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December 16, 2002

Complications

Question from Toronto, Ontario, Canada:

I am 27 years old, have had type 1 diabetes for 17 years, and I started using an insulin pump five years ago. I have always had what I have been told is good control of my diabetes (A1cs 5.8-8%) and that there was no sign of diabetes in my eyes.However, I had my eye appointment with a retinal ophthalmologist yesterday who he told me that I have mild non-proliferative retinopathy in my right eye. He guaranteed me that it would get worse, but could not tell me when, or by how much. He said that I may never need laser treatment, or I may. He told me that all people with diabetes would get some form of retinopathy at some point in their lives. I weigh 208 pounds, and I am currently losing weight. (10 pounds over the past 2 months) I am active; I work out at the gym a minimum of three times per week for 45 minutes each time, and I was so proud to be complication free up to this point in time, but now I feel like - why me, what did I do wrong? Could there be a mistake? Is it possible for something else to cause the result I got like exercise, weight loss, aspirin or an artichoke supplement? Will it go away? Is there anything that I can do to make it go away? I thought that you had to have high blood sugars for a long period of time and have "suboptimal" control for many years for complications to happen. I just don't understand.

Answer:

You are doing great! I congratulate you on how well you have managed your blood sugar and taking the step to the insulin pump. You have really accomplished a great deal. I’ll give you some stats as I know them.

For type 1 diabetes after 10 years duration, 60% of patients show some retinopathy. At 15 years, 90% of patients show retinopathy and 25% of those have advanced to the proliferative stage, the most sight threatening stage. You can see at 17 years duration and only having mild non-proliferative retinopathy and in just one eye, you have done remarkably well. From my experience (I see only patients with diabetes for retinal exams and I have examined over 25,000 patients — that’s 50,000 eyes), you should be very pleased with your results. You are doing better than most.

Your questions concerning exercise, weight loss and aspirin at this stage of your diabetes would all be helpful. My PDR for Herbal Medicines makes no mention of any contraindications for artichoke supplements and diabetes. Mild retinopathy can wax and wane. It is possible that it could not be seen in six months. However, less emphasis should be placed on that and more on maintaining an A1c at 6% or less, which you seemed to have achieved on the pump.

Again, keep up the good work. The only other thing i would suggest is a healthy diet, check with your dietitian, and use a multi-vitamin plus a low dose vitamin E and C daily.

CAG