Is Vision Loss 'Inevitable' With Type 2 Diabetes?

In My Humble Opinion
1

First a little disclaimer. I am under a doctor’s care–several doctors in fact (more on that later). And I am presently taking medicine (Metformin 850mg) for my Type 2 Diabetes. Also, I will be seeing one of my doctors Wednesday. So any advice I receive here will be incidental to that.

And also, a little story, of how I got to this point. A couple of my doctors have been monitoring my fast blood sugar, and my A1C. And only recently, it apparently reached a certain point. My family doctor, said he still wanted to wait until it got a little higher. But my other doctor, almost on the verge of hysteria (I kid you not), said I should go on meds immediately. So my family doc relented, and put me on Metformin 850mg, once a day. (You are supposed to take it with meals. But since I only have one major meal a day, he felt this dosage and instructions would be best.)

I am also seeing an eye doctor once a year. And she too, is fully aware of all that is going on.

Anyways, contrary to my better judgement, I was just leafing thru my copy of the Merck Manual. And it said, eye abnormalities, with Type 2, usu. occur after 10 years of the initial diagnosis. But here is what I hope I misunderstood. It seemed to imply that eye problems were inevitable with Type 2. Is that true? Also, it said treatment “may” be important to avoid this. “May”? They mean, perhaps it isn’t?

Anyways, one piece of advice I can already give myself. I should definitely stop reading the Merck Manual. But I would appreciate any further advice any of you would like to offer (is it really unavoidable [vision change]?). And really, simply any words of encouragement, would be well-received too.

I presently live by myself with my two cats. And I would very much be up the creek without a paddle if I lost my vision (although I suppose that is probably would be when my family stepped in and helped me).

Thank you very much in advice, to anyone who replies (and tries to help:)).

2

I’ve been diabetic for 20 years, and am injecting increasing dosages of insulin to keep my blood glucose down. I see an ophthalmologist once a year, and so far no eye problems attributed to diabetes. It’s important that your eye doctor checks your retina; that’s where the problems can occur.

3

I don’t know for sure, but Google says there are (by one source) about 6.5 million legally blind people in the U.S., and 28 million Type 2 diabetics.

This confirms a suspicion of mine.

4

Anecdotally I’ve never known anyone w/diabetes who followed doctors instructions and had vision loss. The people I have known that have suffered vision loss didn’t follow instructions to manage their blood sugar.

5

“Usually” is not the same as “always”.

The better you manage your diabetes the less likely you are to have vision problems because of it. Keep your blood sugar under control, follow doctor instructions, and keep going to an eye doctor.

6

Underline mine.

One of my coworkers had eye surgery last week; he’s a diabetic. But the issue wasn’t linked to his diabetes, it came from trying to beat up a large bush with his eye on the previous weekend - the bush won, leaving coworker with “a green spot that won’t go away” (coworker is now fine).

Having eye issues is pretty much inevitable; having eye issues directly linked to diabetes is not.

7

Not inevitable as long as it’s well-controlled. Poorly controlled diabetics, on the other hand, will develop retinopathy sooner or later. Inevitably.

8

As others have said, nothing is inevitable when your diabetes is controlled. It affects everyone a little differently.

I’m surprised that you’re starting with 850mg/day of metformin: when I was first diagnosed I started with 500mg/day.

I read this as saying that when/if eye abnormalities are the result of Type 2 diabetes, they usually occur within 10 years of the initial diagnosis. In other words, if you ignore your condition there’s a chance you’ll experience eye abnormalities within 10 years.

9

Working in an ophthalmology clinic in Houston, where a significant portion of our patient base was poor, obese, and African-American, we would routinely (as in, every other month or so) give someone their initial diagnosis of diabetes. It would go something like this:

  • Patient presents in clinic complaining of poor vision.
  • Refractive exam reveals no significant nearsighted or farsighted prescription.
  • Dilated exam reveals diabetic retinopathy (which is not an early symptom of DM!).
  • Eye doctor asks patient, “Have you…been feeling OK recently? Peeing a lot? Can you feel your fingers and toes all right?”
  • Nurse is summoned to take patient’s blood glucose, which turns out to be 375.
  • Patient is referred to his or her primary care physician (or in some cases, the local InstaCare) for diagnosis and treatment of DM Type 2.

I always found this shocking. Type 2 diabetes usually makes people feel like shit. How could you ignore that for long enough to start (irrevocably) screwing up your eyes?

