eye surgery

[cassandra]

so, the previous thread about lasik surgery prompted me to read more about diabetes related eye complications. i was just blogging around, and it seems like a LOT of diabetics that have had diabetes for say... 20 years or so, go through eye surgeries (diabetes related). Many also claim to have always had good control. Many who haven't had complications also say they expect them regardless of their control over 20 years... So, my question is... REALLY!!!??? should we just be, expecting to eventually get SOME KIND of eye problem that will have to be corrected by surgery??? ack!!!!

[Amy C.]

I think that complications can be reduced with good control, but not eliminated. It is good that eye surgery can fix the problems that diabetes brings, as an ace inhibitor can stop the kidney problems.

My son was dx'd 9 years ago and has microalbumina. We had good control by everyone's measure. When he was 3-6, his A1c readings were around 8.5, then on Lantus from 6-12, the readings were around 7.5. I couldn't get the A1c lower than that the way he was using shots, so I really pushed for the pump. Once we get the pump all figured out, I am hoping for regular blood glucose readings around 120 and an A1c of 7 or under. So far it is working. The ace inhibitor is helping, as the urine tests are a whole lot closer to normal.

I never expected this to happen, but on some folks it just does.

[rickst29]

THEN we will be able to count on avoiding those blasted capillaries going nuts.

But right now, even those of us with CGMS still spend 30-60% of time outside "normal" bG. (I'll SWAG that a typical group of T1s without CGMS would be outside of even the range 80-110 between 80% and 90% of the time. And remember, 110 is no longer considered "normal"-- it's considered "pre-diabetic".)

Although some people are luckier than others with development of complications (I am EXTREMELY lucky), spending any time at high bG does make this problem more likely. And with current treatments, all of us spend LOTS of time up there.

IIRC, you're a youngster and you've only been doing this for 10 or 15 years. If they come up with a CURE or a closed-loop system and/or even faster insulin which reduces our "high" time to nearly zero really soon, then you'll never have the risks us 'experienced' folks do.

But I know a guy who's been A1c 6.2 or less for almost 20 years straight, and even he's needed surgery. All those early years, from before we even had at-home bG testing, have taken their toll. (He's had D for 61 years!)

So I'm kinda counting on it, unfortunately.

[cassandra]

17 years... and not under 6.2 either. i guess i was surprised to read about a few people that were fairly young that had complications. i always imagined they may come when i am in my 50s or 60s, but was kind of shocked when i heard that some people see them earlier.

sorry for the not so possitive post.

[rickst29]

i was surprised to read about a few people that were fairly young that had complications.
On the other hand, a lot of those youngsters were doing the suicidal "I can eat like a pig and stay skinny by NOT taking my insulin". A friend of mine, a psychiatrist in another State, has a daughter who was doing this for years. She's real sorry NOW, but that doesn't help her physical complications. Not at all-- and in fact, the new guilty twist "I deserve this for having been such a rotten kid" creates additional psychological problems and behavioral issues.

And a lot of other youngsters didn't have parents who took care of them or taught them what to do. Not EVERY parent visits CWD, unfortunately.
- - - - -

You can't redo the past, at least not in this Universe. But if you stay tight NOW and in the future, your likely outcomes are certainly better than if you DON'T. As the song should have said, "DO worry, be happy" :D It's not a contradiction at all, life is wonderful.

[Amy C.]

On the other hand, a lot of those youngsters were doing the suicidal "I can eat like a pig and stay skinny by NOT taking my insulin". A friend of mine, a psychiatrist in another State, has a daughter who was doing this for years. She's real sorry NOW, but that doesn't help her physical complications.

But if you stay tight NOW and in the future, your likely outcomes are certainly better than if you DON'T. As the song should have said, "DO worry, be happy" :D It's not a contradiction at all, life is wonderful.

The outcomes will undoubtedly be better if you take good care of yourself. But even those who do work at controlling the sugars can develop problems. The problems may be less severe, but they can still happen.

My son is an example. We work hard at keeping his sugar under control, but he still developed microalbumnia. He never exhibited the attitude described above. I am now a nazi about keeping the sugars down and hope the pump will help.

[rickst29]

Your likely outcomes are improved by tighter control... but everyone IS unique. I'm sorry that Phillip had an unlucky roll of the dice. :(

[oldstert1]

My endo says that some diabetics are just fortunate and have good genes. I've been type 1 for going on 36 years and have never needed eye surgery. And goodness knows, the ability to treat and monitor diabetes has come quite a way since I was diagnosed in 1971. We have gone from using tablets in test tubes to check BG levels by visually matching colors to home monitors. I am always a little nervous whenever I go to the opthalmologist or have a microalbumin check and just hope for the best!! I know I've not always had as good a control as I can now with the newer insulins and home BG monitors and hope that the future will bring even better tools or even a cure:) My A1Cs generally range from 5.5to 6.0 and I do indeed have occasional hypos, but to feel good, it's worth it to me.

[cassandra]

yay. relief. i was all worried about the opthamologist appointment because i hadn't been in a while, but had it this morning, and no problems. i was all worried because i was feeling dizzy sometimes, but it is probably just because i am in a new job sitting in front of a computer 10 hours a day. blah.

[Momof4gr8kids]

Glad to hear it went well. Are you able to keep a close watch on your b/g's while at work? That is a long shift. Take care, and stay possitive! Jamie

[rickst29]

probably just because i am in a new job sitting in front of a computer 10 hours a day.
Staring at computer monitors for too long is definitely a bad thing. Be sure to look away, focus your eyes on a distant object every few minutes. Also get up and walk around, at least a few steps, every 15 mins or so.

[cassandra]

thanks:)
well, with overtime my day can get long. normally it should just be a regular 8 hour day though;)

my office is so huge that noone asks or cares about how long your lunch break is or how many bathroom breaks you take or whatever. but, i recently just got in the habit of checking my bg right at my desk. lol. i wonder if anyone has noticed me poking away. i try to be discreet... but check it all the time, so i bet some people are just pretending not to notice. :D

[rickst29]

The LONGER YOU WAIT. The better the surgery will become.

Just last night I was watching a leading researcher talk about new developments. One brand-new thing is creation of the flap itself via laser, which in his Study Trials created 50% better (less Standard Deviation in thickness variability) flap consistency than the current surgical-steel cut flaps.

Leads to better results, of course. About 2/3 of the subjects ended up at 20:15 and even BETTER. 100% made 20/20, and with WAY lower rates of side effects such as halos, etc.)

As with VisX versus the older machines without Fourier-Transform shape analysis in the controllers, it's a big improvement. And even after this, there's other things coming along, like using Iris recognition to keep the cutting laser on target better.

So I say, WAIT!

[cassandra]

oh but so tempting. but i guess my vision isn't really too bad as it is. i don't even usually wear glasses (i'm sure i should, but i am nearsighted, and since i am sitting in front of a computer all day, i see little need to see all this stuff far away). i just wear them when i drive at night. but, i feel like my vision is getting worse after this job.

isn't there some kind of special glasses to wear or screen to put over the computer screen to help absorb the stress on the eyes or something? i've heard of such things, but don't know where to look for them.

[rickst29]

are Snake Oil, worthless. (Although some far-sighted people do have a much easier time using READING GLASSES in front of the computer screen, most screens are viewed from awfully close.)

Avoid excessive screen brightness.

Look away and focus on something distant FREQUENTLY.

Every 15 minutes or so, get your butt OUT OF THE CHAIR and walk a few steps.

You theoretically could reduce the problem by using BIG screens like mine and viwing from greater distance.... but they weight over 100 lbs.

EACH. (Yeah, I've got more than one :D .)