Improved HBA1C and eye damage

[AJLang]

My pump nurse is lovely but warned me today that I must not improve my HBA1C too quickly because it will cause eye damage. Why is this?

 

[Northerner]

My pump nurse is lovely but warned me today that I must not improve my HBA1C too quickly because it will cause eye damage. Why is this?

I have heard this before. A big plunge in your HbA1c can be a shock, particularly to your microvascular system so it's preferable to bring it down gradually if possible. I think your pre-pump HbA1c was quite good though, so I don't imagine it will fall too far, too quickly - not like going from a 10 or 11% to a 6.5% in the space of a few months, for example. I can see you achieving perhaps a 1% drop?

 

[AJLang]

Thanks Northener. A 1% drop is exactly it ie from 7.9 to 6.9 HBA1C but she seemed to think that was too much and suggested 7.5 to begin with. I guess that I will be happy with the 7.9 average that I've had for the past week and try not to improve on that for a while.

 

[trophywench]

I wouldn't actually worry about your A1c too much Amanda. Mine improved drastically really immediately after getting him, but I think you do pay a lot more attention to accuracy, don't you? Have you found that?

Plus of course the general good effect of having the right-ish amount of basal at the right-ish times, even if you haven't got it battened down completely.

I don't know how you could deliberately stop that unless you deliberately under-bolussed and deliberately undid all the correction calculations your new meter does for you!

She's being a tad daft methinks!

Although, I've heard that about the eyes more than once.

 

[AJLang]

Hi Jenny not the first time that I've been called a tad daft. You're right it doesn't make sense to reduce the bolus or stop the improvements that I've made with my basal - that is completely intuitive after the joy of the pump giving me such better control. I think that what I will do is stop more fine tuning of the basal for three or four weeks - unless it is causing hypos and then start basal testing again after Christmas - unless my average BG goes above 8.0? Does that sound like a plan with regard to the eyes?

 

[bennyg70]

Heard this a few times and have possibly experienced it.

My HBA1c was 8.3 in June, and i was told there was protein in my urine and had high blood pressure. I tightened up on everything and most recent HBA1c was 6.4. However I went for retinopathy test a week or two ago and some vessell changes have been seen and I need referal (Still waiting fo rthe letter) I had been warned about it on another forum and when researching after I think its a fairly common thing. When I spoke to the national eye screen service (A doctor) I asked her about this and she told me that yes it is true that it can have an effect, but in the long term its obviously better to have a lower hba1c.

Its something to do with because more oxygen can now get to the eye due to lower glucose levels suddenly the eyes try to repair themselves by growing new weaker unwanted vessels thinking they are being clever. And this si the last thing we want.... Its what Ive been told / read up on anyway...

 

[AJLang]

Hi Benny thanks very much for this explanation. I hope that they are able to sort out your eye problems ok

 

[liam]

eye damage

Hi there

This is an issue that is on-going. I have type 1 and have had extensive treatment for retinopathy (diabetic eye disease). The 2 consultants involved in my care (eye and diabetic) both say that the reasons behind this phenomenon (sudden improvments in BS and retinopathy risk)is still under investigation. The eye and diabetes involves issues with bleeding vessels and treatments are relatively new. I had extensive laser treatment 10 years ago and I am the first genertaion of younger diabetics who doctors will study into old age with treated diabetic eye disease. The eye shape changes with diabetes and there is some medical thought that sudden alteration of blood sugars may cause retinopathy. When you go hypo you have blurred vision because the lens in your eyes changes shape and if you have had higher blood glucose readings and then suddenly have low ones the eye seemingly cannot cope with this. As many of the posts say going gradually seems to be the key. If you have had higher readings than you would want try a sliding scale. For example if currently between 7 and 15, go for 7 and 11, then 6 and 10 etc. Sometimes we have to accept that we know things happen with diabetes and it may be some time before we understand why? Hope this helps and your nurse sounds very informed.

 

[everydayupsanddowns]

Amanda - if you are concerned, might you simply (ha!) raise your target BG on the pump slightly - so that you aim for 7.5 or 6.5 rather than 5.5 ( or whatever the midpoint of your current target range might be. Then try your best to stay within a tight margin around that higher average?

