Ask D’Mine: Is Lasik Safe?, Running from Occlusions

Welcome to Diabetes Advice World, otherwise know as our weekly column Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil’s getting “down in the weeds” on some eye health issues, and what to do about incessant infusion site problems. You go, Wil!

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Hugo from Spain, type 1, asks: Is it safe for a young Type 1 (32 years old) to get refractive surgery with laser technology for the correction of myopia?

Wil@Ask D’Mine answers: Well, I have no frickin’ idea what refractive laser myopia surgery is. Let me Google it…  Hang on a sec…  Oh, OK. Now I know what you’re talking about. Here in the States we usually call it Lasik. That’s an acronym for Laser-Assisted In Situ Keratomileusis, a very specific type of cornea-shaping laser surgery to allow you to throw your contact lenses or glasses into the trash can. The word Lasik is now used as a catch-all phrase for pretty much any type of vision-improving procedure that involves zapping your eye with a laser. When your acronym becomes a common noun you know you’ve hit the big time.

Oh. And to answer your question: no.

It is not safe for you.

The FDA even lists us PWDs under their “When is Lasik not for me?” page on their website, citing concerns over wound healing. And… umm… you remember the parts of your body most at risk from diabetes include your baby-blues, right? Why screw with something that Mother Nature herself is likely to take her anger out on in the first place? But if you don’t believe me, consider these sobering statics: the largest study of Lasik and diabetes found that PWDs had a surgery complication rate of 47% compared to 6.9% for “normal” people. Now, that was back in ’02. A more recent study suggests the PWDs fare much better, but I noticed that only seven type 1s were looked at in that study. And the direct health risks aside, there also seems to be quite a bit of evidence that Lasik doesn’t work quite as well for PWDs, in terms of correcting your vision and keeping it corrected. We also apparently are at higher risk from permanent post-op light sensitivity and other annoying side effects.

Also consider that Lasik isn’t just about lasers. Before the laser does its thing, knives are involved. Check out this chill-down-my-spine animation here. So anytime knives are involved, we need to remember that we don’t heal as well as other folks. Of course, the worse your blood sugar, the worse you won’t heal as well. It varies, but most surgeons nowadays won’t cut into a person with diabetes whose A1C isn’t below 6.5 for any elective surgery. Reminder: elective surgery is any surgery that you don’t need to have in order to survive the next 24 hours. Oh, and beyond knives, there’s this whole suck-your-eye-out-with-a-vacuum-cleaner part of the Lasik procedure that dramatically increases the intraocular pressure, which can be one of those straw-that-breaks-the-camel’s-back things  ¾ the final tipping point for capillaries in your eyes that might already be weakened from your diabetes.

I’m sure we’ll get a storm of comments both for and against Lasik for PWDs, but after looking into it, I wouldn’t do it myself. And I do wear glasses, and I’m as blind as a bat without them. But, hey, wearing glasses or contacts is a minor annoyance at worst; being blind would be so beyond inconvenient that words fail me. My feeling? Not worth the risk.

Laura from Massachusetts, type 1, writes: In the last year, I’ve taken up long distance running. While this has been great for my health (lost 15 pounds, gained a decent amount of muscle), it has made using my insulin pump incredibly difficult. I am having a hard time inserting pump sites without kinks/tubing bends/occlusions happening. I end up 300-400 mg/dl, rip the site out, and can see the tubing was bent. I’m still not an overly skinny person (woman’s size 10), and I certainly still have fat on me. I’ve reduced from a 9mm cannula to a 6mm. This makes a small difference, but I’m still having issues with roughly 1/3 of my attempted insertions. I’ve tried the 30-degree-angled insertion, but I have to admit, it terrifies me and I’m quite afraid to try again.  I rotate sites, between lower back, front thighs and abdomen. I’ve been on the pump for 9 years, and have never had this volume of issues. Any advice?

Wil@Ask D’Mine answers: I think you should give up the long distance running.

Just kidding!

So I guess one thing to consider is whether the cannulas are getting bent when you put them in, or if they’re getting bent from the movement of the running once they’re in place. Generally speaking, bent-on-insertion happens when there isn’t enough fat and the cannula tip hits the underlying muscle. If it happens on insertion you generally know ‘cause it hurts like hell when the guide needle tags the muscle underneath.

The front thighs, anatomically, strike me as the sites most likely to cause trouble, but I’m pretty sure that if all your trouble were there, you would’ve recognized it already. And, in theory, all three locations you use can be effected by the body in motion.

Going from the 9mm to the 6mm was the smart and right first step, and it should have worked. But it didn’t. So the next move is typically towards the angled sets like you tried. Disclaimer: right now, I wear 6mm 90-degree sets. Oh and I don’t run unless being chased by wild animals. But I wore angled sets for many, many years and angled them much more shallowly than 30 degrees. You can slip them almost parallel to the skin and they’ll work just fine. Of course, that requires manual insertion, which totally wigs out a lot of folks. I wasn’t clear on the source of your terror, but I’m guessing it either has to do with putting the damn thing in, or in the risk that you won’t get as consistent an infusion because the exact angle will vary from set to set.

Photo: Kayla's Life Notes

Either way, I have one last-ditch alternative for you to try: I think you should try an old-fashioned steel needle infusion set, such as Med-T’s Sure-T or the Unomedical Contact. My thinking here is that if motion is causing the soft cannulas to kink on you, metal cannulas are a surefire way to stop that from happening. Of course the downside is that if your movement places the tip of the cannula into contact with the muscle and the cannula is metal…  well, there might be some pain involved. On the bright side, I think this will provide a shorter learning curve about which 2/3 of sites will work for you and which 1/3 won’t. It’s amazing how fast we learn when pain is involved.

And, of course, you won’t kink/bend/occlude and go to 300-400mg/dL, and have to rip out infusion sets, and risk DKA and all of that.

I bet if you asked sweetly, the folks that make the metal needle infusion sets would send you a sample.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.