laser eye surgery and cataracts

please help, I’m getting worried. Has anyone had retinopathy from diabetes?

i’ve been diabetic for 15 years, during that time it was largely uncontrolled due to misdiagnosis (they thought i was type 2, but i’m actually insulin dependent). im only in my mid 20′s and i;’ve already had retinopathy with laser surgery, i have cataracts growing, and recently i had some spot bleeds in my eyes again. i’m also beginning early peripheral neuropathy. a lot of this has happened since my sugars have come under control! can anyone explain this? any advice is welcome.

If you are in your mid-20s and have been a diabetic for 15 years you were diagnosed around age 10. Although it is possible for a 10 year old to be type 2 15 years ago this would have been virtually unknown. It is also rather easy to determine if an individual is type 1 versus type 2 by a simple blood test so it is difficult to understand how a physician could make such an error in diagnosis. By the way all type 1s take insulin and all type 2s will eventually require insulin so the term ‘insulin dependent’ is no longer in vogue. Nonetheless whether you were diagnosed as type 1 or type 2 the physician should have been able to control your glucose. Today good control would be a glucose in the range of 70 to 150 mg/dL (3.9 to 8.3 mmol/L) during the course of a day irrespective of when you eat and what has been eaten. The first and essential treatment for retinopathy, cataracts, or neuropathy is strict control of the diabetes. If you are indeed a type 1 diabetic you should be taking both a basal and a rapid acting insulin. If these terms are not familiar to you I would suggest asking your physician to refer you to a diabetic nurse educator. The dose of basal insulin needs to be adjusted about weekly while the dose of rapid acting insulin is adjusted about every 3 days (the so-called ‘sliding scale’ itself) and the sliding scale should take into account the carbohydrate load of the meal that you are going to eat. At this time I only use ‘pen delivery’ systems of insulin and I only use detemir/Levemir for basal insulin (although glargine/Lantus is just as good) and aspart/Novolog for rapid acting insulin (although lispro/Humalog is just as good). There are a few other choices for both basal and rapid acting insulins although at this time I believe that NPH, Lente, UltraLente, and regular insulin are seriously out-dated and no longer appropriate for use under any circumstances. The reason that retinopathy is developing now when your glucose seems to be better controlled is easily explained. The metabolic changes that led to diabetes may have begun a decade before your glucose was found to be elevated. In a similar fashion the disease process of retinopathy, cataracts, and neuropathy begins long before they are able to be detected. Well designed studies have demonstrated that even with strict control these problems tend to occur and progress over time. I am always distressed that an individual must suffer but if I might offer a word of encouragement it would be that our ability to treat diabetes and its complications has advanced more rapidly over the past 5 years than I would have thought possible. I wish you the best of health and may God bless.