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Question:

From New Jersey, USA:

My husband, 28, with type 1, has been a diabetic for 21 years. Recently he was diagnosed with "moderate diabetic retinopathy" after having a fluorescence angiogram. His physicians at this time says no treatment is necessary although he continues to have blurred vision in one eye. Is this the standard procedure? Also recently he has had erratic sugars and has gained weight and we were thinking of seeking treatment at the 3 1/2 day clinic at Harvard for a complete overview. Or can you recommend any other resources? Do you feel this could benefit a 21 year diabetic? These are the first signs of diabetic related complications that we have experienced and would like to get it under control as best we can.

Answer:

The first sign of complications of diabetes are always frightening, often causing patients to want to reassess the diabetes management. I don't see any reason why you should not.

I cannot comment on the exact clinical situation for your husband. I don't know the level of sophistication with which he is approaching treatment, number of shots, number of blood glucose tests, dietary treatment. These are all things your team needs to address. You may not be at maximum therapy. You need to be comfortable with the care you are receiving. If you are not, say so, and get satisfied where you are or elsewhere.

Likewise with the eyes. I don't know the level of training your eye doctor has. You might want to see a retinal specialist.

LD

Additional comments from Dr. Quick:

One specific point to be added to this discussion: if the diabetes is out of control, and rapidly brought back into tight control, it's very possible that there will be short-term deterioration in the retinal changes. This effect was seen in the DCCT and is also seen in women who rapidly tighten up their control in early pregnancy.

Fortunately, the retinal changes settle down after a few months, and the DCCT data indicated that the overall prognosis for the eyes improved after continuing on tight control, compared to the control group in that study who continued on "loose" control. But your husband, and his eye doctor, ought to be aware of this, and watching the retina regularly for deterioration. If there is deterioration, laser therapy might be advised.

WWQ

Original posting 2 Oct 1998
Posted to Complications

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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