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Medical Forum / General / Vision / March 2007

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Diabetes vision questions

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Emily - 16 Mar 2007 02:33 GMT
Hi. I am a newly diagnosed diabetic, and am currently not on any meds,
so my blood sugars are generally quite out of control, despite careful
eating and being relatively active.  I was on glyburide, but had a very
bad allergic reaction.  Then, when my OGTT results came back, the doc
wanted to run more tests to see if I'm type one or type two, and hold
off meds or insulin until we knew what was going on.  Still don't have
all the test results, so the CDE is trying to get me on some fast acting
 insulin to temporarily fix things until we know more. She doesn't like
that I am usually in the 200-300 range, and have often gone to 400+ once
 up at 500.

I am seeing my opthomologist on Tuesday for a dilated exam, to check for
 the more serious complications, and at least get a baseline for
changes in the future.  She also follows me for my graves disease, so
I'm  not a new patient or anything.  I will ask her all this too, but
was hoping for suggestions here as well.

My main issue right now is not the long term negatives of retinopathy,
which hasn't likely set in, this was caught early (A1C was 5.3 at
diagnosis, but BG was high etc.) I know it is progressing fast, as my
A1C will be MUCH higher next time, but I have obviously not been running
 consistently high for ages yet.  The issue I have is with the annoying
vision changes that accompany fluctuating blood sugar. I am moderately
near sighted (-3.0 OS, -3.5 OD). I also have astigmatism, Can't remember
the script for that, I know the axis is about opposite in each eye, the
right eye is worse (always has been, and doesn't always correct to
20/20) but I don't know the strength.  It is also moderate.  Now, I know
many diabetics suggest buying tons of OTC readers to help with the
vision change. (often,one goes from near to far to near sighted back and
forth with the fluctuations). I also know that getting a new script now
is pointless, until the BG's are controlled, cause the vision is just
going to blur in and out until then.  Well, the changes dont' seem to
affect my astigmatism, or if they do, readers won't help. Also, I can't
get clearer vision by removing my glasses, which I possibly could if I
were just near sighted (if a BG just kind mostly corrected the
nearsightedness  instead of making me totally farsighted), I think
because of the astigmatism, but who knows.  Would trying on readers over
my regular glasses possibly help?  I know it would look dorky but I
could see better for the computer and reading and such.  I know the best
fix is getting my BG's under control, and then getting an updated script
for glasses. That is of course the long term goal, but it takes time,
especially when it is taking so long for me to get meds to help me.
Obviously, diet and exercise are not enough, and things are getting
worse--my BG's are trending up.  Any suggestions for a temp fix, or
should I just live with it until I get this all figured out?

Emily

OTIS need not reply with PLUS PREVENTION ideas.  I wasn't put into
glasses until I started driving at 16, and with a family history of very
poor eyesight starting in the teens, it was likely inevitable.  Plus,
the astigmatism I don't think has anything to do with the myopia.
Mike Tyner - 16 Mar 2007 03:28 GMT
> fix is getting my BG's under control, and then getting an updated script
> for glasses. That is of course the long term goal, but it takes time,
> especially when it is taking so long for me to get meds to help me.
> Obviously, diet and exercise are not enough, and things are getting
> worse--my BG's are trending up.  Any suggestions for a temp fix, or should
> I just live with it until I get this all figured out?

When your BG stays below 180-200 all the time, you'll stop fluctuating. If
you had to guess, you might guess that your final refraction will wind up
being the same as your old refraction, before your "osmotic excursion." From
your records, they can often anticipate the direction and range of variation
you can expect. Diabetic changes, as you've seen, are typically similar in
each eye and don't affect your astigmatism.

So meanwhile, ask for a progressive-addition lens that covers the range of
powers you're likely to need. Progressives are your best solution toward
having something that will work almost everywhere.

At least one major retailer offers a 30-day guarantee and extends it to 90
days if the doctor confirms a medical problem.

> Would trying on readers over my regular glasses possibly help?

Depends on the direction of your shift. Are you now at -2 or -4?  (it's
different for individuals but usually recurs the same direction each time.)
If you're -450 now, it could work like a charm.

-MT
Emily - 16 Mar 2007 05:16 GMT
> So meanwhile, ask for a progressive-addition lens that covers the range of
> powers you're likely to need. Progressives are your best solution toward
> having something that will work almost everywhere.

I'll ask my eye doc about that when I see her.  Dunno how it will
work/go over (only ever had single vision lenses...) but perhaps we can
come up with some solution for half decent vision with the fluctuations.

> At least one major retailer offers a 30-day guarantee and extends it to 90
> days if the doctor confirms a medical problem.
SO, uh, I get the glasses, use them until the BG gets below 180-200 all
the time, and if that's less than the guarantee, return them? Doesn't
seem quite right... But certainly economical.  Of course, I'm sure it
might not work, and I would want a guarantee with glasses as expensive
as these may be, especially since I don't know how well I'd tolerate
progressives... Of course, I could return those, and then get a pair of
regular glasses that fit my new stable script instead... I'd not feel
too bad that way...

>> Would trying on readers over my regular glasses possibly help?
>
> Depends on the direction of your shift. Are you now at -2 or -4?  (it's
> different for individuals but usually recurs the same direction each time.)
> If you're -450 now, it could work like a charm.
Well, yeah, I don't know what is the actual change, so I guess just
hitting the drugstore, and trying on the specs to see if any help would
be my best bet. If some do, great, if not, I'll be talking to the eye doc.

> -MT

Thanks for the advice.  I think my script may have changed lately
anyway, but I don't know for sure because of the diabetes. I have
medical insurance that will cover the dilated exam for the diabetes
(covers the graves stuff too, but not regular eye stuff without another
medical condition), and I have vision insurance that will cover the
refraction exam later. So, I plan to use that when my BG's are lower,
and then I can determine if my script has indeed changed. I've noticed
that my vision has gotten worse over the last few years more so than
when I was younger.  I'm still changing (about -.5 diopters) a year even
though by 30 I'm supposed to be leveling off...  (or so most say).  The
astigmatism also changes (mostly right eye) but not so much.

Emily
 
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