Certainly one protein connected with eye changes responds well to a tight range, even if at a higher level

 

[Josco]

I have had personal experience of what your nurse warned you about. At the time I had background retinopathy as would be expected for someone who has had diabetes for 17 years. For some reason, never figured out by any of the doctors, I had a vitreous haemorrhage. I got such a shock that I immediately tightened up my diabetic control. No one warned me of the possible consequences unfortunately and when I had a check up the following month after laser treatment for the haemorrhage I was told that I now needed laser treatment to my other eye. I was really upset and the ophthalmologist made a throw away comment about that happening if control is suddenly improved. In fact I had a total of 7 haemorrhages over the next two years affecting both eyes (thankfully never simulataneously) and 6000 laser burns. The laser treatment saved my sight. But when I started carb counting nearly four years ago I set my target BGs high then gradually reduced. Much to the horror of the diabetes team (and me!) my BGs were between 25 and 30 as they tried to find the right ratios etc. so my initial target BG was 10 then 7 and eventually I had the courage to go for 5. I did avoid further deterioration of the proliferative retinopathy thankfully. The thing is I had no significant changes before suddenly improving control and within months had proliferative retinopathy so just take things easy and all should be fine. I would be glad if my DNS gave me such good advice 🙂

 

[liam]

Hi Mike

What is the protien connected with eye damage? Very interested. I have not had any treattment for ages and have had other issues - high BP and kidney function worries so not having discussions about my eyes as they are now thankfully looking stable thanks to the laser treatment. I have had the same results for 3 years now with no changes in eye presentation but anything that improves my understanding is welcomed. You sound like you have good knowledge.

 

[m1dnc]

Funnily enough, the opposite has happened to me. Which shows, yet again, that this D business is not always as it should be.

At my annual retinal scan last year, some abnormalities showed up and I went to see a Moorfields consultant. He didn't think treatment was needed then, but booked me in for a check-up 9 months later. I told him that I was getting a pump but he didn't give me any particular warning.

I duly started the pump and my HBA1C dropped dramatically to 6.7. I went back to the eye consultant for the check-up and he found that the retinal abnormalities had cleared up. He was very pleased -as was I. He put me in for another 9-month check-up so we'll see what happens next time.

 

[bennyg70]

Funnily enough, the opposite has happened to me. Which shows, yet again, that this D business is not always as it should be.

At my annual retinal scan last year, some abnormalities showed up and I went to see a Moorfields consultant. He didn't think treatment was needed then, but booked me in for a check-up 9 months later. I told him that I was getting a pump but he didn't give me any particular warning.

I duly started the pump and my HBA1C dropped dramatically to 6.7. I went back to the eye consultant for the check-up and he found that the retinal abnormalities had cleared up. He was very pleased -as was I. He put me in for another 9-month check-up so we'll see what happens next time.

Thats excellent.
Its funny because I got hounded on another forum. Ive experienced both scenarios. exactly the same as you a couple of years ago when some abnormalities were found, It scared the life out of me so i suddenly tightened up and within 6 months during regular 1 monthly checks it gradually cleared up to "reversed". I told some people this on the forum and I debated with a few when theyd had the opposite happen, which didnt make any sense to me. Low and behold (After letting by sugars and control slip) I have a few kidney function problems, so decide to take a tight control (For good this time!!) but it seems to be to the detriment of my eyes.... You just dont seem to be able to win sometimes!!

 

[AJLang]

Thank you everyone. There doesn't seem to be a consensus although it does seem to be towards improving control too much might cause an eye problem. I will think about what everyone has said and then review my mid point target. Thank you for all of your help.

 

[everydayupsanddowns]

Hi Mike

What is the protien connected with eye damage? Very interested. I have not had any treattment for ages and have had other issues - high BP and kidney function worries so not having discussions about my eyes as they are now thankfully looking stable thanks to the laser treatment. I have had the same results for 3 years now with no changes in eye presentation but anything that improves my understanding is welcomed. You sound like you have good knowledge.

Hi Liam

Just something I remembered from John Walsh's 'Pumping Insulin' which I read before starting on a pump.

He is commenting on some results from the DCCT study (Diabetes Control and Complications Trial) which seem to indicate the value of tight control as well as lower A1c. In 'traditional' vs 'intensive' groups (ie 2 injections a day vs MDI or pump) there were significantly fewer retinopathy outcomes per 100 patient years (22 vs only 8) for the 'intensive' group where patients had exactly the same A1c of 9%

One explanation is that 'intensive' control (MDI or pump) tends to result in reduced glucose variability - a narrower range of results. Levels of protein kinase C beta (PKC-beta) which is believed to cause retinopathy and vascular disease were even shown to be 80% higher where BG was swinging from 5-20mmol/L rather than kept constantly at 20mmol/L!

