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Medical Forum / Diseases and Disorders / Diabetes / March 2006re-entry retinopathy
http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 1. this article indicates that the retinopathy had to have started BEFORE the bg were dropped........ NOT that the drop in bg CAUSED the retinopathy 2. further down it also indicates that normo-glycemia is indicated even in face of re-entry retinopathy...... that getting your bg down now is most important i think we should warn newbies about clouded vision or floaters in their vision, but not as a general statement about getting their bg in order  SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. > http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > [quoted text clipped - 11 lines] > vision or floaters in their vision, but not as a > general statement about getting their bg in order Soooo good Tiger <<<<<hugs>>>>> Gys > http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 <snip> > i think we should warn newbies about clouded > vision or floaters in their vision, but not as a > general statement about getting their bg in order My ophthalmologist says that floaters have nothing to do with diabetic retinopathy but are a normal feature of aging that has to do with drying up of the stuff inside the eyeball. Clouded vision is something else. What concerns me about scaring newbies with the suggestion that they're going to go blind if they lower their blood sugar is that most of us who lower our blood sugar DO experience changes in visual acuity due to the changing concentration of glucose in the eye. For people who haven't read every message ever posted here (i.e. everyone new who visits)it is all to easy to confuse this normal change in vision with something dire. Suggesting that people go to their doctors to have their vision checked after a diabetes diagnosis is one thing, telling people who have just posted proudly about their greatly improved A1cs that now they have to worry about retinopathy is another. It in 999 out of 1000 cases it is irrelevant, and for the person to whom it is relevant--the one whose doctor put them on a lot of insulin for very high blood sugars, it is probably too late. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >> http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > [quoted text clipped - 32 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control I've had floaters since I was about 9 years old. As you said, they are not related to RO. Long live misinformation on ASD. Nothing ever changes, even with RK gone. Dave David.......... some people have described their retinopathy as 'floaters' hence my use of the term........ i don't have retinopathy so i don't have anything to go by did you have any comments on the URL that was posted and the information contained within? thank you kate SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. > >> http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > > [quoted text clipped - 29 lines] > > > > http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > > Sugar Under Control > I've had floaters since I was about 9 years old. As you said, they are > not related to RO. Long live misinformation on ASD. Nothing ever > changes, even with RK gone. > > Dave http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 >> <snip> >> [quoted text clipped - 4 lines] >> My ophthalmologist says that floaters have nothing to do with >> diabetic retinopathy but are a normal feature of aging that has to >> do with drying up of the stuff inside the eyeball. >> >> Clouded vision is something else. >> >> What concerns me about scaring newbies with the suggestion that >> they're going to go blind if they lower their blood sugar is that >> most of us who lower our blood sugar DO experience changes in visual >> acuity due to the changing concentration of glucose in the eye. For >> people who haven't read every message ever posted here (i.e. >> everyone new who visits)it is all to easy to confuse this normal >> change in vision with something dire. >> >> Suggesting that people go to their doctors to have their vision >> checked after a diabetes diagnosis is one thing, telling people who >> have just posted proudly about their greatly improved A1cs that now >> they have to worry about retinopathy is another. >> >> It in 999 out of 1000 cases it is irrelevant, and for the person to >> whom it is relevant--the one whose doctor put them on a lot of >> insulin for very high blood sugars, it is probably too late. >> --Jenny >> [quoted text clipped - 4 lines] > I've had floaters since I was about 9 years old. As you said, they > are not related to RO. Long live misinformation on ASD. Nothing ever > changes, even with RK