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Question:

From Cary, North Carolina, USA:

I am a 20 year old female with type 1 diabetes since July of 1997. I've used an insulin pump since April of 2004 and have a current A1c of 8.5. I found an ophthalmologist, whom I visited today, because I have pain/pressure/random blurry vision in both eyes.

I went in and he did a dilated eye exam and found two "spots" where he said I've had aneurysms. I was diagnosed with retinopathy at this point and asked to come back in six months. He didn't distinguish whether I have background or proliferative retinopathy. Can I work on lowering my glucose levels without having the microvascular damage progress any further? The ophthalmologist said the next step would be to do laser treatments.

I volunteer at a diabetes camp for kids and teens, so this summer I have a whole month (June) to get back on track and develop a solid (better) plan for diabetes care. I also work out quite a bit and coach gymnastics and cheerleading at a health club. Do you think modifications to my exercise (yoga/much weightlifting/gymnastics) are in order to help my retinopathy?

Also, he said I could benefit from a new contacts prescription. My old contacts I received after an exam by an optometrist last April, were of this strength: R -3.25 L -3.50. Now, my contact strengths are R -3.75 L 4.00. Is this a large change over the past year? He gave me aspheric lenses called Biomedic55 Premier. What are aspheric lenses? My previous ones are Acuvue2 and don't say "aspheric" on the box.

Answer:

Congratulations on going to the pump and setting a goal to improve your A1c. I would advise you to make your efforts at "getting on track and developing a solid plan for diabetes care", a day to day process. Our busy schedules can delay the attention we need for our health, to find a break in our lives to focus attention on those needs can delay action. I encourage you to work into your daily schedule, action plans to maintain your diabetes care "on track" on an ongoing daily basis.

Having been asked to return for another eye appointment in six months would suggest to me that you have mild to moderate non-proliferative (background) retinopathy. Proliferative retinopathy would require closer monitoring, with one to two months follow-up, or immediate laser intervention. At your next appointment, become proactive and ask all your questions before you leave the office. Your doctor should want you well informed. Lowering your A1c will slow the progression of retinopathy as well as delay or minimize the progression of neuropathy and kidney disease. Your goal should be an A1c of 6.5 or less. You would also want your blood pressure (BP) to be well controlled, as uncontrolled BP aggravates retinopathy and is a great risk for kidney disease. At your current level of retinopathy, no modification in your exercise routine is needed as it concerns your eyes. Your exercise should be planned with consultation with your diabetes team and with your overall fitness, daily blood sugar, meals and A1c in mind.

The change in your contact lens prescription is not necessarily unusual at your age and for one year's time. An aspheric lens is a lens that has a gradual change in curvature from the center of the lens to the edge, compared to other lenses not labeled as aspheric, which have a fixed radius of curvature. The aspheric design is intended to give a better fit, contouring the aspheric shape of the cornea, better vision, masking aberrations from fixed radius lenses or both.

CAG

DTQ-20050526230202
Original posting 1 Jun 2005
Posted to Complications and Exercise and Sports

  
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Last Updated: Tuesday April 06, 2010 15:10:02
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