Retinopathy & starting on Pump Therapy

Hi, I’ve been type 1 for 35+ years and during the early 2000s developed Retinopathy. It deteriorated very quickly and now I only have vision in one eye. I’ve been offered pump therapy but have read studies that T1D s with high HbA1 pre pump, risk destabilising their retinopathy and making their sight worse by suddenly gaining better BG control. Can anyone offer their experiences (good or bad) on starting a pump with Retinopathy and Macular issues? TIA

This did happen to me in 1980s and also observed in many participants of the DCCT studies back then, and most started with very high A1Cs (12-15), lowering A1C to 8-10 by end of study.

But you should be able to improve your bg gradually, especially with pump settings/calculations to reduce your BGs and A1Cs over more time.

Avoiding extended high bg or short time super high bg is much easier to do with pump. Ability to use different basal patterns, temp basals, extended bolus, pump suspend are some techniques that give you more options to stay in the range you want.


Maybe true, but I agree with Ponder (Sugar Surfing) that more important than a pump would be a CGM to bring down a high A1c. It could also be easier to SLOWLY bring down a high A1c with a CGM, by gradually lowering your target BG range.


Agree! CGMS along with pump, have great flexibility of keeping bgs in whatever range they want.

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I’m no eye expert and everyone is different, but let me share what I know about eyes, pumps, and CGMs:

I became a T1D at age 22 in 1972 … so am pushing 50 years. Of course, that was the POS (pee on stick) era before BGMs, HbA1C. I pretended that I was under control .… but clearly wasn’t.

15-18 years in (1987-1990, as I recall), I developed a few leakers in one eye. In that era they “carpet bombed” the perimeter of that eye with a laser to “seal” the leakers. No peripheral vision out of that eye, crappy night vision, but I can still see out of it a bit.

From that time until about 2013, my A1C bounced around between 10.2 and 8.5, but, luckily my eyes have been pretty stable.

In 2013 I started on CGM, and 18-24 months later started on a pump. My A1C has gradually dropped to 7 and my TIR is now about 80-85%.

During that slow, gradual improvement, I’ve seen no nagative eye effects and am sufficiently stable that I only see my Ophthtamologist once per year.

This year, after he pronounced my retinas “rock stable”, he commented: “You wouldn’t believe how many of my patients on pumps and CGMs have stabilized their retinopathy …”. This is a guy who spends his day treating diabetics with retinopathy.

I was very happy with the choice of starting with CGM and then after a year or so, moving to a pump. And that approach is likely to result in nice, gradual improvements.

Also, I have read that rapid reductions in BG can make vision blurry because it changes the index of refraction of lens and other elements … but can/does it also exacerbate retinopathy?

I would not presume to make a recommendation to you about something as important as your vision, but I have been very happy with first starting on a CGM and then adding a pump later. Of course, many will laugh at my modest improvements with all that high falutin’ technology … but I am happy with the improvement.

Stay safe!