Diabetic retinopathy is a terrible disease causing blindness. It is slowed by exercise, tight blood sugar control, tight blood pressure control, fibrates, certain vitamins, and anti-VEGF intraocular injections. Diabetes also causes problems like heart disease, stroke, leg and foot amputations, and early death. Diabetes and diabetic retinopathy can be prevented, slowed, and even reversed if the patient and doctor work together. Ultimately, diabetes is eating more sugars and starches than you can exercise and burn off. Sugars are fast-acting carbohydrates and starches slowly turn into sugar.
Everyone must play their best game, but the hard work is up to you. Doctors try harder when they know you try harder. A pill or a shot won’t “fix it”. The causes are 70% behavioral, which you can fix. You can prevent Type 2 diabetes, and live very well with either Type 1 or 2 diabetes if you work at it. Your body. Your choice. This is how to control diabetes and avoid retinopathy, neuropathy, kidney damage, and leg loss:
1. Don’t Smoke
2. Check and record your fasting blood sugar at home every morning. At least twice weekly
a. Sugars and Starches (CARBS) need insulin. Proteins, Fats, and Fiber don’t. More Carbs require more medications. Excess carbs damage the blood vessels, heart, liver, and cause muscle weakness.
b. Choose a low carb and moderate red meat Mediterranean diet. Ask your doctor and a dietician.
c. Keep your fasting blood sugar below 120 and your Hemoglobin A1C below 7.0.
d. Use your medications just as prescribed. Ask for sliding scale dosing according to your blood sugars.
3. Keep your blood pressure below 135/85.
a. Salt and lack of exercise both raise blood pressure.
i. Don’t salt your food if you have high blood pressure, heart, or kidney disease.
b. Call your doctor if your blood pressure is above 135/85, or below 100/65
i. Ask for sliding scale dosing if your blood pressure swings high and low.
4. Bring a record of your blood sugars, blood pressures, and current medications to every doctor’s visit.
a. If your doctor sees you are working hard, then your doctor will work harder too.
b. If you experience a headache, get dizzy, have confusion, nausea, numbness, or weakness: Check your Blood Sugar AND Blood Pressure! Then call your doctor or the emergency room with the results.
5. Avoid eating after 8 PM, especially sugars and starches. If bedtime snacks are needed, choose protein, not carbs.
6. Sleep 8 hours from 11 PM to 7 AM in a dark room with no lights, or TV. Put black tape over LEDs.
7. Exercise a minimum of 150 minutes per week
a. This reduces medication requirements, improves blood sugar control, and reduces cardiovascular risks.
b. Exercising in the morning before breakfast (fasting) reduces insulin resistance more effectively.
8. Treat elevated cholesterol and triglycerides. Fibrates prevent retinopathy better than statins.
a. Do not take them within 3 hours of vitamins or mineral supplements (fibrates block absorption).
9. Keep your serum vitamin D level around 50 ng/ml. Brains and Eyes need more than bones.
a. Take 2000 IU daily of Vitamin D3 with a meal if you are not regularly tested unless told differently.
10. Have your serum homocysteine tested. Keep it <9.0mol/L with B2, B6, L-methylfolate, methylB12, and betaine.
11. Take 100 mg vitamin B1, thiamin, with food daily, to protect your blood vessels from blood sugar damage.
12. Take 1 mg of methyl B12 sublingual every day to prevent peripheral neuropathy unless told otherwise.
13. Take at least 120 mg, up to 1000 mg/day of vitamin C daily to protect against high blood sugar.
14. Take a daily multivitamin that uses L-methylfolate instead of folic acid. Some examples are Eyefolate™ and Ocufolin™. They provide sufficient vitamins for most diabetic patients and are designed to lower homocysteine and protect the eyes.
15. Take 500 mg of omega-3 fatty acids (DHA & EPA) daily, or 2 servings/week of oily fish (salmon, mackerel, etc.)
16. Have an annual dilated eye exam by your eye care physician with the results sent to your primary physician.
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Dr. Craig Brown!