📌 This post is a continuation of our story. Read the previous part here: Financial Shock: The True Cost of Treatment in Kyiv.
🗓️ The ophthalmologist's words kept echoing in my head: starting eye injections without proper blood sugar control was not only pointless, but dangerous. I needed to clearly understand the target numbers we had to reach and evaluate where we stood right now.
I immediately started researching clinical standards and consulting medical guidelines to establish precise benchmarks for our upcoming daily routine and nutrition plan.
1. Target Blood Sugar Levels for Safe Treatment
To safely begin intravitreal eye injections, fasting blood glucose needs to consistently stay between 5.5 and 7.5 mmol/L (99–135 mg/dL), while post-meal glucose (two hours after eating) should remain below 10.0 mmol/L (180 mg/dL).
However, the most critical indicator is Glycated Hemoglobin (HbA1c), which reflects average blood sugar levels over the previous three months. To initiate therapy safely, HbA1c should ideally drop below 7.5%, with a target closer to 7.0%.
Stabilizing these metrics requires consistent management for at least 2 to 3 months prior to starting anti-VEGF injections.
Why Strict Glycemic Control is Mandatory:
- Infection Prevention: Elevated blood sugar suppresses local and systemic immunity, significantly increasing the risk of severe post-injection intraocular inflammation.
- Treatment Efficacy: Persistent glucose fluctuations continue to damage microvessels, neutralizing the long-term benefits of costly injections.
- Avoiding Rapid Drops: Overly aggressive, sudden reductions in blood glucose immediately before a procedure can temporarily aggravate retinal edema through osmotic shifts.
2. Facing Reality: An HbA1c Level Around 9%
Reflecting on our recent lab results, I realized we were far from those targets. My mother's latest HbA1c result was around 9%.
An HbA1c of 9% indicates unmanaged hyperglycemia, meaning retinal microvessels remain under continuous stress from excessive blood glucose. At this level, elective intraocular injections carry elevated risks, which is why ophthalmologists postpone procedure scheduling until glycemic control improves.
Risks of Injecting at an HbA1c of 9%:
- Severe Intraocular Infection: High glucose impairs the immune response, increasing susceptibility to endophthalmitis (a serious internal eye infection following an injection).
- Reduced Therapeutic Response: Uncontrolled diabetes drives ongoing vascular leakage, counteracting the medication's therapeutic effect.
- Disease Progression: Unstable metabolic states can trigger unpredictable abnormal vessel growth following invasive eye procedures.
Our Actionable Next Steps:
- Urgent Endocrinologist Consultation: Adjust medication dosages or temporarily introduce insulin therapy to systematically lower blood glucose.
- Daily Blood Glucose Logging: Track fasting glucose (target: under 7.5 mmol/L / 135 mg/dL) and 2-hour post-prandial levels (target: under 10.0 mmol/L / 180 mg/dL).
- Re-test HbA1c in 2 to 3 Months: Because glycated hemoglobin turns over slowly with red blood cells, measurable improvements require this timeframe to register accurately.
Crucial Note: Injections can be safely considered once HbA1c drops to at least 7.5%. Rapidly forcing blood sugar down within days is discouraged, as sudden drops can trigger transient retinopathy worsening.
Understanding these targets defined our path forward. Our immediate priority was not rushing into eye injections, but consulting our endocrinologist and completely restructuring our daily diet 💡
👉 Read the next part: [Link to Part 4 when published]
Disclaimer: This post shares our personal experience and information tracking for educational purposes only. Medical treatments and diagnostic thresholds vary. Always consult with a qualified health professional regarding diabetes management and ophthalmic treatment choices.