Background retinopathy

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Paula1158

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Type 2
I am type 2 and been diagnosed approx 8 years, take metformin, sitigliptin and dapagliflozin. For the past 4 years my Hba1c has been stable at 57 every year, my BP is perfect (take ramipril) and on my last check about 7 months ago my cholesterol was within a good range. I've just had my results of eye screening and have been told I have background retinopathy that doesn't require any treatment. My question is if I'm managing my blood sugar, BP and cholesterol, why has this happened and what can I do to stop any progression or is that inevitable? My next check up isn't due until July and they are already running behind so I'm unlikely to be able to bring my appointment forward to discuss with my diabetic nurse.
 
Paula1158 said:
My question is if I'm managing my blood sugar, BP and cholesterol, why has this happened and what can I do to stop any progression or is that inevitable?
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I don't think we know what caused it. Keeping HbA1c and BP (and cholesterol) under good control reduces the risk but probably not to nothing.

Perhaps 57 is just high enough that that could be considered the important risk factor? It's still pretty good.

Provided your results are R1M0 (so still no more than annual screening) I wouldn't worry too much (mine have been that for decades). If you can reduce your HbA1c further that would surely reduce the risk of progression further. And it's possible that even the mild background retinopathy will disappear.
 
Paula1158 said:
I am type 2 and been diagnosed approx 8 years, take metformin, sitigliptin and dapagliflozin. For the past 4 years my Hba1c has been stable at 57 every year, my BP is perfect (take ramipril) and on my last check about 7 months ago my cholesterol was within a good range. I've just had my results of eye screening and have been told I have background retinopathy that doesn't require any treatment. My question is if I'm managing my blood sugar, BP and cholesterol, why has this happened and what can I do to stop any progression or is that inevitable? My next check up isn't due until July and they are already running behind so I'm unlikely to be able to bring my appointment forward to discuss with my diabetic nurse.
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Some people will get that result but at the next check it will be all clear, however you are still a way into the diabetes zone so doing as much as you can to reduce your HbA1C will reduce the risk.
 
Thank you, that's reassuring and I will try harder to reduce my numbers - I did see a dietician in Nov 2023 but didn't find her particularly helpful.
 
Bruce Stephens said:
I don't think we know what caused it. Keeping HbA1c and BP (and cholesterol) under good control reduces the risk but probably not to nothing.

Perhaps 57 is just high enough that that could be considered the important risk factor? It's still pretty good.

Provided your results are R1M0 (so still no more than annual screening) I wouldn't worry too much (mine have been that for decades). If you can reduce your HbA1c further that would surely reduce the risk of progression further. And it's possible that even the mild background retinopathy will disappear.
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Thank you, I thought that once the damage is done, it's done so that's reassuring. I will try to reduce my numbers. Its difficult when they only test you once a year to know if changes you're making are actually making a difference.
 
Paula1158 said:
Thank you, I thought that once the damage is done, it's done so that's reassuring. I will try to reduce my numbers. Its difficult when they only test you once a year to know if changes you're making are actually making a difference.
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Many people buy a home blood glucose monitor to give them control over managing their condition so they are not in the dark between HbA1C tests, inexpensive ones can be bought on line. The GlucoNavii or TEE2 have the cheaper test strips.
May regard it as an essential part of managing to reduce blood glucose.
 
57 is higher than a non diabetics a1c would be, so that is likely part of why you’ve got it.

It could be that you’d have got it even with a lower a1c though, some of it is luck
 
Paula1158 said:
Thank you, I thought that once the damage is done, it's done so that's reassuring. I will try to reduce my numbers. Its difficult when they only test you once a year to know if changes you're making are actually making a difference.
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That is why many people here on the forum find it a wise investment to self fund a BG meter and test strips. Then using some strategic testing just before and 2 hours after a meal, they can see the impact that meal had on their BG levels. If that increase was more than 3mmols, then they ate too many carbs and need to reduce the carbs in that meal next time they eat it..... So if you tested before a Sunday dinner of meat, Yorkshire pudding, roast potatoes and veg and you were 6.1 and 2 hours after the meal. you were more than 9.1, you need to have less tatties or no Yorkshire pud and then test it next Sunday and if it still raises you too high reduce the carbs further.
Testing allows you to see your diabetes meal by meal. We liken diabetes without testing, to driving a car without a speedometer. You have no idea if you are sticking to the limits of what your body can cope with until you get an HbA1c that is perhaps higher than ideal and by then, you have no idea which foods caused the problem so don't know what to change.

As regards the Background Retinopathy many of us have had that letter and a year or two later we have got the all clear. I tend to think of it a bit like a bruise or small cut. You can see it for a while but as the body heals it disappears, but if you keep cutting or bruising yourself in the same place the tissue will become damaged and scar. It may not be a totally accurate analogy but that helps me to rationalize it and it certainly isn't a one way street of progression at that very low level of retinopathy, provided that you manage your diabetes and BP as best you can.
 
Lucyr said:
57 is higher than a non diabetics a1c would be, so that is likely part of why you’ve got it.

It could be that you’d have got it even with a lower a1c though, some of it is luck
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Yes, I do think I need to work on lowering my a1c. I'm going to purchase a glucose testing machine to help me have more control as advised by another member.
 
rebrascora said:
That is why many people here on the forum find it a wise investment to self fund a BG meter and test strips. Then using some strategic testing just before and 2 hours after a meal, they can see the impact that meal had on their BG levels. If that increase was more than 3mmols, then they ate too many carbs and need to reduce the carbs in that meal next time they eat it..... So if you tested before a Sunday dinner of meat, Yorkshire pudding, roast potatoes and veg and you were 6.1 and 2 hours after the meal. you were more than 9.1, you need to have less tatties or no Yorkshire pud and then test it next Sunday and if it still raises you too high reduce the carbs further.
Testing allows you to see your diabetes meal by meal. We liken diabetes without testing, to driving a car without a speedometer. You have no idea if you are sticking to the limits of what your body can cope with until you get an HbA1c that is perhaps higher than ideal and by then, you have no idea which foods caused the problem so don't know what to change.

As regards the Background Retinopathy many of us have had that letter and a year or two later we have got the all clear. I tend to think of it a bit like a bruise or small cut. You can see it for a while but as the body heals it disappears, but if you keep cutting or bruising yourself in the same place the tissue will become damaged and scar. It may not be a totally accurate analogy but that helps me to rationalize it and it certainly isn't a one way street of progression at that very low level of retinopathy, provided that you manage your diabetes and BP as best you can.
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Thank you for such a detailed explanation- no Yorkshire pud tho . In all seriousness, I will get a test machine to give me more control and understanding of how different foods affect my bg levels.
 
Paula1158 said:
Thank you, I thought that once the damage is done, it's done so that's reassuring.
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I think that was the belief some time ago. It's what I was told: that complications are inevitable, and specifically the only way to avoid retinopathy was to die before it happens. (Which isn't as pessimistic as it sounds: there were plenty of elderly people with Type 1 who hadn't developed retinopathy.)

My guess is that back then we just didn't have technology (like home blood glucose testing) that would make it possible to keep BG low enough to make a difference so the belief probably was true.
 
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