gone. http://vision.about.com/od/diabeticretinopathy/a/diabetesvision.htm "Symptoms of Diabetic Retinopathy: a.. Declining color and/or night vision. b.. Fluctuating periods of blurry vision, or sudden and significant loss of vision. c.. Floating spots (floaters) or flashes within the field of vision, blurred or distorted vision, and loss of image clarity." http://www.webmd.com/hw/diabetes_1_2/tf1323.asp "Symptoms of diabetic retinopathy and its complications may include: Blurred or distorted vision or difficulty reading. Floaters or flashes of light in your field of vision. Partial or total loss of vision or a shadow or veil across your field of vision. Pain in the eye " Should I keep going? > http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > [quoted text clipped - 114 lines] > > Should I keep going? Even with the help of Google, you still don't know what in the hell you are talking about. Floaters are extremely common and are no cause for alarm, in and of themselves. Do you think that everyone with a cough has lung cancer? Dave > Even with the help of Google, you still don't know what in the hell > you are talking about. Floaters are extremely common and are no > cause for alarm, in and of themselves. Do you think that everyone > with a cough has lung cancer? If more than one eye specialist says that a symptom of retinopathy can be floaters than I will believe them over over you. That doesn't mean that people without retinopathy can't get floaters. So until I see your degree in Ophthalmology I will believe the specialists. >>Even with the help of Google, you still don't know what in > [quoted text clipped - 15 lines] > can't get floaters. So until I see your degree in > Ophthalmology I will believe the specialists. floaters are so common it really isn't indicative of anything, BY ITSELF. arguing facts with you is useless. believe what you want; the fact remains floaters are very common. I know the specialists wouldn't argue the point. I've been to plenty of them and we have often conversed on the subject. I've also seen a very good retinal specialist. please choose to believe whatever nonsense you wish;just don't expect me to join you in cluelessland. Dave >>>Even with the help of Google, you still don't know what in >> [quoted text clipped - 19 lines] > ITSELF. arguing facts with you is useless. believe what you want; > the fact remains floaters are very common. I know the specialists > wouldn't argue the point. I've been to plenty of them and we have > often conversed on the subject. I've also seen a very good retinal > specialist. please choose to believe whatever nonsense you wish;just > don't expect me to join you in cluelessland. So you are saying that if someone, especially diabetics, suddenly gets a new floater they shouldn't have it checked out? Nearly 30 years ago my sister developed a floater and went to a specialist. Her retina was beginning to detach! My floaters, according to my ophthalmologist are "probably" because of my myopia. They developed around the time I started having significant long distance vision problems. That doesn't mean that I may not develop a floater as part of retinopathy or at the beginning of retinal detachment. To dismiss a floater as being something commonly seen and therefore harmless is just plain stupidity. If a visit to a specialist rules out anything serious then fine. If ophthalmologists are saying one of the symptoms of retinopathy can be floaters then once again, I think I will believe them over you. For someone who dislikes people playing doctor, you sure know how to play one yourself. It would be a sorry day if a person in here was having a retinal detachment and listened to someone like you saying that floaters are common and harmless, because the many eye specialists Dave has been to said so. I only change specialists if they die, I move cities or they are obviously incompetent. On Wed, 08 Mar 2006 05:13:09 GMT, "Ozgirl" <are_we_there_yet@maccas.com> Huffed and Puffed the following into the madness of usenet: deleted troll references. >So you are saying that if someone, especially diabetics, >suddenly gets a new floater they shouldn't have it checked [quoted text clipped - 19 lines] >specialists if they die, I move cities or they are obviously >incompetent. you'll notice that in all his denial of floaters being a symptom of retinopathy BS he never makes any distinction between the types of floaters. Duration. etc. Floaters are very common and can occur for many reasons some totally harmless. But they are not to be ignored and they can most definitely be symptoms of retinopathy. We are born with only 2 eyes. And when they are blind that's it. Our chances of getting our sight restored are extremely slim. When in doubt get your a.s in to see an OPHTHALMOLOGIST. This