How can diabetic retinopathy progression be slowed in women?

Question

Hello doctor,

My cousin, a 38-year-old female with type 1 diabetes for over 25 years, who has recently been diagnosed with diabetic retinopathy. She is very concerned about the potential for vision loss and is unsure how to better manage her diabetes to slow the progression of the condition.

Her recent eye exam showed signs of background retinopathy with microaneurysms, but no immediate vision loss. Her most recent lab reports showed an HbA1c of 8.3 % and fasting blood glucose levels around 180 to 200 mg/dL.

She is currently on a basal-bolus insulin regimen with Lantus 14 units at bedtime and Novorapid (doses adjusted with meals). Her blood pressure is managed with Amlodipine 5 mg daily, and she takes Atorvastatin 10 mg for cholesterol.

The ophthalmologist has recommended laser treatment, but my cousin is uncertain about its effectiveness and potential risks. She is also considering tightening her glucose control to minimize further eye damage.

Could you provide guidance on how she should adjust her insulin regimen to achieve better control without increasing the risk of hypoglycemia?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Since her blood sugar levels are still higher than the recommended range, improving glucose control gradually may help slow the progression of diabetic retinopathy and reduce the risk of further eye damage over time.

At the same time, it is important to avoid sudden or aggressive changes that could increase the risk of hypoglycemia, especially in someone with long-standing type 1 diabetes.

She could consider adjusting her insulin regimen with the support of a continuous glucose monitor (CGM), as this can help track glucose patterns throughout the day and allow safer real-time adjustments.

In addition, bolus insulin doses should be carefully matched with carbohydrate intake and meal timing, while basal insulin may need adjustment based on fasting blood glucose readings.

These changes are usually most effective when done gradually and under the supervision of her endocrinologist.

Working closely with her endocrinologist to fine-tune the insulin regimen and regularly monitor HbA1c (glycated hemoglobin) levels can help improve overall diabetes control safely.

It is also important for her to continue managing blood pressure and cholesterol as advised, since these factors can also affect eye health. Avoid packaged foods and opt for a protein-rich diet.

I hope my answer is clear to you.

Revert in case of further queries.

Thank you.