DR without DKD is common. DKD without DR is rare. Accurate?

@MM1, @Marie20, here’s an excerpt from an abstract from:

“Beside functional and structural changes in vascular biology, alterations in the rheologic properties of blood cells mainly determines to an impaired microvascular blood flow in patients suffering from diabetes mellitus. Recent investigations provide increasing evidence that impaired C-peptide secretion in type 1 diabetic patients might contribute to the development of microvascular complications.”

I don’t believe that there is anything in our bodies that is useless… e.g. the spleen, which has been considered to have no function until it was recently found out that it is a storehouse for white blood cells and T-cells, releasing them as needed.

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This is a very interesting discussion, but I suspect that there are 2 main factors. First is the number of years since diagnosis and the quality of your control over the years. But second would simply be how good your body is at keeping those systems healthy - at repairing the damage as it is accumulating over the years.

If you have underlying issues that support or compromise those systems, the health of those systems is either maintained or it isn’t.

I passed my 35th diaversary a few weeks ago. So far, my kidney function is good (knock on wood), but then kidney disease isn’t one of the things that appears much in my gene pool (yay for me!). On the other hand, I started with very mild retinopathy about 12 years ago. For the last year, almost, I have had monthly injections for retinal edema in one eye.

As for insulin and control, I started with Humulin at the end of 1986 - never had animal-based insulin. Through unintentional cluelessness on my part (and lack of pushy doctors) until about 7 years ago, my A1c has often been between 8 and 9 over the years, occasionally higher. It’s been 7 or lower for the last few years. My edema has slowly been lessening, but my doctor doesn’t know whether the shots will continue indefinitely, or eventually become unnecessary. She says that she has seen it go both ways in different patients.

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Yes the data shows that under 7% is the key cut off for preventing complications. I really like to be lower and in the normal range.
However I spent many y ears above 7 and even 8%.
I was taking purified pork insulin until 1990 when it was pretty much retired.
At that time I didn’t know what I was doing, I relied on my doctors. I then went back and forth between humalog and novolog. And I’m currently on humalog.
I really want one of the newer ones but my insurance doesn’t want to switch me because my a1c is looking good, around 5.5%.
So I can’t really make a case for switching.
I will be asking again when I see her next time, but it’s tough to get them to consider it.

I would use lumyjev if I had my way.
Since tandem doesn’t recommend it, it’s tough all around.

It’s the one thing I don’t like about Kaiser Permanente. Mostly I’m happy with it.
My pump,supplies are reduced and I pay on the reduced amount.

Still I want to try the newer ones just to see how it goes
I researched c peptide injections and it’s not available in the us.

I used animal lente only for 20 years (poor control, but alive), and then animal NPH + Regular which reduced spikes after meals. But had eye complications about 25 years in, and many trigger and frozen shoulder complications. Then switched to pump, and human insulin with few additional complications.

My early years I was treated by non-endo. When started vision problems, was referred to retinal specialist who was surprised I did not have endo. (Pre-internet… we relied on what doctors told us.)

My all-time average is probably 7.3-7.4

Mostly high 6’s to mid 7’s, with the odd mid 6 or low 8.

This is consistent since diagnosis in 1998

23.5 years in, no complications so far, fingers crossed.

I’ve always thought of frozen shoulder as an inflammatory co-morbidity more than a complication. Or maybe that’s just my story and I’m sticking to it…. It’s Not My Fault?! | Test Guess and Go

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Yeah, it’s not a complication (generally not correlated with glucose control), it’s likely a highly co-morbid autoimmune process (also linked to thyroid immune dysfunction).

I wouldn’t be surprised if T1D who have frozen shoulder also have higher risk for additional autoimmune problems. Similarly, I would guess T1Ds with celiac and/or thyroid problems or other autoimmune disease have higher risk of frozen shoulder.

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What is the relationship between frozen shoulder and diabetes?

Last updated: Wednesday, January 26, 2005

“Individuals with diabetes are more prone to have frozen shoulders than those without diabetes. Furthermore, the frozen shoulders of patients with diabetes are more difficult to treat, responding less well to exercises and to examination under anesthesia. The reasons are not completely understood, but there is evidence that in diabetes the collagen fibers in tissues such as those around the shoulder are more extensively cross linked.”

I wrote a blogpost many years ago giving links to frozen shoulder research. “ What most doctors don’t know is that recent studies, including those led by Thomas and Yian, indicate that A1c’s are not associated with the development of frozen shoulder . These studies found that the strongest correlation for those with Type 1 was with duration of diabetes . Similarly in a Finnish study headed by Arkkila, A1c levels for the previous five years had no correlation to the onset of frozen shoulder. In fact, the Type 1 patients with frozen shoulder had a lower mean A1c than the Type 1’s without the condition.” Argh! Frozen Shoulder | Test Guess and Go

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I must be the exception. I have double the years now and no additional problems since I lowered my A1C to near normal range, 25-30 years ago (57 total years).