is the type of eye doctor that is qualified to diagnosed and treat eye problems and diseases, and specifically those related to diabetes. EVERY diabetic should go to the ophthalmologist soon after diagnosis for an initial exam to establish a baseline. For type 1s this is usually not as critical time wise as it for type 2s because type 1s do not go undiagnosed for as long as type 2s often do. It is this speed of onset and diagnosis that confuses so many people about diabetic complications. By the time a type 2 is actually diagnosed they may have been diabetic for many years and have already been developing diabetic complications. And it is one or more of the complications of diabetes that actually send them in to the doctor to get checked out in the first place. In the USA a diabetic should NEVER trust the opinions of eye doctor with less qualifications than an Ophthalmologist. Outside the USA, the eye doc may have a different title but the same qualifications depending on the country, I don't know, you will have to check your own country's standards. Ozgirl is right to trust her doctor only in this matter. SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. > In the USA a diabetic should NEVER trust the opinions of eye doctor > with less qualifications than an Ophthalmologist. Outside the USA, > the eye doc may have a different title but the same qualifications > depending on the country, I don't know, you will have to check your > own country's standards. And I'd add to that that if your ophthalmologist seems to be minimizing your concerns, find another one. My original ophthalmologist retired, and when I saw his replacement, she told me I had nothing to worry about, because I had good control. In fact, based on the numbers I told her, she referred to "mild diabetes" and expressed doubt as to how "bad" it had ever been (never mind my 350 BG at diagnosis!). That's the last time I saw her. My new ophthalmologist is much more proactive, and sensitive to the general idea that my good control is minimizing the likelihood off complications, not eliminating them. SignatureAF >>>>Even with the help of Google, you still don't know what > [quoted text clipped - 70 lines] > specialists if they die, I move cities or they are obviously > incompetent. now we are back to the orginal argument. if one develops a cough, is it usually lung cancer, Ozzie?? Dave > now we are back to the orginal argument. if one develops a cough, is > it usually lung cancer, Ozzie?? No, and neither is a floater necessarily something more sinister than merely a benign floater. But you have tried to cloud the issue. TigerLily said this: "i think we should warn newbies about clouded vision or floaters in their vision, but not as a general statement about getting their bg in order" You said this: "I've had floaters since I was about 9 years old. As you said, they are not related to RO. Long live misinformation on ASD. Nothing ever changes, even with RK gone." I showed you just a few cites about retinopathy symptoms, all say floaters can be a symptom - there are many many more. According to you that is misinformation. Your only proof is a general "I have had them for 9 years and I spoke to many eye specialists". Saying floaters CAN be a symptom of eye problems is not misinformation. Believing someone who trivialises a symptom that could or could not be serious could be tragic. As you are fond of saying - don't play doctor and don't try and change what the debate is about. >>now we are back to the orginal argument. if one develops > [quoted text clipped - 30 lines] > As you are fond of saying - don't play doctor and don't try > and change what the debate is about. Heck, I'm hardly "playing doctor". I'm trying to defuse some of the "panic in the streets" over every little physical symptom a human being can have. EVERYTHING isn't life threatening. Most problems resolve themselves over time. The trick is knowing when to go to a doctor and when to RELAX. There are actually people who've lived to be 80+ who rarely go to the doctor and then there are people who go every few weeks for one thing or another, mostly FALSE ALARMS. Moderation in all things is a good habit to consider, Oz. Dave >>>now we are back to the orginal argument. if one develops >> [quoted text clipped - 34 lines] > "panic in the streets" over every little physical symptom a human > being can have. EVERYTHING isn't life threatening. Most problems > resolve themselves over time. The trick is knowing when to go to a > doctor and when to RELAX. There are actually people who've lived to > be 80+ who rarely go to the doctor and then there are people who go > every few weeks for one thing or another, mostly FALSE ALARMS. > Moderation in all things is a good habit to