Questionsir my mother is age 70.her one eye is being operated for corneal graft due to degeneration.second eye may be also under same procedure.she is diabetic,osteoartharities .it is believed that she has vascularity and resultive eye damaged.So dr has prescribed steriod medicine.But we have afraid that this type of medicines can increase her diabetic situation and can make worse.pl advice..any alternative of steriod medicines,,,MTX?
AnswerHello,
This is a very challenging problem when it comes to diabetes. There really is no more potent anti-inflammatory medication than prednisone or the similar steroids. When patients with diabetes develope vasculitis, like your mother, there is always some concern to introduce a steroid into the situation.
But remember, even under the most difficult circumstances with diet and medication, tight glycemic control can still be maintained. It might be that you need to use insulin to do that, but it can be done. Before I would even think about using methotrexate (Methotrexate is one of the most vicious medications that I am familiar with). I would look into the possibility of being on an insulin sliding scale (subcutaneous injections) and follow the doctor's recommendation of going on the steroids.
The hypervascularity of diabetic retinopathy is really serious. In my overall impression of the things are important for your mom, her vision is number one. Without a doubt. I have seen to many elderly people decompensate, or simply give up after losing their vision.
best of luck,
Dr. T.