Now that's not to say that 20mmol/L would do you any favours... but it's an important reminder that it's not quite as simple as 'lower is better'.

 

[liam]

Thanks Mike

Its interesting that - I remember a nurse who I worked with as a social worker with older people saying this to me. I didn't let on I was diabetic but she said that carers needed to know that swings in BS were the problem not necessarily slightly higer BS than normal. I find that if my BS are between 6 and 8 I am better than 4 -5. My DN also says they are now recognising that not every1 has a BS between 4 and 7 pre-diabetes or in the geenral polpulation so to make it go down this low isn;t necessarily appropriate anyway. I work on my daily BS as this is a realistic goal - I find trying to predict HbA1c can be demotivating so I focus on daily improvments. It seems to work better. Thanks again for this info.

 

[liam]

Thats excellent.
Its funny because I got hounded on another forum. Ive experienced both scenarios. exactly the same as you a couple of years ago when some abnormalities were found, It scared the life out of me so i suddenly tightened up and within 6 months during regular 1 monthly checks it gradually cleared up to "reversed". I told some people this on the forum and I debated with a few when theyd had the opposite happen, which didnt make any sense to me. Low and behold (After letting by sugars and control slip) I have a few kidney function problems, so decide to take a tight control (For good this time!!) but it seems to be to the detriment of my eyes.... You just dont seem to be able to win sometimes!!

Hi Bennyg

I know that feeling 'you can't win' and its hard to pick yourself up some times when you get it! Sounds like you have got good control back - this issue with eyes is very hard to manage or know what to do for the best. I have developed kidney function issues after 8 years of laser treatment for retinopathy in both eyes. There is unfortunately a known connection between eye and kideny damage (sorry if you know this already) and some people who get improvment in one can get symptoms in another. I don't know whether you are a sceptic in terms of natural appproaches? I am great fan of the food hospital!! Since getting retinopathy I have eaten blueberries everyday (apart from when supply runs out) and I do think this has had an affect. My eye consultant is sceptical but my 100% clear up seems unexplainablle as I have not managed to get toght control consistantly yet though do my best. Blueberries have an enyme known to help with cardiovascular problems and there was a strange case of a man after the war who cured himself of blindness using bilberry (same enyme I think?) Something to maybe consider? I donlt know whether your consultant has mentioned asprin as a possible treatment either? It is now not generally used to prevent heart disease in diabetics but it is still recommended to reduce or slow down retinopathy. I take asprin for retinopathy now. Hope you get on top of your retinopathy take care and mind how you go.

 

[bennyg70]

Hi Bennyg

I know that feeling 'you can't win' and its hard to pick yourself up some times when you get it! Sounds like you have got good control back - this issue with eyes is very hard to manage or know what to do for the best. I have developed kidney function issues after 8 years of laser treatment for retinopathy in both eyes. There is unfortunately a known connection between eye and kideny damage (sorry if you know this already) and some people who get improvment in one can get symptoms in another. I don't know whether you are a sceptic in terms of natural appproaches? I am great fan of the food hospital!! Since getting retinopathy I have eaten blueberries everyday (apart from when supply runs out) and I do think this has had an affect. My eye consultant is sceptical but my 100% clear up seems unexplainablle as I have not managed to get toght control consistantly yet though do my best. Blueberries have an enyme known to help with cardiovascular problems and there was a strange case of a man after the war who cured himself of blindness using bilberry (same enyme I think?) Something to maybe consider? I donlt know whether your consultant has mentioned asprin as a possible treatment either? It is now not generally used to prevent heart disease in diabetics but it is still recommended to reduce or slow down retinopathy. I take asprin for retinopathy now. Hope you get on top of your retinopathy take care and mind how you go.

Cheers Liam,

Ive read about the bilberry and blueberry things a few times, as supplements. Maybe ill take as a precaution. Its all a bit unknown at the moment... Ive been diabetic for 20 years, all all i get told is, well we expect to see reductions in kidney function after that long or things like that! Im waiing on my retinopthy referal so will update when Ive been. Ive certainly not experienced any issus with my eyes, apart from Ive had bad eye sight since a kid. So fingers crossed. And with the kidneys, Im told my function is fine, and my ultrasound came back ok, but im leaking a bit of protein and it was a marker that something could happen if I dont take a grasp of things. Ive been put on losartan so hopefully this should help!! Keep in touch pal and hope you keep on top of it all!