How can diabetic retinopathy progression be slowed in women?

Question

Hello doctor,

My cousin, a 38-year-old female who has had type 1 diabetes for over 25 years, was just diagnosed with diabetic retinopathy. She is very afraid that she will go blind. She doesn’t know what she can do to help control her diabetic condition and slow down the progression of the condition.Her last eye exam showed some background retinopathy with microaneurysms, but no vision loss at this time. Her most recent lab work showed an HbA1c of 8.3% and fasting blood glucose levels of around 180-200 mg/dL.She is currently on a basal-bolus insulin regimen (Lantus 14 units at night, NovoRapid, with doses adjusted to meals). Her blood pressure is controlled with Amlodipine 5 mg daily, and she is on Atorvastatin 10 mg for cholesterol.The ophthalmologist recommended laser treatment, but my cousin is unsure about its effectiveness and possible risks. She is also thinking about tighter control of her glucose to avoid further damage to her eyes.Can you tell me how she can adjust her insulin schedule to gain better control, without making herself more likely to get too little sugar in her blood?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

However, her blood sugar levels are still too high. Therefore, a slow improvement in glucose control may help slow the progression of diabetic retinopathy and reduce the risk of further eye damage over time.

At the same time, care must be taken not to make abrupt or aggressive changes which may increase the risk of hypoglycaemia, particularly in a person with longstanding type 1 diabetes.

She might want to change her insulin regimen to include a continuous glucose monitor (CGM). This would allow her to see glucose patterns throughout the day and make safer decisions in real time.

Bolus insulin doses also need to be carefully matched to carbohydrate intake and the timing of the meal. The dose of basal insulin can be titrated based on fasting blood glucose.

These changes are best done gradually, under the guidance of her endocrinologist.

Working closely with her endocrinologist to alter her insulin regimen and closely monitor her HbA1c (glycated haemoglobin) can improve her diabetes management overall in a safe manner.

She also needs to keep managing her blood pressure and cholesterol as directed, as these can also affect eye health. Stay away from packaged foods. Eat a lot of proteins.

Revert in case of further queries.

Thank you.