What is your explanation to the parents who do not want to give their child insulin injections to treat type 1 diabetes because they have heard that pills can be used to treat this condition?

Choice A reason: Cataract development is a common issue in people with diabetes due to the high blood sugar levels that affect the lens of the eye. However, it is not the primary cause of visual impairment. Cataracts cause the lens to become cloudy, leading to blurred vision, but the impact is generally less severe compared to the microvascular complications of diabetes.

Choice B reason: Exophthalmos, or bulging of the eye, is not typically associated with diabetes. It is more commonly seen in conditions like Graves' disease, an autoimmune disorder affecting the thyroid. Therefore, while it is important to be aware of various conditions that can impact eye health, exophthalmos is not a primary complication of diabetes.

Choice C reason: Abnormal metabolism in the lens can contribute to the formation of cataracts, but it is not the main reason for diabetic visual impairment. The primary issue in diabetes-related visual impairment is damage to the small blood vessels in the retina, not just changes in the lens metabolism.

Choice D reason: Microvascular changes in the eye, particularly diabetic retinopathy, are the primary cause of visual impairment in people with diabetes. High blood sugar levels can damage the blood vessels in the retina, leading to leakage, swelling, and the formation of new, abnormal blood vessels. This can result in significant vision loss and even blindness if not properly managed. Regular eye examinations and control of blood glucose levels are crucial in preventing and managing diabetic retinopathy.

Choice A reason: Neuropathies occur due to the thickening, sclerosis, obstruction, and ischemia of the small blood vessels that supply the nerves (vasa nervorum). Chronic hyperglycemia leads to damage of these blood vessels, reducing blood flow and oxygen supply to the nerves. This ischemia results in nerve degeneration, delayed nerve conduction, and impaired sensory function, which are characteristic of diabetic neuropathy.

Choice B reason: Infection in the nerves is not a primary cause of diabetic neuropathy. While infections can affect the nerves, the neuropathy associated with diabetes is primarily due to vascular complications and chronic hyperglycemia, not infections.

Choice C reason: Excessive glucose exposure to the brain and spinal cord is not directly related to neuropathy. The neuropathic complications in diabetes are due to the damage of peripheral nerves caused by hyperglycemia and vascular insufficiency, rather than glucose affecting the central nervous system.

Choice D reason: Inability to provide continuous glucose to the brain and spinal cord is not a cause of neuropathy. The brain and spinal cord typically have a continuous supply of glucose. Neuropathy in diabetes results from the damage to the peripheral nerves due to prolonged high blood glucose levels and subsequent vascular complications.