DAFNE and Retinopathy

I graduated from DAFNE last week, and I was advised by my DSN delivering the course that those who have undergone retinopathy should not try to attain strict DAFNE BG targets too quickly, as it could cause further damage.

I didn't pursue this further at the time, but as I have an appointment at the eye clinic next week, I would like to be as well informed as possible, in order to have a meaningful discussion with the Consultant. Could any HCP explain this further to me? Please feel free to be as technical as you want in your explanation!
Many Thanks

Richard

Hi,

I am not an HCP but I would like to contribute............

High blood sugars over long periods of time can cause retinopathy, as can just being diabetic for many years, changes are bound to happen..........at least that's what they tell us...... ...........I have some background retinopathy myself......

Another factor to consider with this and with any other micro vascular diabetic condition is the speed at which blood glucose levels change, if you were suffering retinopathy through high sugar levels, then went on DAFNE and very quickly dropped you levels, this quick change could actually cause further damage, so its important to consider slow gradual improvements when suffering from these things..........

Normal BG levels as well as steady ones are both required to have the least impact on the veins, large or small......


Thats my understanding anyway, someone may be along with a more technical explanation.............

Sorry, I forgot to say in my original post that I've had two lots of laser treatments, both for only about ten seconds, and the Consultant told me I only had a minimal leakage, which was expected in somebody who has been type 1 for 20 years as I have.

I'm just worried that in the middle of improving my BG levels, I will have to endure another round of lasering, and I guess I would like to know whether this extra need for retinopathy will signal a permanent worsening in the condition or whether through better BG control, this will diminish or indeed be reversed.

I think that minor retinopathy can be reversed if the weakened blood vessels are allowed to heal and strengthen through normal, stable blood sugars, and even so with laser treatment, but I think the use of the laser will cause some damage of its own as opposed to the retinopathy causing it........

Diabetic eye disease may worsen temporarily if someone improves their blood glucose control dramatically over a short time period. It is probably because high blood glucoses tend to lead to increased blood flow to various part of the body. Since improving control will result in reduced blood flow (a good thing in the longterm) this reduced oxygen delivery and so the affected area loses oxygen which can aggravate diabetes eye trouble. So if you have eye changes to start with they can get worse. By 12 months the good effect is outweighing the short-term bad effect. So the message is that it only affects people who already have significant changes and by 12 months the worsening effect has worn off and the trend towards progressive changes can be reduced or perhaps even reversed.
ATB
Simon

Thanks Simon. It's almost a week sice I graduated, and although I can't say all my readings are within target yet, they will most certainly be lower than pre-DAFNE, hence my concerns. Hopefully in the longer term, sticking to DAFNE principles will preclude the need for further treatment.

I hope so too.......

Well explained Simon.....

I currently have an HBA1C of 9.3% and have just graduated from the Dafne course. I have retinopathy and only sight left in one eye. I have been advised that I cannot have any more laser in my good eye so am worried as I have heard that lowering your HBA1C too quickly can cause retinopathy to worsen.
Does anyone know what the safe timescales of lowering your HBA1C are when you have retinopathy?

Hi Joanne, the trouble is that these changes aren't predictable and don't apply to everyone, I am sure your eye specialists would be pleased if you can get your HbA1c down a bit but they should probably be seeing you a little more frequently if you do manage to tighten your control. I think no-one can say for sure but if you gradually got your control tighter over about 6 months this might be a good idea.
Simon

Thanks for you quick response, Simon. I spoke with my Eye Consultant's secretary who advised me just to come for my yearly check up in August. Feel this is a bit late so will probably ask for appointment to be changed to Feb/March time for peace of mind.

Thanks for your advice. Much appreciated!!