consider, Oz. It's not panic. There are many cites from trials (including the large DCCT trial) that show retinopathy takes a steep upward step when an A1c is above 6.0, especially at the 7.0 mark. How many people do you know with A1c's above that? It stands to reason that all things concerning the eye should be checked out rather than not. The blind mail list, diabetic-talk is a rather interesting, but sad place to be. How many people do you know with A1c's above that? It > stands to reason that all things concerning the eye should > be checked out rather than not. The blind mail list, > diabetic-talk is a rather interesting, but sad place to be. I hear you. dave : >>Even with the help of Google, you still don't know what in : > [quoted text clipped - 15 lines] : > can't get floaters. So until I see your degree in : > Ophthalmology I will believe the specialists. : floaters are so common it really isn't indicative of anything, BY : ITSELF. arguing facts with you is useless. believe what you want; the [quoted text clipped - 3 lines] : specialist. please choose to believe whatever nonsense you wish;just : don't expect me to join you in cluelessland. : Dave I fyou have never had floaters and suddenly get them it makes sense to have them checked ou. theywell may be nothing, but they might be indicative of some problem that has just begun to develop. Wendy > : Dave > [quoted text clipped - 3 lines] > > Wendy I agree, if one is concerned about something going on with their eyesight, get it checked out. My point was that floaters are so common, they aren't generally a cause for concern unless there's a sudden and dramatic change. My floaters gradually got worse over the course of time until when I was in high school, when I'd look down, the floaters would obstruct my central vision. Dave > : >>Even with the help of Google, you still don't know what in > : > [quoted text clipped - 15 lines] > : > can't get floaters. So until I see your degree in > : > Ophthalmology I will believe the specialists. > : floaters are so common it really isn't indicative of anything, BY > : ITSELF. arguing facts with you is useless. believe what you want; the [quoted text clipped - 3 lines] > : specialist. please choose to believe whatever nonsense you wish;just > : don't expect me to join you in cluelessland. > : Dave > I fyou have never had floaters and suddenly get them it makes sense to > have them checked ou. theywell may be nothing, but they might be > indicative of some problem that has just begun to develop. In my case they turned up suddenly at about the same time that I now see, with the wisdom of hindsight, that I was probably entering the phase of increasing insulin resistance where my overworked pancreas had started to fail. SignatureChris Malcolm cam@infirmatics.ed.ac.uk +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/] ahhhhhh so floaters ARE exactly what people have been calling them the part about field of vision certainly relates to Chris's problem doesn't it kate SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > >> <snip> > >> [quoted text clipped - 42 lines] > >> > >> http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm > Get Your Blood > >> Sugar Under Control [quoted text clipped - 3 lines] > Nothing ever > > changes, even with RK gone. http://vision.about.com/od/diabeticretinopathy/a/diabetesvision.htm > "Symptoms of Diabetic Retinopathy: > [quoted text clipped - 21 lines] > > Should I keep going? > http://vision.about.com/od/diabeticretinopathy/a/diabetesvision.htm > "Symptoms of Diabetic Retinopathy: Unfortunately, every one of these symptoms can also be caused by other, common eye conditions. That's why anyone, especially someone middle aged, should see an eye specialist at frequent intervals and not attempt to self-diagnose. > a.. Declining color and/or night vision. I've had poor night vision since I was a kid, it goes along with a bunch of other non-diabetes related visual problems I was born with. It can also occur when your vitamin A is low. > b.. Fluctuating periods of blurry vision, or sudden and > significant loss of vision. These are two different things. The fluctuating periods of blurry vision with newly diagnosed diabetics is almost always from changes in the glucose concentration in the eye. There is even an scheme I read about online where they are developing a meter that reads glucose concentration via the refraction of the eyeball. Sudden, significant loss of vision, that is NOT common and would be a sign of advanced retinopathy. > c.. Floating spots (floaters) or flashes within the field > of vision, blurred or distorted vision, and loss of image > clarity." Flashes of light can also be the scotoma that Chris Malcolm and I were discussing. It is a middle aged, near-sighted