOVA.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.



Optometric Management, Volume: 48 , Issue: November 2013, page(s): 34 35

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