NPDR and pioglitazone and exercise

Raghu_Nandan

Active Member
Messages
33
Type of diabetes
Type 2
Hello everyone ,
I had my Retina specialist visit yesterday and he has asked me for another round of laser in my right eye- i was not at all expecting another round laser as my glucose , BP and cholestrol control is excellent-I am following strict low carb and exercise (4 days strength training ) . My last HB1AC was 5.3 and constantly in low and mid 5's since last march . , i have NPDR and DME in right eye .. D2 currently on Amrayl 0.5 mg and pioglitazone -10 mg .
I was just reading on http://www.diabeticretinopathy.org.uk/pre-proliferative.html and it's mentioned pioglitazone shouldn't be prescribed for severe patients with DME ..
I am not sure is the pioglitazone culprit for odema and more bleeds

Also i am doing resistance exercise with Moderate weights (squats,deadlift etc) ... getting conflicting views on this , some people say shouldn't do wights some are saying we can do ... really not sure my retina doc last time said i can do exercise but this new bleeds made me doubt ..

Any help/pointers will be appreciated ..this is so frustrating ...
 

Raghu_Nandan

Active Member
Messages
33
Type of diabetes
Type 2
I was kind of reading around the website you gave. I found some useful info here, especially talking about how blood sugar control should be gradual, differences in type 1 and type 2 levels, the odd thing about deleterious effect of hypos:

http://www.diabeticretinopathy.org.uk/diabetic_maculopathy.html#targets

I notice you do not yet have the only injection I have ever had, which is Eylea, temporarily stopped until I absolutely nee them because in America they prep for what are usually monthly injections with povidone iodine to which I am allergic

There are, as far as I know, only two alternatives, i.e. the laser treatments you are having, periodically when necessary, and the injection of this tiny capsule filled with steroids that needs doing less often. I don't know the effect of having small amount of steroids in your eye once a month.

I saw the case on your mentioned website giving details on how when the pioglitazone was stopped, the macula healed. It seems they are suggesting Exenatide, i.e. Byetta, which I took for a while but stopped as the side effect of exenetide can be pancreatitus and death. So, personally I wouldn't add the exenatide

Here is the Pubmed article on the topic

Retina. 2006 May-Jun;26(5):562-70.
Diabetic macular edema associated with glitazone use.
Ryan EH Jr1, Han DP, Ramsay RC, Cantrill HL, Bennett SR, Dev S, Williams DF.
Author information
Abstract

PURPOSE: To describe diabetic macular edema (DME) in patients who developed fluid retention as a consequence of glitazone use.

METHODS: A chart review identified 30 patients who used pioglitazone or rosiglitazone and had both lower extremity edema and macular edema. Clinical reports, photographs, and fluorescein angiograms were reviewed. Patients followed for >3 months were analyzed separately.

RESULTS: Seventeen patients took oral pioglitazone, 11 took rosiglitazone, and 2 took both drugs at different times. Eleven patients were observed for >3 months after cessation of glitazones. Mean weight gain during drug administration in this group was 30 lb, and mean weight loss after drug discontinuation was 19 lb. Rapid reduction in macular edema off drug occurred in only 4 of 11 patients, but 8 of 11 had reduced edema over 2 years. Mean visual acuity in this group at the initial visit was 20/60, and at the final visit, it was 20/85. Four eyes of three patients had resolution of diffuse macular edema with improved vision after cessation of glitazones without laser treatment.

CONCLUSIONS: Fluid retention occurs in 5% to 15% of patients taking glitazones. In some of these patients, glitazone use appears to be a cause of macular edema, and drug cessation appears to result in rapid resolution of both peripheral and macular edema. Fluid retention associated with glitazone use should be considered when assessing treatment options for patients with DME, especially those with concomitant peripheral edema.

