Retinopathy with better control?

Over the years, I’ve heard stories of people improving their control/A1c (usually T1 women preparing for pregnancy), only to suddenly find themselves with signs of retinopathy. My opthomologist mentioned the phenomenon to me a while back — just in casual conversation; I wasn’t planning to become pregnant.

Anyway, I’m curious about this, as I’ve recently gone low-carb, and my day-to-day control has improved significantly (another topic!). My A1c levels have generally been in the low 6s, so I don’t expect much change there, but I’m wondering if this sudden switch from “M & W” CGM graphs to relative flatlines is going to do something paradoxically nasty to my eyes (which were completely clear last check-up).

Not that I’m planning to go back to wacky BG swings, but … anybody have any info on this strange-sounding phenomenon?

I haven’t heard this. I believe what I’ve heard is that if one already has retinopathy and suddenly improves control, then it can cause worsening. Therefore a slower rate of improvement of A1c is recommended for those who already have retinopathy. But I find it highly unlikely that this could occur, even if you already had retinopathy, if your A1c was in the low 6’s to start with. I believe it is for those starting from higher numbers (9’s maybe).

I think it’s usually people who drop their A1c significantly who see this phenomenon.

I dropped my A1c about 4% in 3 months, a few years ago, and what was mild retinopathy very quickly turned into severe proliferative retinopathy requiring dozens of laser treatments and an invasive surgical procedure. I had never been warned that dropping my A1c so quickly would most likely lead to this.

Well, we brought a retina specialist in to talk to my support group. He is very knowledgable. His position is that you can reduce the risk of retinopathy by controlling your blood sugar, but that diabetics are at increased risk independent of their glycemic control. And that retinopathy can occur as the blood vessels in the eye grow abnormally, not because of elevated blood sugar, but because of hormone imbalances (remember that insulin is a hormone).

Thanks for this info, folks — very interesting. One thing I have noticed since improving my BGs is that my deteriorating distance vision, which I suspected was being affected by highs, has improved noticeably. I took off my glasses while cycling around the city yesterday and realized there wasn’t much difference in what I was seeing!

That was the very first thing I noticed when I tightened up my BG control after years of bad control. My distance and middle distance vision improved dramaticall, very quickly. It seems like it happened overnight but I was able to see street signs clearly from distance again. My near vision is still worsening and my nighttime vision hasn’t improved much though.

Great news, but were you previously diagnosed with retinopathy, or was this just the first time you had your retinas checked by a specialist?

Yes — I expect I’ll soon be needing reading glasses. But at least that’s not a uniquely diabetes thing!

I was inbolved in the DCCT study - This was back in 1990 - 1991 I do not know what my A1c’s were, but i am sure they were not good before the study and were greatly improved after a few months in the study and thru follow up after the study. By 1992 I had prolifis dibetic retinopathy abd in 1993 and 1994 had Victrectmy in each eye. I was told by research physicians that it was not uncommon to have rapid onset of eye complications after sudden improvements in glucose control. Fortunately a wonderful eye doctor Dr. Feman) at Vanderbilt Hospital returned my sight to me and now 18 years later no further degradation. I would not hesitate to make improvements in control - the long term complications are what we need to avoid.

This is really quite heartening news. Some, like Bernstein have long argued that you can stop and even reverse many complications. But it is entirely different to hear it directly. This really inspires us to make sure we control out blood sugars.

ps. Awesome new moniker.

I notice you said you’ve had no further problems since you had a vitrectomy in each eye.

I had one (left eye) 2 years ago, and it’s been fine since - no problems at all.

My right eye continues to be a problem, but I can’t have more laser (too much scar tissue build up already - my dr. does not want to risk causing so much it’s pulling on my retina…). I’m very much considering a voluntary vitrectomy to my right eye to stabilize it as well as my left eye has been stabilized.

I’m not sure how common it is to REQUEST a vitrectomy though, haha.