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Re: [IP] Tight control + Eye problems (Was:Transitioning to pump)

At 04:49 PM 10/8/00 -0700, you wrote:
>Date: Sun, 08 Oct 2000 16:48:51 -0700
>From: "Frank W. Tegethoff, Jr." <email @ redacted>
>Subject: Re: [IP] Transitioning to pump

Thanks for the comforting picture Frank!  I was envisioning a month of
wobbly BG and hypos while getting basals right.  I suppose the low dosage
changes possible with the pump make tweaking your BG much easier than the
0.5 unit changes with needles.

>I must advise you however (and there are several members on the list to
>details) that tightening Bg control can worsen eyes.  Especially
significant eye
>complications, that you indicate.  This is something I suggest you discuss at
>length with your Endo and Opthamologist.

I'm afraid I am aware of this problem the hard way.  I tightened up my
control about 2 years ago and was getting good HbA1cs with MDI.  My eye
problems started a few months ago and pan-retinal was prescribed for both
eyes due to the start of PDR.  Macular edema was already affecting vision
in one eye and was starting in the other.  I had had no problems 8 months
previous at my last eye exam.  I am currently running my BG as low as I
feel comfortable with - 110 is my goal for the moment due to hypos if I go
lower.  Does anyone have experience with complications worsening while
going from 110-120 avg BG to 100?  Does eliminating the roller-coaster
effect make complications jump out - or is it just average BG that matters?
 I'll ask my endo this week what his opinion on the matter is, whether I
have had the worst of it yet or whether there are more "surprises" in store
for me.

I suppose retinopathy must run in my family to some extent.  My brother
started PDR treatment at 18 (he's 33 now, type I since age 4, no kidney
disease yet thank g-d).  He does not have any macular edema, thankfully,
but has had a number of vitrectomies.  I'm waiting to see if Eli Lilly's
phase III PKC inhibitor for macular edema works as advertised without
significant side effects... keeping my fingers crossed.

Dave S.

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