Retinopathy and optic nerve swelling

[Michelle92371]

I was wondering if you could tell me about the kinds of treatments there are for optic nerve swelling and diabetic retinopathy.  My brother is a diabetic of 16 yrs and is experiencing complications with his eyes.  He was diagnosed with juvenile diabetes and has been on and off of insulin in the past 16 years.  He is currently on nph and regular to control his diabetes.  He weighs appx 260 and he tries to exercise to control his blood sugars, as well as diet.  He has turned to me regarding all of the laser treatments and steroid shots that he has and is undergoing.  He asks is there any hope to saving his eyesight and also does not understand why all of this is happening to him since his HA1c has always been around 6 or 7, and his blood pressure is around 135/80.  All other test run into normal areas except he is on zocor for the bad cholesterol level. He also is an ex-smoker.  Is there something else that could be causing the optic nerve to swell that he is doing or from what I have read could it be totally different from diabetes? any insight into these problems/questions would be greatly appreciated.

[JDRF-Team-sgg]

I am sorry that your brother is dealing with these problems. Those of us who respond to these questions are not physicians, so please check my responses out by having your brother ask his opthamologist to explain exactly what his situation is. Perhaps the following information will be helpful to both you and to your brother.

My research tells me that diabetic retinopathy can take many forms. I, too, am a long-time diabetic, and my own opthamologist has explained that the danger of vision loss depends on WHERE the problems develop in the eyes. I have two web sites that explain diabetic retinopathy and the possible link to optic nerve damage. These may be helpful to you. Please read them first and then finish reading my response:
http://www.ohiovalleyeye.com/eyeinfo_dsgdia.html
http://www.visionsimulator.com/diabetic_retinopathy_proliferative/

Now, without knowing whether your brother has the proliferative retinopathy and is perhaps growing new, weak vessels on his optic nerve, or whether he has nonproliferative retinopathy that perhaps is starving the optic nerve of healthy blood flow, I cannot tell you which is the cause of the optic nerve swelling. But, it is clear that diabetic damage can very well be the root cause of the optic nerve problem.

Please notice that both of these web sites state that most optic nerve swelling goes away on its own in a few months. If the problem is due to blood vessel growth on the optic nerve, then surgery may be recommended. It is important for your brother to ask his doctor lots of questions, for many of the problems of retinopathy are very treatable, and he needs to find out what treatments are available to him so he can make good decisions BEFORE vision loss occurs.

There are two other things your brother needs to do to help himself as much as possible. First, is to lower his weight. According to ideal body weight charts for men, even if he were as tall as 6'4", his weight would be close to 50 pounds too much for an adult male. He absolutely must get some help from his physician and lower his weight, for obesity causes even more stress on already damaged blood vessels and he can find himself in trouble with blood vessels feeding heart and kidneys, too. In many diabetics, if a complication involving blood vessel damage is happening in one area of the body, then it is reasonable to seek the beginnings of problems in other areas, too. So his kidney function and heart may be at risk, and obesity certainly is the most pressing issue in addition to the diabetes for these major organs. This is something HE CAN FIX even though he cannot cure himelf of diabetes. Please encourage him to do so.

Although his HA1c numbers seem to be within the range that physicians like to see in their patients, perhaps he can tighten up his control even more and get that number down to upper 5's or right around 6. The reason for this suggestion is that this number tells the AVERAGE blood glucose number during a several-month long period of time, and he could be having some high numbers averaged with some lows to acheive these good HA1c numbers that he usually has. Since he is dealing with a complication, it would make sense to try to avoid the highs altogether or to get them down to normal as quickly as possible. He might want to discuss with his doctor the possiblity of using a pump for optimum control or, if he doesn't like that idea, perhaps changing from the older NPH/Regular insulins to the newest treatments using Lantus and a quick-acting insulin such as Novalog or Humalog. Either of these newer treatments for diabetes can keep his glucose levels from rising high after a meal and then dropping back to normal, which is what tends to happen with NPH/Regular insulins. Obviously, if the lower glucose numbers become more the norm, the body has a chance to perhaps heal the optic nerve and even sometimes the hemorrages in the eyes can get better if high glucose is no longer a factor, for the body can sort of reabsorb some of that blood. I, too, was on NPH and Regular for years, and, like your brother, had good HA1c numbers, but I eventually changed to Lantus/Humalog after reading about the benefits. I find that my glucose numbers stay much more steady all day long now, and I can easily keep that baseline glucose reading at around 80 without having to worry about a peak dropping me lower during the day. Also, with the quicker-acting insulins used in both of these regiments, any errant high glucose reading that happens due to a miscalculation can be brought down to normal within about 2 hours rather than having to wait a much longer time for the Regular insulin to bring a high reading down to normal. So there is less time for an accidental high to cause damage to the body with this system. I believe this may be a good time for him to investigate these two newer treatment options (pump or Lantus/quick-acting isulin) to perhaps help his eye condition and perhaps to avoid other complications.

You are a great sister to care enough about your brother to ask these questions. The most important thing you can do for him is to give him love and  support, for he is probably feeling alone and frightened now. I wish him the very best.