My brother was diagnosed with type 1 diabetes when he was nine years old. He has been on insulin injections since then. Recently, he complained of blurred vision and a doctor in my country, Cameroon, informed him that he was getting blind in one eye and had to undergo some liver tests. I want to save my brother’s sight and control his blood sugar properly. What can I do to help him from the United States? I am desperate for help!

It is not entirely clear from your question whether or not your brother’s eye problem is due to his diabetes. The leading causes of vision loss in Cameroon are cataracts, uncorrected refractive error (i.e., a patient needs eyeglasses, but none are available), and onchocerciasis (so-called “river blindness”). If he has long-standing diabetes, it is certainly possible that he has developed diabetic retinopathy, but the key to getting appropriate treatment is correct diagnosis. The specific recommendation for liver tests makes me also wonder about the possibility of schistosomiasis, which also can cause eye problems (I do not know if this is endemic to Cameroon). The point is, just because someone has diabetes does not mean that a medical problem is necessarily related to his or her diabetes.

Assuming that the eye problem is diabetes related, the best course of action is to consult an ophthalmologist, preferably one specializing in retinal diseases. This may be no easy task in Cameroon, I understand. We know that tighter blood sugar control and blood pressure control greatly reduce the risk of blindness and other complications of diabetes so, hopefully, your brother is able to check his blood sugar frequently and adjust his insulin dosage accordingly, and, hopefully, he is under the care of a physician who is knowledgeable about diabetes. The U.S. standard for good blood sugar control is an A1c test result of 6.5% or less (this test measures the average blood sugar over the last three months), and blood pressure should be less than 130/80. Once you get more complete information (hopefully, you can) and if you have more questions, please feel free to contact me at [email protected].

PC