person thing and is, as horrifying as it seems, normal. Floaters are also a middle aged person thing, and one of the nastier parts of getting older. > Partial or total loss of vision or a shadow or veil across > your field of vision. The "Veil" can also be a sign of retinal detachment which can happen without any diabetes being involved. If you experience it, you should go immediately to the ER of the best hospital in the area because you have about 24 hours in which a retinal specialist can reattach your retina. Miss that window and you can go blind. My dad had a detached retina but got the surgery in time. > Pain in the eye " Also a symptom of glaucoma. The BIG problem with retinopathy is that it usually doesn't have symptoms until it is quite advanced. So rather than worry about these symptoms, everyone with a diabetes diagnosis should have the annual exam with an ophthalmologist so that it never gets to the advanced stage where the symptoms you describe occur. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control good to know that floaters have nothing to do with retinopathy, i hope that Mack jumps in and describes to us what the first signs of retinopathy were for him...... thank you for a good summary of the info in the URL Jenny kate SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. > > http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > <snip> [quoted text clipped - 28 lines] > > http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control >http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > >1. this article indicates that the retinopathy >had to have started BEFORE the bg were >dropped........ NOT that the drop in bg CAUSED the >retinopathy I saw that too, but another study indicated that in 2% of patients *without* pre-existing retinopathy, normoglycemic re-entry phenomenon can occur. This was probably what happened to me, as I had no pre-existing retinopathy two months prior to Dx. In other words, very rare, but it does happen. >2. further down it also indicates that >normo-glycemia is indicated even in face of >re-entry retinopathy...... that getting your bg >down now is most important This is my ophthalmologist's opinion, too. However, my retinal specialist beleives slower is better. Even the experts can't agree. However, insulin intervention seems to play a role, and if that's the case, once treatment begins it's too late. >i think we should warn newbies about clouded >vision or floaters in their vision, but not as a >general statement about getting their bg in order I disagree. I think it's appropriate to warn newbies to get themselves to an ophthalmologist ASAP if they have had a precipitous decrease in BG's, especially if insulin is involved. I've been doing this, and I shall continue to do so. My retinal specialist concurs. As for suggesting slower vs. faster, I've heard some good expert opinions on that, and they contradict each other. So, I'm staying out of that for the time being. I am trying to get to the bottom of it, though. BTW, I don't have floaters, nor any of the other symptoms described. Symptomology varies, and in many cases of retinopathy there are no symptoms. I was told however that floaters could be a symptom. However, IMHO anyone seeing ANYTHING out of the ordinary should see an ophthalmologist ASAP. Chris, what exactly were your symptoms? blurred vision and loss of periferal or central vision? kate SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. >http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 > > [quoted text clipped - 40 lines] > However, IMHO anyone seeing ANYTHING out of the ordinary should see an > ophthalmologist ASAP. >Chris, what exactly were your symptoms? > >blurred vision and loss of periferal or central >vision? > >kate No, though those are normal symptoms. Mine were, true to form, rather strange. :-) Mine were "dim spots", of the sort you would normally get from looking at a bright light, but lasting for hours instead of minutes. They were very small. These would only occur occasionally, maybe once a week, for a few hours. The biggest warning sign was a blurry, out of focus area well away from my focal center. When looking at a computer monitor it was about the size of a U.S. quarter. I'd only see it when looking at black text on a white background. However, this occurred once I already had my eye appointment. I also noticed that my eyes were slightly more sensitive to bright sunlight, so sunglasses were often needed. I have also found that if I look at an ansler grid eye test, I see a very slight distortion in a couple of areas of my peripheral vision. Slight enough that it's hard to detect. Other than that, no other visual trouble before or after my exams. No actual vision loss so far. Basically, those intermittent small dim spots were the only warning sign I can think of. They occurred mainly late last year, and I've had about three this year. They seem to last about half a day, then go away over a few hours. good........ we should include this and the 'common' symptoms when talking to a newbie i remember not being able to see a da** thing when i was first diagnosed............ my eye vision was that far off kate SignatureJoin us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/ http://www.diabetic-talk.org/freeveggies.htm I have no medical qualifications beyond my own experience. Choose your advisers carefully, because experience can be an expensive teacher. > >Chris, what exactly were your symptoms? > > [quoted text clipped - 32 lines] > about three this year. They seem to last about half a day, then go > away over a few hours. Hi Chris J.: >>http://bmj.bmjjournals.com/cgi/content/full/315/7116/1105 >> [quoted text clipped - 9 lines] > > In other words, very rare, but it does happen. It has been a few years ago, but there was a Medscape article that mentioned basement membranes. I am not sure if these membranes are conspicuous in eye exams. Pathways Leading to Diabetic Microvascular Complications and the Latest Clinical Therapies - http://www.medscape.com/viewprogram/2636 retinopathy+basement+level+membranes+diabetic - 1150 finds - http://tinyurl.com/pajrn From a March 4, 2004 post on neuropathy - http://tinyurl.com/g2job The Molecular Basis for Vascular Changes (see Slide 4) http://www.medscape.com/viewarticle/460902_4 Note the insertion of benfotiamine into the glycolysis scheme of things between the pathways. Benfotiamine is a thiamine derivative. Thiamin is used in the enzyme TPP used E1 cycle of the pyruvate dehydrogenase complex (PDC). PDC follows glycolysis and is prior to the TCA cycle. It is technical yet very basic stuff in our physiology. "... having a basis or a mechanism by which we can say, the vasculature is really important. All the studies that Brownlee has done are based in cell culture in endothelial cells. And he has clearly shown that glucose, the primary mover, causes a whole array of abnormalities and eventually causes endothelial cell death. So there is no doubt that the endothelium is the target of all these bad pathways. And if we can block them in the endothelium and not elsewhere, we may have a chance to deal with these complications." Pathology - Slide 5 "There is a common pathologic change no matter whether you look at the retina, the kidney, or the nerve. The changes that one sees are related to base membrane, endothelium, and pericytes. This shows the retina, the glomerulus, and the nerve. The changes are those of thickening of base membrane, endothelial cell changes, and pericyte cell death. These are common to all the so-called microvascular complications of diabetes." http://www.medscape.com/viewarticle/460902_6 "Moreover, if you do a correlation, you see that as the basement membrane thickens in the nerve capillaries, the fiber density falls. Again, at the pre-diabetes stage this process has already started. So microvascular disease is related to neuropathy. Slide 15." Look at all the slides but see Slide 9. Fluorescein Abnormalities: There are 2 aspects of vascular damage, underperfusion but also overperfusion, and you can see that in this fluorescein angiogram. It's also present in the nerve; we've done some studies that show very similar changes in the nerve. Not only do you have inadequate blood flow, but sometimes you have too much blood flow." In another article that I have read there has been an association established for fluorescence in the skin and nephropathy. There were AGEs deposited or bound in the kidneys. I won't jump to that now, but keep it mind. All of this is in Google Groups archives. Slide 11. Epineurial Hemorrhage - "... there is distinct epineural hemorrhage in the nerves. So there are very similar pathophysiologic processes between the retina and the nerve." Slide 12. IGT and Neuropathy - Impaired glucose tolerance and neuropathy - (now we are getting with it at lower blood glucose levels.) Note the publications in the slide if you want to go further. "There are 3 published studies recently that have clearly shown that if you take a group of patients who have a sensory neuropathy of unknown etiology and you do an oral glucose tolerance test on them, 35% to 36% of these patients will have impaired glucose tolerance. So at the very early stages of neuropathy, there is already the presence of nerve damage. ... there is already significant endoneurial capillary damage in the patients with impaired glucose tolerance. The process of microvascular disease has already started pre-diabetes and this is also present for the nerve. Slide 