OCT & retinal exam today: mostly good news.
in [Diabetes]
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From: Chris J. on 10 Mar 2006 00:24 I had my second recent OCT scan and retinal exam today, plus a long chat with the Ophthalmologist. In brief, my retinopathy seems to be receding quickly. The left eye shows a great deal of improvement, as do many areas of my right. The bad news is that one of the edemas is worse, and will require laser surgery. I'll be having it done on Tuesday. However, all in all I'm very happy with the results. Now, about my talk with the Ophthalmologist: He confirmed my belief that my retinopathy is most likely transient (temporary). HOWEVER, he does not believe that applies to the edemas they can cause. Those need treating once past a certain point, as at least one of mine is. As for what caused this (and thus important for newbies) he did confirm that in his opinion, the rapid decrease in my BG's was causal. HOWEVER, he feels that I'm "much better off in the long run". He said the main danger is if a condition like mine was left untreated UNTIL VISUAL PROBLEMS BECOME APPARENT. The reason is that once visual changes occur in a case like mine, they are most likely irreversible. So, he pointed out that I'm lucky I went in when I did. This tells me, loud and clear, that getting a newbie in for an exam is critical, because in many cases once symptoms occur some irreversible damage has likely been done. He most strongly recommends getting an exam within a few weeks of DX. (So, yes, I'll be continuing to post my warnings to newbies.) Regarding blood sugars: He also said there are many schools of thought as to whether a slower decline would lessen or avoid normoglycemic re-entry phenomenon. He said he does not know the answer to that one. I also asked him for specifics regarding HBA1C target levels. He said under 6 is the ideal goal, as eye damage and degradation becomes far more likly and severe as blood glucose levels increase. He also said that there are recommendations out there that say 7% is ok, but he said he doubted I'd find an ophthalmologist who thinks that. OK, no major surprises so far, but here comes a doozy: I asked him for target HB1AC's for me, personally. He remembered that I was at 5.4 after Dx. He took a look at my BG logs for that week (the week I had the test) and my one for last week. He said that most likely my A1C was already lower, and guessed around 5.0. (that was my guess, too). I mentioned that I'd been keeping my BG's up a little (90's between meals, by snacking on apricots) and he said that couldn't hurt in my case, but he wouldn't advise anyone with higher BG's to try that. I asked about lowering my BG's further, (and here comes the shock) he said he wouldn't advise it! At least not until my retinas are stable. He also said he didn't see much point in even trying, even once I was stable. My opinion is I'll leave things as they are for at least a year, and see where things stand. He didn't say so directly, but I think he was indicating that a BG change right now (in either direction) could have a negative impact. My current BG limits are under 120 at one hour, under 100 at two hours, between 80 and 90 between meals. Without the fruit snacks I've been having, my between meal bg's are in the low 70's. I'm going to ask my new GP (as soon as I find one) about reducing my metformin dose so I don't need to snack to keep the between meal BG's up. A note to newbies reading this: Please don't let my numbers bother you. I mention them here only because it's relevant, but it needs to be pointed out that apparently my diabetes (T2) is a bit atypical, so I have an easier time with BG numbers than many others do. So, all in all, a very interesting day, and one I'm personally very happy with. The fact that the retinopathy seems to be reversing delights me, as I was very concerned that it's previous rapid progression would continue.
From: bantista on 10 Mar 2006 01:25 "Chris J." <chris(a)noadress.com> wrote in message news:pb0212pimk442mrho47r0jpitmion096qa(a)4ax.com... > > I had my second recent OCT scan and retinal exam today, plus a long > chat with the Ophthalmologist. > > In brief, my retinopathy seems to be receding quickly. The left eye > shows a great deal of improvement, as do many areas of my right. > > The bad news is that one of the edemas is worse, and will require > laser surgery. I'll be having it done on Tuesday. > > However, all in all I'm very happy with the results. > > Now, about my talk with the Ophthalmologist: He confirmed my belief > that my retinopathy is most likely transient (temporary). HOWEVER, he > does not believe that applies to the edemas they can cause. Those need > treating once past a certain point, as at least one of mine is. > > As for what caused this (and thus important for newbies) he did > confirm that in his opinion, the rapid decrease in my BG's was causal. > HOWEVER, he feels that I'm "much better off in the long run". > > He said the main danger is if a condition like mine was left untreated > UNTIL VISUAL PROBLEMS BECOME APPARENT. The reason is that once visual > changes occur in a case like mine, they are most likely irreversible. > So, he pointed out that I'm lucky I went in when I did. This tells me, > loud and clear, that getting a newbie in for an exam is critical, > because in many cases once symptoms occur some irreversible damage has > likely been done. He most strongly recommends getting an exam within a > few weeks of DX. (So, yes, I'll be continuing to post my warnings to > newbies.) > > Regarding blood sugars: > > He also said there are many schools of thought as to whether a slower > decline would lessen or avoid normoglycemic re-entry phenomenon. He > said he does not know the answer to that one. > > I also asked him for specifics regarding HBA1C target levels. He said > under 6 is the ideal goal, as eye damage and degradation