Recommended Adjustments and Novel Therapy
TR and I discussed the clinical findings, and I suggested that he get a continuous glucose monitoring system (CGMS) to better assess blood glucose patterns at various times of day and guard him against acute hypoglycemia. My goal was to minimize TR’s post prandial blood sugar spikes and reduce his HbA1c by 10 percent.
I asked TR to minimize the duration of post meal hyperglycemia as much as possible via 15-minute pre
-prandial insulin delivery, moderation of carbohydrate intake, and intramuscular injection of insulin when blood glucose levels are above 200 mg/dl.
In addition, I recommended that TR take a multi-component nutritional supplement (EyePromise DVS, ZeaVision). This formula has been shown to improve visual function (contrast sensitivity, color perception, and visual field sensitivity), blood lipids, hsCRP, and macular pigment as shown in a 6-month randomized control trial of adult diabetes (both type 1 and type 2) patients both with and without diabetic retinopathy, and without affecting HbA1c levels.8
TR was asked to return in six months to assess his DME.
TR’s color vision and contrast sensitivity improved in each eye. His last HbA1c value was 6.9 percent, and he reported high satisfaction with his CGMS. In particular, he reports less frequent acute hypoglycemia thanks to the CGMS alarm feature and fewer episodes of blood sugar levels >200 mg/dl.
He has taken the recommended vitamin twice per day since his last visit, and his vision remains at 20/20 in each eye. Dilated fundus exam shows total resolution of hard exudate OD (Figure 2) with resolution of the subtle cystic DME on SD-OCT.
TR will continue to be followed every six months for now.
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8. Chous AP, Richer SP, Gerson JD, Kowluru RA. The Diabetes Visual Function Supplement Study (DiVFuSS). Br J Ophthalmol. 2016 Feb;100(2):227-34.