10

I’m not a doctor, but here’s what I know. My father is 82, and has had Type 2 diabetes for many years. He’s careful about his medical condition and sees his doctor regularly, and is totally on the ball with medication.

His vision is better than mine. He needs reading glasses (who doesn’t, at 82?), but does not need any correction at all for distance vision.

So I’m thinking that vision loss is not inevitable.

11

There is a long list of things which can go wrong if you have diabetes, and eye problems is not the worst. But if you keep your blood sugar levels under control by a combination of diet, exercise and medication the probability of any of these problems occurring is low. While you talk about metformin, diet and exercise are equally or more important in doing this.

12

Vision loss, meaning a noticeable loss in visual acuity, is not inevitable at all.

However, some degree of ocular pathology is more or less inevitable if you have diabetes long enough. The risk for diabetic retinopathy, meaning bleeding and other retinal signs (cotton wool spots, exudates, etc) rises with each year. It’s worth pointing out that time since diagnosis is the single largest predictor of diabetic retinal pathology, with a higher correlation even then A1C or average blood sugar.

What that means is that the majority of people who have had diabetes for 15-20 years will have some form of ocular pathology visible to the eye doctor on dilated fundus examination, even if it causes no symptoms.

13

Is vision loss possible when prediabetic, or is that just not eye-damaging yet?

14

There are a few definitions of pre-diabetic, including values on multiple blood sugar readings and borderline A1C values. However, once you have end-organ damage of the sort seen in diabetes, the vast majority of doctors will move you from the “borderline” column to the “diabetes” column.

In other words … a long enough period of borderline findings can occasionally be associated with diabetic retinopathy. But once you have that, it’s safe to say you have plain old diabetes, and not pre-diabetes.

As with regular diabetes, lower A1C and lower average blood sugar readings leads to lower risk of end-organ damage. So your risk is correspondingly lower as a pre-diabetic.

15

You know, I quickly tired of doctors (and others) telling me how much better I’d feel once I was on medication. I never felt bad. Even recently, when my A1C spiked to the point where an additional medication was needed, I didn’t feel bad. Not peeing a lot, fingers and toes are fine, etc. My diabetes was diagnosed after I had a urinalysis done for a possible UTI and they discovered sugar in my urine. I never had – or have since had – any symptoms. So the answer to your question is in your use of “usually”: clearly type 2 diabetes doesn’t always make people feel bad, so the ones who wind up with eye problems and ridiculous blood sugar levels probably weren’t ignoring anything.

16

Not inevitable. I have no eye problems per my ophthalmologist and have had disregulated blood sugar for over a decade and been on Metformin for just under a decade. My FBS tends to hold at 90-125 with Metformin, diet, and exercise.

17

Aside from what Misnomer said (which is absolutely correct) consider that most people who are poor, obese and work or worked manual labor jobs involving lots of heavy lifting and/or standing on your feet all day already feel like crap, all the time. Pain and fatigue is just how you feel.

And when diabetes goes uncontrolled long enough, the body adjusts. Then you run into problems where going under 200 makes you feel worse than staying above it. That’s fun, lemme tell ya. The damage is being done on the cellular/vascular level, but if you get your blood sugar down to 180, you feel hypoglycemic.

18

Thanks for the perspective.

19

Can’t find it now, but once read a research article that had a table that showed the probabilities of different complications of diabetes (including diabetic retinopathy) associated with different average hA1c values.

IIRC, if you keep your hA1c at 6.1 or under, your likelihood of diabetic retinopathy is no higher than a non-diabetic person. The higher your average hA1c, the higher your likelihood of each and every complication went. None of them ever got to 100%, I don’t think.

So it all depends on how good your blood sugar control is, and nothing is ever a certainty.

20

This is a very bad thing for your diabetes. you really should try to eat a normal 3 meals + 2 snacks a day schedule. Ask your doctor how much better that would be for you, and listen to his advice. Why ask for more health problems?

This is very common – most people don’t find out they are diabetic until they already have suffered irrepairable damage from it.

This may change in the future, with Obamacare in the USA.
Diabetes is a fairly easy diagnosis (A1c test), but has mostly occurred in people too poor to have regular medical coverage & checkups. If they start seeing a doctor regularly, many more diabetes cases may be caught early, before major eye damage.

It comes on slowly, and your body compensates as well as it can. So you don’t relize that you are “feeling like shit” – seems to feel just the same as every day.