This is the one nobody tells you. The one that explains why seven years of controlled numbers did not stop the progression.
Blood sugar management reduces the metabolic pressure generating reactive oxygen species. That matters. It slows how fast the radicals are produced.
But it does not neutralize the radicals already attacking the vasa nervorum walls. The oxidative process does not stop because your A1C improved. The radicals are already there. The capillary walls are already under attack. The destruction continues between appointments while the meter looks fine.
Your doctor watches the A1C. The A1C is the gauge. The pipe is corroding while the gauge reads normal.
Controlling blood sugar is necessary. It is not sufficient. Nobody in standard care is addressing the oxidative mechanism destroying the capillary walls. That mechanism requires something that reaches the vessel wall specifically, not a general antioxidant, not a volume control, not a myelin support. Something that goes directly to the endothelial tissue being destroyed.