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1st setback

B

BOWENI

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Hi all, I received my first setback this week (after 5.5 years of being diagnosed type 1) when I got my annual eye screening results in the post. There was one ominous line which read......'your results show early changes in your diabetes (retinopathy) which do not require any treatment at this time'............ I really do not know how concerned to be! My hba1c has never been above 6.1. I do admit to my night time control not being as tight as i would like it to be due to my tendancy to eat/nibble prior to going to bed. I guess this is the kick up the backside I deserve. I would welcome any replies from anyone who has been where I am now.

thanks, Ian.
 
Hi

Firstly, for an insulin dependant diabetic your hba1c is very very good. In fact you are controlling your bg levels so very tightly that you have an a1c identical to a person who isn't diabetic.

I'm not sure why you have been told that you have some background retinopathy, a possibility could be because you are being too tight with your levels. I would go and see a dsn at either a hospital or your surgery and get them to discuss with you what to do. An optician may also be able to look at the back of your eyes and put your mind at rest.
 
Normal non-diabetic HbA1c is 3.5-5.5%, sorry. Assuming that the screening was done by an Ophthalmologist I don't think that seeing an optician would be particularly helpful either.
Furthermore, all diabetic complications are ultimately due to damage to blood vessels because of high blood glucose (in particular, diabetic eye disease); the various BG and HbA1c guidelines are a compromise between lowering the risk of such complications and the increased risk of severe hypos and hypo unawareness (sanity check: healthy people have even tighter control and don't get diabetic eye disease)

Personally I wouldn't worry too much - you are already doing everything you can, and the prognosis is presumably good if it's caught early enough (otherwise there wouldn't be much point in doing annual tests)
 
AMBrennan said:
Normal non-diabetic HbA1c is 3.5-5.5%, sorry. Assuming that the screening was done by an Ophthalmologist I don't think that seeing an optician would be particularly helpful either.
Furthermore, all diabetic complications are ultimately due to damage to blood vessels because of high blood glucose (in particular, diabetic eye disease); the various BG and HbA1c guidelines are a compromise between lowering the risk of such complications and the increased risk of severe hypos and hypo unawareness (sanity check: healthy people have even tighter control and don't get diabetic eye disease)

Personally I wouldn't worry too much - you are already doing everything you can, and the prognosis is presumably good if it's caught early enough (otherwise there wouldn't be much point in doing annual tests)
Click to expand...

Hi

Before I got myself onto an insulin pump I discussed what a healthy hba1c should be and my consultant who is the National Clinical Director for Diabetes informed me that a non diabetic a1c can be anything between 4.6 - 6.4%. For insulin dependant diabetics they should try ideally to be between 6.5 - 7.0% so that as you say they can keep complications at bay and at the same time retain their hypo awareness.

Lots of people do develop some blood vessel changes to the back of the eye when they get elderly and no they are not diabetic.
 
Thanks everyone for taking time to reply. I tend to go along with the theory that healthy people have tighter control and thereby don't get diabetic eye disease, hence I am still convinced that my slack evening control is the culprit here.... (regular morning BG readings in double figures). I will let you know how I get on with my gp and dsn later in week (where I also intend to discuss the use of supplements).

Thanks again
 
Whilst you have an excellent HbA1c, it is in fact the ups and downs that cause as much damage as long-term high levels. I've had that confirmed by my opthalmologist - an old friend who was type 1 long before me told me that many years ago, and when I was diagnosed, I wanted to know. An Hba1c only gives the average result. Also some of us will never get any complications, and some of us will - no matter how good and stable our control is. So in a way it's a game you can't play because there isn't a level playing field. I wouldn't beat yourself up about it, perhaps just take it as a sign to stop snacking before bed - it sounds like you wanted to anyway :) or - force yourself to have some extra insulin with your snacks? I know it's easy to say "Oh it won't hurt, oh it'll be fine", I do it too.
 
iHs is quite right. Non-diabetics do get the kind of minute retinal changes described in bowen's letter from the eye people. And these can also go away again - I've had them appear and disappear.

Just one thing; might be worth checking what's going on at night before stopping snacking before bed. It could be that the morning higher levels are actually a result of a night hypo (the somogyi effect, which I know is contested, but I think it's still worth considering). Since your hba1c is so low, you may well be having hypos without symptoms waking you. Might be worth checking your basal insulin is at the right level, perhaps doing an early morning blood sugar (3am) to see what's going on?
 
Snodger said:
iHs is quite right. Non-diabetics do get the kind of minute retinal changes described in bowen's letter from the eye people. And these can also go away again - I've had them appear and disappear.

Just one thing; might be worth checking what's going on at night before stopping snacking before bed. It could be that the morning higher levels are actually a result of a night hypo (the somogyi effect, which I know is contested, but I think it's still worth considering). Since your hba1c is so low, you may well be having hypos without symptoms waking you. Might be worth checking your basal insulin is at the right level, perhaps doing an early morning blood sugar (3am) to see what's going on?
Click to expand...

Good advice.

Ironically, your eyes can get worse as your hba1c improves (or so I was told when it happened to me), but then they can recover. So stick with it and try not to worry.
 
Thanks again everyone for your replies. My gp gave me a copy of the screening results yesterday which confirmed background retinopathy in my right eye. She just said that although I was diagnosed 5 years ago at 42, the damage is probably compounded by the prior undiagnosed years when my insulin levels were presumably already failing. She just said it is one of those things which is unpreventable and just to look after my blood pressure, cholestral and BGs. A rather simplistic response I thought.
I have lost count of the number of 3.00am tests I have done and they all tend to show a gradual increase so I think I can safely discount the night time hypo theory. If I am honest with myself I reckon I have been yo-yoing and snacking more than I would like and just need to focus harder on keeping my levels in check 24 7. Not easy, as we all know.
Thanks everyone.
 
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