14. Basement Membrane IGT" PN (peripheral neuropathy) in the slide. "Slide 20. Diabetic Nephropathy - http://www.medscape.com/viewarticle/460902_8 ... diabetic patients, before their clinical diagnosis of nephropathy, that is without microalbuminuria, already have increased glomerular basement membrane, and increased fractional volume of mesangium and mesangial matrix." As is said "enough already." Not a rabbit trail but see this later - Diabetes Microvascular Complications Resource Center - http://tinyurl.com/28ruv Frank >Hi Chris J.: > [quoted text clipped - 19 lines] >Clinical Therapies - >http://www.medscape.com/viewprogram/2636 This had expired, so I clicked on the "print" link, which displayed it. Very interesting! Especially the part about myogenic response. >retinopathy+basement+level+membranes+diabetic - 1150 finds - >http://tinyurl.com/pajrn It will take me a few days to read through those, but basement membranes do seem to be involved. Thanks, that's one aspect of this that I'd missed, and I'll start tracking it down. > From a March 4, 2004 post on neuropathy - http://tinyurl.com/g2job >The Molecular Basis for Vascular Changes (see Slide 4) [quoted text clipped - 5 lines] >complex (PDC). PDC follows glycolysis and is prior to the TCA cycle. It >is technical yet very basic stuff in our physiology. I'm afraid I don't quite understand the above. I'm abysmal at biochemistry. Thiamine is vitamin B1, and if I recall from basic chemistry "insert", in this context, would mean that it is needed for the process (glycolysis) to occur, and glycolysis leads to endothelial cell dysfunction? If I'm reading this right (and I don't think I am) is vitamin B1 needed for the damaging reaction to occur? >Pathology - Slide 5 >"There is a common pathologic change no matter whether you look at the [quoted text clipped - 8 lines] >Again, at the pre-diabetes stage this process has already started. So >microvascular disease is related to neuropathy. Slide 15." >Look at all the slides but see Slide 9. Fluorescein Abnormalities: >There are 2 aspects of vascular damage, underperfusion but also >overperfusion, and you can see that in this fluorescein angiogram. It's >also present in the nerve; we've done some studies that show very >similar changes in the nerve. Not only do you have inadequate blood >flow, but sometimes you have too much blood flow." Myogenic Response issues definitely look interesting! >In another article that I have read there has been an association >established for fluorescence in the skin and nephropathy. There were >AGEs deposited or bound in the kidneys. I won't jump to that now, but >keep it mind. All of this is in Google Groups archives. I've put that on my research list, thanks! >Slide 11. Epineurial Hemorrhage - "... there is distinct epineural >hemorrhage in the nerves. So there are very similar pathophysiologic >processes between the retina and the nerve." >Slide 12. IGT and Neuropathy - Impaired glucose tolerance and neuropathy >- (now we are getting with it at lower blood glucose levels.) >Note the publications in the slide if you want to go further. This seems to prove the contention that IGT BG profiles are enough to be causal for retinopathy in some people. Therefor, staying below those seems like a better and better idea. >As is said "enough already." >Not a rabbit trail but see this later - Diabetes Microvascular >Complications Resource Center - http://tinyurl.com/28ruv Thanks.. I glanced at it, and will read it in detail tomorrow, but it's 3:30 am and I've got my OCT scan tomorrow. I've basically been focusing on the available treatments, and finding info on normoglycemic re-entry, in preparation for this scan. Once I have those results tomorrow I'll know which avenues to peruse, and hopefully have more time for following interesting lines of research. Frank, thank you VERY much for this and all your other help. It's really been a great help to me, and I greatly appreciate it. Hi Chris J.: >>From a March 4, 2004 post on neuropathy - http://tinyurl.com/g2job >>The Molecular Basis for Vascular Changes (see Slide 4) [quoted text clipped - 12 lines] > cell dysfunction? If I'm reading this right (and I don't think I am) > is vitamin B1 needed for the damaging reaction to occur? Thiamine or benfotiamine inhibits AGE - the negative effects of glycation. "michael brownlee"+benfotiamine - http://tinyurl.com/kxc8x Inhibition of GAPDH activity by poly(ADP-ribose) polymerase activates three major pathways of hyperglycemic damage in endothelial cells - http://www.jci.org/cgi/content/full/112/7/1049 The medical biochemistry page - http://web.indstate.edu/thcme/mwking/home.html http://web.indstate.edu/thcme/mwking/glycolysis/index.htm Frank |
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