Pre-proliferative changes

[Haleema85]

Hi Everyone, I hope you are well.
I received a lettter, post diabetic screening, saying that I need to attend the hospital to see an opthalmologist. The letter said that I have pre-proliferative changed and I am really worried now, especially as I underwent bilateral cataract surgery in 2009.
My last Hba1c was 8.3. My consultant was not struck by this as my previous readings have been similar; reading various articles I know that ideally my Hba1c should fall around the 6 mark (avoids complications). I know this is not where I should be with my diabetes and am now considering the pump. I am currently on the basal bolus regime.
Is anyone using a pump and have you noticed an improvement in your control?
Thank you
Haleema

 

[catapillar]

The pump can help with improving control, but in reality this is very much dependent on the pump user.

So, what have you done to improve control on a basal bolus regime?

Have you basal tested to check your basal dosage is doing the right job for you? Basal testing is a key part of successful pumping.

Have you reviewed your carb counting skills to make sure you are accurately carb counting? Have you reviewed whether you are on the right insulin to carb ratio for you? Again, carb counting and ensuring you're using the right I:C ratio are key for pumping.

There are things a pump can help with that you can't do on MDI - like dawn phenomenon, extended bolus and more accurate bolusing. But if you're not getting the basics of basal bolus down on mdi having a pump isn't going to change that much.

 

[saruhbeau]

I can understand why the letter worried you. I'm kind of in a similar place, I found out I have retinopathy two weeks ago but mine is proliferative and I had an urgent referral for treatment. Try not to stress, there are treatments available and it may be you don't even need treatment yet.

Getting better control is a good move to try and stop it progressing. Although suddenly getting tight control when it hasn't been great can actually make retinopathy worse so try to bring your bgs down slowly. The main thing is to try and prevent spikes and fluctuations as much as possible.

My last hba1c was similar to yours is at 8.4. I also really want to try a pump, mainly due to excessive injecting to get ok control (10 injections most days) and also gastroparesis.

Could you ask your dsn if your hospital run a libre trial? I did this and it really helped with my bg control and seeing where I was spiking. Could see I was spiking between 5 and 8am so increased my basal by a unit which really helped.

I love the libre! I would even buy a sensor if needed. @catapillar makes some great points. Worth reading think like a pancreas too if you haven't already. Good luck.

S

 

[Haleema85]

The pump can help with improving control, but in reality this is very much dependent on the pump user.

So, what have you done to improve control on a basal bolus regime?

Have you basal tested to check your basal dosage is doing the right job for you? Basal testing is a key part of successful pumping.

Have you reviewed your carb counting skills to make sure you are accurately carb counting? Have you reviewed whether you are on the right insulin to carb ratio for you? Again, carb counting and ensuring you're using the right I:C ratio are key for pumping.

There are things a pump can help with that you can't do on MDI - like dawn phenomenon, extended bolus and more accurate bolusing. But if you're not getting the basics of basal bolus down on mdi having a pump isn't going to change that much.

I went on the Bertie course about 4 years and that helped with my carb counting; had to have cataract surgery because of complications. I was guessing how much to inject prior to the Bertie course. I have stuck to taking 1 unit for every 10 grams of carbs but when I see a high sugar then I panic and over inject. I use the carbs and Cals app as well l.
My reasoning for wanting to look at the pump was that I might get better control. I just don't want to end up with major complications. It's really scared me.

 

[Haleema85]

I can understand why the letter worried you. I'm kind of in a similar place, I found out I have retinopathy two weeks ago but mine is proliferative and I had an urgent referral for treatment. Try not to stress, there are treatments available and it may be you don't even need treatment yet.

Getting better control is a good move to try and stop it progressing. Although suddenly getting tight control when it hasn't been great can actually make retinopathy worse so try to bring your bgs down slowly. The main thing is to try and prevent spikes and fluctuations as much as possible.

My last hba1c was similar to yours is at 8.4. I also really want to try a pump, mainly due to excessive injecting to get ok control (10 injections most days) and also gastroparesis.

Could you ask your dsn if your hospital run a libre trial? I did this and it really helped with my bg control and seeing where I was spiking. Could see I was spiking between 5 and 8am so increased my basal by a unit which really helped.

I love the libre! I would even buy a sensor if needed. @catapillar makes some great points. Worth reading think like a pancreas too if you haven't already. Good luck.

S

Thank you
Just try to stay on top of your sugars (I need to take the same advice) and hopefully that makes a difference for you.
I inject 4 times a day (once long acting and three times fast acting), so completely feel for you having to inject so much.
I will definately ask about the libre trial, thanks.

 

[catapillar]

I went on the Bertie course about 4 years and that helped with my carb counting; had to have cataract surgery because of complications. I was guessing how much to inject prior to the Bertie course. I have stuck to taking 1 unit for every 10 grams of carbs but when I see a high sugar then I panic and over inject. I use the carbs and Cals app as well l.
My reasoning for wanting to look at the pump was that I might get better control. I just don't want to end up with major complications. It's really scared me.

So where do you think your control isn't working at the moment? A hba1c of 8.3 is equivalent to an average blood glucose of 10.6. Where are you getting highs now? That should inform whether you need to consider changers with your insulin:carb ratio to deal with post prandial highs or maybe pre bolusing to fight post prandial highs or you might need to consider basal dose adjustments if you are having highs unrelated to food.

Again, you would need to consider the same adjustments whether youre on pump or not. A pump is just a different tool to deliver insulin. Control is really down to the individual, not the tool. It's nice to think a pump will magically improve control, but at the end of the day it's the pump user that effects diabetic control.