Why are my eyes getting worse in spite of well controlled diabetes?
My ophthalmologist told me that I have developed mild macular edema recently. The strange thing is that when I first visited him four months ago, when my blood sugar was poorly controlled (HbA1C=9%), the eye check was fine. Four months later (my recent visit), he said I have mild macular edema and gave strict advice on weight loss/blood sugar control etc. What I could not understand is that, how come my blood sugar was well control (5.9%) but yet there is a deterioration in my eye condition? I was told, if you control your blood sugar too well, you might experience diabetes related symptoms, e.g. tingling sensation, macular edema. Why is this so?
I measured BP during the visit and had a record high of 170/110. Was told that I should go treat hypertension. I have been monitoring my BP at home, it’s been borderline 120/80. I know there is something called white coat hypertension, but what can I do to confirm if I have to start on hypertension medication? Also, pardon my ignorance, will polyclinics/GP clinics the right place to diagnose if I have hypertension? If I’d like to see a specialist, which specialisation does this fall under?
Hello Sad. Thank you for your question. First of all, congrats on improving your diabetic control! Dropping your Hba1c from 9% to 5.9% is an amazing conscientious effort on your part.
1. What I could not understand is that, how come my blood sugar was well control (5.9%) but yet there is a deterioration in my eye condition?
With too well controlled sugars, you can certainly get tingling sensations which is related to low blood sugar, or hypoglycaemia. It’s your body’s way of telling you that you need to eat. If you are youngish and not prone to falls, tighter control of diabetes is ideal, and 5.9% is safe – your doctor will advise you on this. Macular oedema on the other hand is due to POOR control of diabetes, and not well-controlled diabetes.
As to how you got macular oedema – it’s probably from your period of poorly controlled diabetes, resulting in damage to the small blood vessels of the retina. The leakage of fluid into the retina leads to swelling of the surrounding tissue, causing macula oedema. This takes some time to happen, which may account for why it was only picked up 4 months later. Early worsening of your eye condition is also common when you improve your diabetes control, but this paper clearly explains how the long-term benefits of intensive control of your diabetes clearly outweigh the risk of early worsening. Furthermore, no case of early worsening resulted in serious visual loss (you need to register for free to Medscape to read the article).
At this point, if I were you, I would continue closely controlling my diabetes, and attend regular eye checks as directed by your eye doctor. Down the line, if necessary, he may offer laser treatment to your eye to prevent further deterioration.
2. What can I do to confirm if I have to start on hypertension medication?
From what you’ve described, it indeed sounds like white coat hypertension. Normally your doctor would want to take a couple of BP readings on separate occasions, which are confirmed to be elevated, before starting you on BP meds. Otherwise, he may also suggest a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night, to confirm if you truly need BP meds to control your blood pressure.
3. Also, pardon my ignorance, will polyclinics/GP clinics be the right place to diagnose if I have hypertension?
Yes, they are absolutely the right people to diagnose and manage high blood pressure. They see and manage the most number of cases of patients with hypertension. They may only refer you to see a specialist when some conditions are fulfilled such as:
– Your blood pressure is difficult to control on multiple meds
– Your blood pressure is very high
– There may be other underlying causes for your high blood pressure
4. If I’d like to see a specialist, which specialisation does this fall under?
You definitely do not need to see a hospital specialist at this point.
However if you want to spend a lot of money privately:
– Internal medicine doctors in hospital work up and manage a lot of high blood pressure cases.
– Endocrinologists too, so if you are already seeing one for your diabetes, you could just sound him out.
– Cardiologists and nephrologists also both manage their own share of hypertensive patients.
So who you see at the end of the day should be guided and recommended by what your GP suggests.