becomes far > more likly and severe as blood glucose levels increase. He also said > that there are recommendations out there that say 7% is ok, but he > said he doubted I'd find an ophthalmologist who thinks that. > > OK, no major surprises so far, but here comes a doozy: > I asked him for target HB1AC's for me, personally. He remembered that > I was at 5.4 after Dx. He took a look at my BG logs for that week (the > week I had the test) and my one for last week. He said that most > likely my A1C was already lower, and guessed around 5.0. (that was my > guess, too). I mentioned that I'd been keeping my BG's up a little > (90's between meals, by snacking on apricots) and he said that > couldn't hurt in my case, but he wouldn't advise anyone with higher > BG's to try that. > > I asked about lowering my BG's further, (and here comes the shock) he > said he wouldn't advise it! At least not until my retinas are stable. > He also said he didn't see much point in even trying, even once I was > stable. My opinion is I'll leave things as they are for at least a > year, and see where things stand. > > He didn't say so directly, but I think he was indicating that a BG > change right now (in either direction) could have a negative impact. > > My current BG limits are under 120 at one hour, under 100 at two > hours, between 80 and 90 between meals. Without the fruit snacks I've > been having, my between meal bg's are in the low 70's. I'm going to > ask my new GP (as soon as I find one) about reducing my metformin dose > so I don't need to snack to keep the between meal BG's up. > > A note to newbies reading this: Please don't let my numbers bother > you. I mention them here only because it's relevant, but it needs to > be pointed out that apparently my diabetes (T2) is a bit atypical, so > I have an easier time with BG numbers than many others do. > > So, all in all, a very interesting day, and one I'm personally very > happy with. The fact that the retinopathy seems to be reversing > delights me, as I was very concerned that it's previous rapid > progression would continue. > > Hello, Chris J This almost all sounds great to me. I hope the surgery is a success. I'm sure it will go fine; your doc sounds like he is pretty capable to me. But I wish you the best possible result with that. Did you happen to ask him about the insulin tie-in? That sounds like it might be involved from what you have learned. I'm sure your doc thought that normal bg is good enough, and you are operating in normal ranges these days. And you are probably correct that he wants you to be stable. I expect he'll want to monitor your eyes pretty closely for a while to make sure things are not getting worse. This is looking like it might be ok, which, I hope you know, would be a tremendous relief because I know how worried about it I am, and I know the rest of the group is surely just as concerned. Very good news. best wishes, rudy bantista(a)thuntek.net T2, last A1c 5.9, current bg 119
From: Alan S on 10 Mar 2006 03:25 On Thu, 09 Mar 2006 22:24:09 -0700, Chris J. <chris(a)noadress.com> wrote: <snipped for brevity - but read it all> >In brief, my retinopathy seems to be receding quickly. The left eye >shows a great deal of improvement, as do many areas of my right. > >The bad news is that one of the edemas is worse, and will require >laser surgery. I'll be having it done on Tuesday. Wonderful news about the retinopathy Chris, and I'll be thinking of you on Monday (Australians are ahead of the rest of the World - apart from Quentin). Thanks for all the detail. Some thought-provoking points there. On your comment on newbies, try not to scare them too much. I'd suggest a general advice to see the standard specialists - eyes, feet, heart - but watch for newbies who seem to go gung ho - like one I could name who lives in high-altitude bear country. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg -- Everything in Moderation - Except Laughter.
From: Jenny on 10 Mar 2006 09:27 Chris J. wrote: > My current BG limits are under 120 at one hour, under 100 at two > hours, between 80 and 90 between meals. Without the fruit snacks I've > been having, my between meal bg's are in the low 70's. I'm going to > ask my new GP (as soon as I find one) about reducing my metformin dose > so I don't need to snack to keep the between meal BG's up. > Chris, What are you eating????? If you are dropping into the 70s without insulin and need to eat fruit to bring your blood sugars up to 80-90, there's some question in my mind whether you are still "officially" diabetic. Though I was always told I had "mild diabetes" I was never able to get anywhere near the numbers you're posting with diet alone or with diet and metformin. Only wish insulin do I get close, but I'm still capable of missing the target. The question in my mind is this: is it possible that your diabetes really was a result of the massive infection combined with earlier weight gain and that by taking care of both you are back within normal limits? This wouldn't mean you are "cured". We all know that the diabetes would come back any time you got sloppy with the weight (or had another massive infection). But it might mean that you are, for the time being not diabetic, and that you might not have been diabetic before the infection, which would cast more light on the whole thing you've gone through this past year. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control
From: Just on 10 Mar 2006 09:37
Jenny wrote: > If you are dropping into the 70s without insulin and need to eat fruit > to bring your blood sugars up to 80-90, there's some question in my > mind whether you are still "officially" diabetic. I was dx'ed 5 years back. I take metformin now. I go upto 75 3-4 hours after any meal. If it's a low carb meal it may be earlier also (2.5-3 hours). And my one hour reading may be as high as 180-190, if I eat a high carb meal. |