Two questions: My daughter was diagnosed one week ago with type 1 and we are using Lantus and Humalog to control her blood sugars. She has been a very active teen with swimming and band. The doctor wants her to continue these activities, but with her sugars still high I don’t know what to do. We have not been able to gain any control. Her sugars are running between 200 to 300 mg/dl [11.1 to 16.7 mmol/L] routinely with occasional drops to 120 to 180 mg/dl [6.7 to 10.0 mmol/L]; we even had one 95 mg/dl [5.3 mmol/L]. Is it normal to take so long to get control? We have made several adjustments to her coverage from 1 unit for every 12 grams of carbohydrates to, now, 1 unit for every 6 grams of carbohydrates. She has eaten the same breakfast everyday for a week and none of these have covered her and the numbers are running about the same. She gets her Lantus every night before bed. My thinking is the Lantus needs to be changed to get her baseline lower. The specialist keeps changing the bolus. Since her sugar seems the same before and two hours after a meal, that means to me that the meal was covered but the baseline is wrong. Help me understand.

Also, on day three following her diagnosis, she wore her contacts for one day. When she had them in she said everything looked “too clear”. When she took them out that night she freaked because she could still clearly. This has remained the same now and she has not used her glasses or contacts since although she does get a headache every other day The specialist said the eye thing should only last a few days but when should we get concerned? He said the cones in her eyes were reshaped by the contacts and have now gone back but will. Will they?

The cones, a part of the retina, are an internal structure and cannot be reshaped by wearing a contact lens externally on the eye. Sorry, but some of us in the professions still use “simple, ” “story book” language to explain things. You deserve a more appropriate explanation.”The eye thing” is a result of abnormal blood sugar. Only when the blood sugar is within the normal range is the refractive state of the eye at its true status. That true status may be hyperopic, emmetropic or myopic. Elevated blood sugar in general tends to shift the focusing state of the eye toward myopia, sometimes toward hyperopia. This shift is always reversible. The example I give my patients is to think of the eyes’ refractive state like the number line…….. +4, +3, +2, +1, 0. -1, -2, -3, -4,……… etc. Numbers in the (+) represents hyperopia, numbers in the (-) represents myopia and zero represents 20/20 or emmetropia.

Place an arrow under any number. This arrow moves as the blood sugar fluctuates out of the norm. When the blood sugar is normal the arrow will be under a specific number that represents the true status of the eye. The arrow can shift to the left or to the right as the blood sugar goes up. Typically, it shifts to the right with elevated sugar and shifts back to the left with sugar lowering. You can see how during a period of glycemic increase a person who is hyperopic can become less hyperopic and start to see clearer without their glasses (getting closer to zero) and a person who is myopic becomes more myopic and needs stronger glasses to see clear (getting farther from zero). There can be the instance when one wasn’t really myopic (focus shift to the right caused by elevated sugar) and when the sugar returns to normal the arrow shifts back to the left and aligns with zero or 20/20, that persons true state.

The true refractive state of the eye is determined by irreversible physical properties of structures like the crystalline lens and the cornea. The physical curve of the cornea and the eyes axial length play the major role. The refractive state can be changed by changes in the “matrix” or index of refraction of the various components of the eye caused by the influences of elevated sugar. This more dynamic and fluid circumstance is reversible.

In your daughter’s case, a change in vision can be due to true physical changes in the eye, blood sugar induced changes and contact lens induced changes. Quickie exams and changing doctors looking for the best price in contacts is not recommended. A thorough history, exam, frequent follow-ups for contact lens wearers, a blood sugar log and a historical patient record will help the doctor sort these things out.

CAG
Additional comments from Brenda Hitchcock:

For an answer about your daughter’s blood sugar control, you should search our Ask the Diabetes Team section.

BH