NPDR and pioglitazone and exercise

Contralto said:

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

https://www.ncbi.nlm.nih.gov/pubmed/18644073

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ringi said:

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.

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ringi said:

I don't think a normal BP monitor will pick up the short peaks of BP that are the issue.

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Contralto said:

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

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