Re: Chris: The Actual Data about the Relationship of Tight Control & Retinopathy
- From: Chris Malcolm <cam@xxxxxxxxxxxxxxxxx>
- Date: 11 Feb 2006 16:08:50 GMT
Chris J. <chris@xxxxxxxxxxxx> wrote:
On Fri, 10 Feb 2006 12:40:29 -0500, Jenny <lottadata@xxxxxxxxxxx>
wrote:
And even more importantly, every article you will read makes the point
that controlling blood sugar and blood pressure, over time, is the only
way to prevent blindness.
Right now, I'm more concerned with the short term, as in letting this
inflammation of the retinas subside. My concerns are whether BG's that
would give an A1C of, say, 5.2 might be temporarily less stressful
than BG's that would give a 4.9.
I might be about to spout utter bunk, but I have a theory on the
causality mechanism here. Basically, the Aqueous Humor is known to
retain glucose far longer than many other body structures. The
capillaries of the retina are in contact with this fluid. Could sudden
lowering of blood glucose levels thus result in an osmotic pressure
differential (due to differing glucose concentrations)between the
aqueous humor and the interstitial fluids and/or capillary walls, and
thus cause inflammation and leakage in the capillary walls?
Reading these threads I've been thinking the same thing. It occurs to
me that there could be two effects with different timescales. The
short term effect would be across the boundaries of the local osmotic
differences in small structures, such as capillaries. These would be
affected by post-prandial peaks. The longer term effects could be due
to average osmotic differences over enough time to saturate large
structures, such the aqueous humour. Then a sudden shift average shift
downwards after a long time of high average levels could cause the
aqueous humour (and any other large transparent structures) to soak up
water because of the persisting average difference in osmotic
pressure, which in the very tight physical structure of the eye, which
is very sensitive indeed to small changes of dimension, could cause
optical distortions and perhaps also damage from pressure and changing
sizes of structures, until the aqueous humour etc. finally settle down
at the new levels.
Based on this theory and the disappearance of my symptoms on the trip
when my Bg's were slightly higher, I was wondering if raising my PP
and between meal BG's SLIGHTLY and temporarily could thus be
beneficial. I'm talking of a 1 hour PP of 125-130 for my main meal,
and a between meal BG of around 90. This is a very slight increase,
and still within any definition of very tight control.
OK, I'll surely catch hell for this, but as stress yesterday basically
did that to my Bg's anyway, I decided to gamble and give it a shot.
This is not based on anyone's advice here, so all fault and risk is
mine and mine alone. It's such a tiny change I can't see it being
harmful, but if my wild theory is right, it might help enough to start
a reversal and avoid risky eye surgery.
There is another way you could effect this change, which is by raising
your inter-meal BG levels a little bit by appropriate grazing. That
way you could raise your average BG without raising your postprandial
peaks. Whether that matters might depend on whether your problem is
mostly microstructural or macrostructural. Your eyes, your call. I
can't give you advice, but I hope I can help you to think about
this. And congrats on having the courage of your convictions!
[Children, don't try this at home! It's dangerous. Personal
experiments are only performed in asd by seriously curious people who
are aware of the risks.]
I've tried googling and medline searches on this kind of thing, but it
looks like one of those inter-topic problems that is either not
researched, or mentioned in passing in papers that are about something
else. Quick searches aren't very productive, which is all I've time for
just now.
So you didn't screw yourself by going for normal blood sugars. You'd
have been screwed going for anything but utterly out of control blood
sugars--if, in fact, that is what happened, which I think is still
unproven.
I'm not saying that I think tight control might be bad, just that a
more gradual approach might have been a better road to it, in my case,
with benefit of hindsight, than the one I took.
You've made me think back about my own scintillating scotomas, waving
jagged flashing rainbows of light, often curved, which ripple across
bits of the retina. I used to get a minor one every few months. They
gradually increased in frequency and severity. I din't know it at the
time, but I now know that this was developing just before my diagnosis
of diabetes, when my BG levels were probably at the highest they've
ever been. They persisted after diagnosis, and then, a few months
after diagnosis, when I was well into eating to my meter, I had the
lqargest and most frightening attack, in which I felt quite ill, and
thought I was losing the sight of that eye.
But it slowly recovered completely over about half an hour, and now
nothing has happened for well over a year.
Is it coincidence that this started during my probably highest BGs,
and had a sudden very bad episode some months into seriously dragging
my BGs down, and then seems to have gone away? My doc thought it might
be. When I consulted him about the bad episode he said I should come
back and see him if it happened again after my eyes stabilised around
lower blood sugars. It did, so I didn't.
Think I might ask him to check me into an opthalmologist though.
Thanks to you, Jenny, and the others who have opened this interesting
can of worms. If my case is relevant, and you're like me, from now on
it's going to get better. Let's hope so :-)
--
Chris Malcolm cam@xxxxxxxxxxxxxxxxxxxx +44 (0)131 651 3445 DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]
.
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