My 17 year old daughter has had type 1 diabetes for six months, and before she was diagnosed she practically lost her sight. Her eyes are okay now except that she wears contacts. Does this necessarily mean that the diabetes is going to be more aggressive to her eyes?

Vision problems with diabetes are directly correlated with long-term care of diabetes. The better the control of blood sugars on a long-term basis, the less chance of developing eye problems.

MSB
Additional comments from Dr. Charles Garcia:

The fact that your daughter “practically lost her sight” does not mean that the diabetes is going to be more aggressive. The most common scenario with new onset type 1 diabetes is that there is a relative sudden increase in blood sugar prior to diagnosis. This increase in blood sugar can cause a shift in the optical properties of the eye resulting in blurred vision. This is not a “loss of vision” but an out of focus eye, which could be refocused by glasses, usually requiring lenses stronger than what is truly needed. When the blood sugar is returned to within normal limits any residual blur is the eye’s true optical nature. In your daughter’s case she remains out of focus requiring compensating lenses (contact lenses). What will contribute to the aggressiveness of her diabetes is a delay in achieving good blood sugar control after diagnosis and not maintaining her hemoglobin A1c at 6 -7 % or less.

CAG
Additional comments from Dr. Dilo DeAlwis:

It is unusual for people with type 1 diabetes to develop any visual problems until they have had the disease for about 5 years, at least. Whilst it is possible for vision to be affected by high sugar levels due to the lens inside the eye swelling, this should then automatically reverse itself after the diabetes has been controlled. From the fact that she now needs to use contact lenses, I am inclined to think that she might, in fact, have become short-sighted (myopic). Most children are born slightly long-sighted and then, as they get older, this becomes less and less — in most cases becoming almost normal-sighted by about 5 years. If, however, you are born slightly short-sighted, then the natural progression towards short-sightedness can make it worse. Eventually, at some point, you can become so short-sighted that without glasses or contact lenses, things become very blurry. This change from seeing reasonable well to suddenly becoming quite handicapped can, in some cases, be quite a sudden change. It is also possible that the high sugar level at the time, which also tends to make the eye more short-sighted, could have precipitated the event.

I am not aware of any connection between visual problems at diagnosis (either due to the high sugar level, or due to concurrent myopia) and subsequent problems with diabetic eye disease. It is important, however, to be aware that type 1 diabetic patients have a higher risk of serious eye disease. Furthermore, one of the most important associations of eye complications (and indeed all of the other complications such as kidney disease, etc.) in diabetes is the duration of diabetes. Obviously, the younger you are when you develop diabetes, the longer you have to live (!) and hence, eventually, longer duration eventually. It is therefore very important that your daughter manages her diabetes as well as possible, starting right now.

DDA