Does better control worsen background retinopathy?

[deelee33]

I've been lurking for a while but this is my first post -- hello! I was diagnosed with T2 in September 2018. I've read the advice on the forums about diet changes and using a meter etc (I was lucky enough to be hospitalised with hypertension and so got one prescribed) and my morning blood sugars have reduced a lot (from 11 to around 5) and my HbA1C went from 81 in Sept to 57 in Jan, and I think it will be lower again when it's checked in another month or so, as I've eaten even less sugar since a gallbladder infection.

I was feeling cautiously optimistic but then earlier this week, I read several posts about how retinopathy can get worse if your blood sugars come down too quickly, and now I'm petrified for my screening in November. My last one showed background retinopathy, but the letter said better blood pressure and blood sugar control should prevent it getting worse. (I know there are treatments if it does deteriorate, but I got into such a state thinking about them that I think I'd need extensive therapy or a lobotomy first.)

Is my sugar improving slowly enough, or is there a way I can make it more steady? Am I putting my eye health at risk by trying for tighter control each day, or is there no way to limit the potential for damage? Just when I'm starting to feel calm about diabetes, I hear something else that puts my head in a spin!

 

[Rachox]

I had a similar experience. I was diagnosed Type 2 in May 17 and retinal scan was clear. After a year I got a ‘background retinopathy’ result. I posted on this forum and got some very reassuring answers. Here’s the thread:
https://www.diabetes.co.uk/forum/threads/worried-by-my-retinal-screening-result.148002/

Edit: sorry forgetting my manners. Welcome to posting!

 

[Mr_Pot]

Are you sure you are not confusing this with the fact that eyesight can get worse temporarily with an increase or decrease in blood glucose?
Background retinopathy is not serious and can come and go even with good BG control. It is a very sensitive test with human judgement involved so in borderline cases some people examining the photographs would say there is retinopathy and some would not. It is caused by the tiny blood vessels rupturing due to high glucose levels, I can't see how lowering BG could cause it.

 

[Dark Horse]

There is useful information about sudden lowering of HbA1c here:- http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm

 

[deelee33]

I can't see how lowering BG could cause it.

There are a few threads about it on this forum and the site linked to by Dark Horse here says:

"A sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime may cause rapid and often uncontrollable retinopathy. This is a very common problem in clinical practice."

I don't know how long I have had diabetes (probably for some time) so I am worried.

 

[deelee33]

There is useful information about sudden lowering of HbA1c here:

Thank you! That is some horrifying information, wish I'd seen it sooner.

 

[deelee33]

I had a similar experience. I was diagnosed Type 2 in May 17 and retinal scan was clear. After a year I got a ‘background retinopathy’ result. I posted on this forum and got some very reassuring answers. Here’s the thread:
Edit: sorry forgetting my manners. Welcome to posting!

Thank you, on both counts! I'm not really concerned about the background retinopathy tbh, just the info that really good control can worsen it, which seems so unfair. It's heartening to hear that you haven't had that experience, though.

 

[Rachox]

Thank you, on both counts! I'm not really concerned about the background retinopathy tbh, just the info that really good control can worsen it, which seems so unfair. It's heartening to hear that you haven't had that experience, though.

Well I suppose thar remains to be seen in a couple of months when my next scan is due, but I'm optimistic that long term, I’m protecting my eyes by my strict control.

 

[deelee33]

Well I suppose thar remains to be seen in a couple of months when my next scan is due, but I'm optimistic that long term, I’m protecting my eyes by my strict control.

Yes, I know it can vary from one year to the next, and of course bringing down Hb1AC is great long-term -- just seems like doing so in the space of a few months makes complications a lot worse for some in the first year of diagnosis, which I can see from your signature wasn't the case for you. (Which is great!)

 

[Bon83]

I've been lurking for a while but this is my first post -- hello! I was diagnosed with T2 in September 2018. I've read the advice on the forums about diet changes and using a meter etc (I was lucky enough to be hospitalised with hypertension and so got one prescribed) and my morning blood sugars have reduced a lot (from 11 to around 5) and my HbA1C went from 81 in Sept to 57 in Jan, and I think it will be lower again when it's checked in another month or so, as I've eaten even less sugar since a gallbladder infection.

I was feeling cautiously optimistic but then earlier this week, I read several posts about how retinopathy can get worse if your blood sugars come down too quickly, and now I'm petrified for my screening in November. My last one showed background retinopathy, but the letter said better blood pressure and blood sugar control should prevent it getting worse. (I know there are treatments if it does deteriorate, but I got into such a state thinking about them that I think I'd need extensive therapy or a lobotomy first.)

Is my sugar improving slowly enough, or is there a way I can make it more steady? Am I putting my eye health at risk by trying for tighter control each day, or is there no way to limit the potential for damage? Just when I'm starting to feel calm about diabetes, I hear something else that puts my head in a spin!

I too got a background retinopathy letter last October- after really getting serious with bg control. I am type 1 and spent 3-6 months getting hba1c right down. I went to an optician straight away and was reminded why it's important to go. He showed me the small bleed and really explained things well. He said it will heal eventually. He also said if I hadn't got diabetes he would say get blood pressure checked. I hadn't long been for a check so knew blood pressure was excellent- always has been. Anything vision related is scary but I try to remain rational as best I can

 

[Dark Horse]

Thank you, on both counts! I'm not really concerned about the background retinopathy tbh, just the info that really good control can worsen it, which seems so unfair. It's heartening to hear that you haven't had that experience, though.

Bear in mind that when this does happen, the retinopathy only worsens in the short term. In the long term good control reduces the risk of retinopathy progression. Also, any problems are more likely to occur if the sudden improvement in control comes when the person already has quite severe retinopathy (pre-proliferative retinopathy). The chance of problems occurring in someone who is newly diagnosed with diabetes and who only has background retinopathy is likely to be small.