PMID:16770264
_____________________________________________________

http://www.diabeticretinopathy.org.uk/case49.html

Glitazones may increase macular oedema
Glitazones may increase macular oedema. If there is retinopathy they drugs should be stopped, and may be replaced in some patients with Exenatide or Sitagliptin. Case 49. If there is no retinopathy they will not have an effect on the retina so are safe from the eye point of view.
_______________________________________________________

Finally, look at this article on how your eyes could be helped if you discontinued

https://www.ncbi.nlm.nih.gov/pubmed/18644073
Thank You for your reply and pointing to links , i have stopped pioglitazone for now will talk to my Retina doc as i have laser session tomorrow ...
Any pointers on exercise as is this is another gray area which i come across with lot of conflicting views and studies ...personally i am 100% convinced that strength training is one of the factors which helped in controlling my overall numbers(HB1AC ,Cholesterol ,BP and overall being) but these new bleeds are making me think about strategy ...
 

ringi

Well-Known Member
Messages
3,365
Type of diabetes
Type 2
Remember that with resistance training you should train until you can't lift the weight anymore, then give the part of your body you trained at least a few days to recover. You must also breath while lifting the weights otherwise your BP will increase.
 

Raghu_Nandan

Active Member
Messages
33
Type of diabetes
Type 2
Remember that with resistance training you should train until you can't lift the weight anymore, then give the part of your body you trained at least a few days to recover. You must also breath while lifting the weights otherwise your BP will increase.
Thanks for your reply ..yeah i am following all precautions as you mentioned ..training every alternate days and also breathing while lifting to avoid spikes in BP.. should i monitor my BP while exercising ?
 

ringi

Well-Known Member
Messages
3,365
Type of diabetes
Type 2
I don't think a normal BP monitor will pick up the short peaks of BP that are the issue.
 

Raghu_Nandan

Active Member
Messages
33
Type of diabetes
Type 2
I don't think a normal BP monitor will pick up the short peaks of BP that are the issue.
so any suggestion how these peaks can be monitored i am going libre to understand BG spikes if any while exercising , need to understand for BP ... i just want eliminate all the known variables ...
 

ringi

Well-Known Member
Messages
3,365
Type of diabetes
Type 2
The only ideals I have is to lift weights that you are able to do a few reps with and to keep breathing. Outside of a medical research centre I don't think BP peaks can be monitored, as the high risk peaks will only be while lifting with the most effect. But lifting until you can lift no more reduces Inslin resistance the most of any exercise.

You may find the "Body by Science" book useful.
 
  • Like
Reactions: Raghu_Nandan

Raghu_Nandan

Active Member
Messages
33
Type of diabetes
Type 2
OK, here is what I have done when unable to normally exercise

Yoga breathing

gentle isometrics while lying flat on a mattress.

stretch bands and stretching exercises without breaking a sweat.

sitting on an exercise ball

rolling feet on plantar fasciitis roller

Basically, you are trying not to atrophy while you are recovering while retaining flexibility. You can sweat but not dehydrate. I have a scale that shows dehydration

I use a meter that has irregular heartbeat monitoring personally and since I have had a MET test (heart lung combined test), I know what my max pulse rate is before having to quit exercising for a few minutes. This pretty much correlates with the too much eye pressure situation.

Use a pulse oxymeter and use your breathing exercises to raise your oxygen levels to help healing.

Any dizziness, fractals in vision, spots in vision, etc. take your blood pressure, your oxygen and see if there is a correlation and quit when you have learned your limits

Basically, that's what I learned in physical therapy
Ok Thanks for inputs ... actually i have never faced any dizziness or other issue as such while lifting i also take 3-5 mins rest in between lifts to ensure my BP and heart rate comes down to normal and also drink lot of water in between to ensure hydration .Even for eyes i haven't noticed any blurriness apart from the usual which i have when looking long distance and some time eyes feeling watery although there is no water coming actually ...so not sure ..I am having laser for bleed after 8 months last time (which was my first) last year and also had one check up 3 months post 1st laser and all was good ... and while all this 8 months i was doing lifting ...so not sure exercise can be a culprit here or is it normal course of retinopathy which worsens while healing...