I have had two frozen shoulders both within a few years of each other. The first one happened about 30 yrs ago and the second one, which wasn’t as bad, happened a few yrs later. I also had problems with trigger fingers etc. In the past 25 yrs, I haven’t had those kinds of problems. I have now had type 1 for 62 yrs. My A1c’s have been in the non diabetic range for at least 16 yrs.

My sister, who doesn’t have diabetes, has also had 2 frozen shoulders.

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My father, who doesn’t have T1D, had bilateral frozen shoulder in a very similar fashion to what happened to me (mild injury, one frozen shoulder, irritation of other shoulder due to impairment of first, second frozen shoulder right afterward). I suspect that we share the same genetic vulnerability toward some autoimmune response that resulted in the frozen shoulder and may have in me also contributed to T1D (but not for him–we know that it also requires environmental triggers and likely a combination of genetic factors, so who knows).

It is pretty rare from my understanding for frozen shoulder to recur in the same shoulder, so you would expect that association to be a between person, not a within person effect, which means that on average, people who got frozen shoulder tended to have had diabetes for a long time, not that it keeps being a problem the longer you have diabetes. The correlation with duration of diabetes may just be an effect of typical age onset for frozen shoulder (after age 40) and typical diagnosis age, especially if the comorbidity is higher for those of us who have child/teen-onset T1D, for example (no idea if that’s true, but one possible explanation).

The last time I was officially diagnosed with frozen shoulder (4th time), my rheumatologist with a hint of criticism asked what my most recent A1c was. I had an endo appointment that afternoon and my A1c was 4.9. Three of my four frozen shoulders happened with A1c’s below 6. My first frozen shoulder happened after an injury. It was before I had started Lantus and my NPH control was reflected by A1c’s mostly in the 7’s. But even now with A1c’s in the “normal” range, I could never argue that I have normal blood sugars. At the same time I strongly believe that frozen shoulder is some sort of inflammatory (autoimmune?) disease process that at least for me has a beginning, middle, and end.

I had both of my shoulders go frozen at the same time, and it was a year and a half and physical therapy to get back to normal. My sugars were probably in the 7s back then.
I had also dislocated both shoulders playing sports in high school at different times.
It’s not so easy to separate the issues to pin it down.
I also have dupuytrens in my hands and feet. And I think that’s probably more closely related

Yeah I now have some sort of autoimmune inflammatory arthritis that may or may not be lupus, in addition to T1D and never fully resolved frozen shoulder. I also have what I suspect are other autoimmune mediated long term fascia problems following Epstein-Barr infection, but there’s no dx for that. It’s all enough that I consider myself to have multiple autoimmune syndrome, even though the lack of clear cut dx and the lack of formal recognition of some of these as autoimmune means I don’t technically meet criteria. And that’s the main reason I’m hyper vigilant about COVID, more out of concern of trigger further autoimmune responses than anything specifically diabetes-related.

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I just can’t figure my endo out.

Spilled a little protein 6-7 years ago. Protein was negative my next appointment and EVERY appointment since, even when off losartan.

Asks me on two separate occasions if I even WANT to be on losartan.

Says “You do not have kidney damage from diabetes.” when I asked if I had kidney problems.

But most recent appointment leaves it up to me whether I should be on 100mg losartan or 25 mg. Says 100 works for diabetics according to studies, that he was also on it (he’s also a diabetic) and that “You did have the protein before.”

What the heck? He’s using an unconfirmed blip on the microalbumin radar to justify keeping me on 100mg? After questioning whether I should be on it at all two earlier times? AND confirming that I didn’t have kidney spillage or problems?

What confuses me the most is I’ve read studies where they say not to put type 1’s on losartan at normoalbuminuric baseline because it can cause macroalbumin. Maybe i’m wrong about that and some of you who don’t spill are also on losartan?

I can’t tolerate any by meds. My pressure is low even without it but every new doctor tells me I should be on some kind of ace inhibitor or blocker. It’s like a reflex, diabetic needs an ace.

We need to find doctors who actually see us as individuals

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Every time it snows and the walk needs shoveling, I get a frozen shoulder. It happens every time. I go to the door, as I stand watching the snow falling, I scream Oh !!! After 44 years Sheryl knows that means who is shoveling the walk. Well more important she knows who isn’t. :slight_smile:

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Get a snow blower, or pay the kid down the street 20 bucks