I’m seeing my Dr tomorrow, so I’m gonna talk to him about it and see if she can see him instead too, IDK though if she can.
Edit: she has proliferative diabetic retinopathy and cataracts in both eyes.
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Sorry to double post, my Dr has no openings , but one of the other drs at his practice has some, and apparently she’s pretty good and my Dr says she’s versed in diabetes enough,so I’m going to call her tomorrow and see if I can get her an appointment before her eye surgery with this lady. Might be after the other primary, but I’m just not happy with with the post hospital care she’s had thus far, and even her cardiologist wanted her to check out my Drs office because everyone there is pretty good and well equipped for people like her. She seems to hint she needs a much more experienced Dr than a resident too.
My Dr also reassured me, I did nothing wrong giving her insulin and he told me to advocate for her, because proliferative retinopathy really needs the person to be tightly controlled to prevent worsening of it. He’d recommend insulin until her health improves to then see about non-insulin treatments if she’s type 2. Obviously if she’s type 1 it’s all insulin from here on out. Still waiting if they find any autoantibodies.
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, I wouldn’t aim to get her BGL’s “too perfect too quickly” as this can cause a flare-up of acute painful neuropathy and may also cause retinopathy to worsen. I would suggest aiming to bring it down over a couple of months rather than a couple of weeks. A sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime may cause rapid and often uncontrollable retinopathy. Sorry to add more to your worries but best you are aware of this possibility.
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This happened to me before we knew better (Late 1980s). Ended up needing a vitrectomy soon after.
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Same!
This page suggests getting HbA1c under control “gradually, over a year if necessary,” to avoid the problem of rapid progression of retinopathy that comes with rapid tight control.
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
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Same here 
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Additional info here.
In patients whose retinopathy is already approaching the high-risk stage, it may be prudent to delay the initiation of intensive treatment until photocoagulation can be completed, particularly if hemoglobin A1c is high.
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I’m finding the same now, but so far , it’s not worsening as much as it’s lightening, but not going away yet. I’m not sure if these studies apply to every person or situation either, I also am trying to keep her blood glucose lower because her kidney levels aren’t great, I think it may be temporary due to the treatment of her chf or the chf itself but we’ll see . It seems reasonable control ( correcting over 300s aggressively, but not as much for the 200s unless it’s pre meal) works without issues and she feels more energy now than the past few months . I’m getting her under 300 fairly easy, but not pushing for perfect numbers. I just don’t wanna add more to her health issues by having her much higher than 200 all day.
So far she’s seemingly doing better though. Her blood pressure is still slightly higher than they like of 125/75 but barely after they doubled her meds. Blood sugar isn’t great of course, but I’m doing ok at keeping her in the 100s most the day until dinner. If she’s legit a type 2 I’m going to see if they can give her extended release metformin though , because the gi upset is real… That or add another med and decrease the metformin or something.
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Officially a type 2. We’re increasing metformin to 1000 twice a day to try to bring her night time numbers, and this new Dr seems nice. Yay.
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Glad they got it figured out, and that there might be a solution that is easier than insulin therapy. Hopefully her eye issues get sorted in short order.
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Well, the insulin isn’t the worst option, it’s just she can’t inject herself too easily right now, I think lantus is fine but if she has to do meal insulin, it’d be harder until her vision is better. Metformin is giving her gi upset, so we might have to see if they can get the extended release kind or add some other treatment so she can reduce the metformin. It seems as soon as we got up to this dose it started the gi issues.
Edit: we’re trying 25 mg of jardience on top of the 1000 mg of metformin and 5 units of lantus.
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I agree! She needs a background insulin starting now. It takes a few days to get setted. I started at 10 u Lantus and ended up at 16. But she needs for her numbers to come down.
AFA keeping people high–I get it, but “high” should be 130, not 300. Hope she is doing better??