From Louisiana, USA:
My son was diagnosed with Type 1 diabetes at 25 months of age with a A1C of 14.9. He is now 5 years and 1 month. He also has an ANA of 695 plus several other autoantibodies. He is being followed by a nearby Children's Hospital.
He has had yearly dilated retinal exams since he was 3 years old by a pediatric ophthalmologist. His eye exam recently showed dilated retinal blood vessels and increased tortuosity. Our doctor says that this is very unusual in a child his age and is seen before diabetic retinopathy. Help! Is any one familiar with the scenario or has any information regarding prognosis? His current A1C is 6.9. I don't know if I can get any tighter control. We already give glucagon frequently. I saw the report of the Swedish study in the April, 1997 issue of Diabetes Forecast. Any information or insight would be greatly appreciated. We are seeking a second opinion from a retinal specialist soon.
Diabetic retinopathy is extremely rare prior to puberty. It is generally believed that in patients with type 1 diabetes the blood-retinal barrier remains stable until puberty, achieving a maximum of efficiency and protection. Retinopathy is usually diagnosed at a mean age of 15 years, after a mean duration of diabetes of 9 years.
The presence of retinopathy is usually associated with the long-term diabetes control, duration of diabetes, age and albuminuria. The initial signs of retinopathy are microaneurysm(s), hemorrhage(s), and IRMA lesion(s). Fluorescein angiography is able to detect capillary dilation, fluorescein leakages and smallest microaneurysms. Fundus photography is far more reliable than ophthalmoscopy in detecting early retinopathy and nearly equivalent to fluorescein angiography. Retinal vasodilatation has been shown in diabetic children and adolescents (Falck and Laatikainen, 1995) to be associated with chronically elevated blood glucose level; according to this report, the superior temporal vein dilated more than the inferior temporal vein, and signs of early retinopathy developed more often in the eyes with venous dilation (6 of 18 eyes) than in those without (3 of 24 eyes), but the difference did not reach statistical significance.
Vasodilation and increased tortuosity of retinal vessels are observed more frequently in hypertension, and it must also be excluded as a congenital trait.
Additional comments from Dr. Quick:I agree with Dr. Songini: It doesn't sound likely that your son's eye problems are due to diabetic retinopathy, based on his young age, short duration of diabetes, and excellent blood sugar control.
Original posting 21 Sep 1998
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:08:58
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