Nutritional and medical food therapies for diabetic retinopathy

Diabetic retinopathy (DR) is a form of microangiopathy. Reducing oxidative stress in the mitochondria and cell membranes decreases ischemic injury and end-organ damage to the retina. New approaches are needed, which reduce the risk and improve the outcomes of DR while complementing current therapeutic approaches. Homocysteine (Hcy) elevation and oxidative stress are potential therapeutic targets in DR. Common genetic polymorphisms such as those of methylenetetrahydrofolate reductase (MTHFR), increase Hcy and DR risk and severity. Patients with DR have high incidences of deficiencies of crucial vitamins, minerals, and related compounds, which also lead to elevation of Hcy and oxidative stress. Addressing the effects of the MTHFR polymorphism and addressing comorbid deficiencies and insufficiencies reduce the impact and severity of the disease. This approach provides safe and simple strategies that support conventional care and improve outcomes. Suboptimal vitamin co-factor availability also impairs the release of neurotrophic and neuroprotective growth factors. Collectively, this accounts for variability in presentation and response of DR to conventional therapy. Fortunately, there are straightforward recommendations for addressing these issues and supporting traditional treatment plans. We have reviewed the literature for nutritional interventions that support conventional therapies to reduce disease risk and severity. Optimal combinations of vitamins B1, B2, B6, L-methylfolate, methylcobalamin (B12), C, D, natural vitamin E complex, lutein, zeaxanthin, alpha-lipoic acid, and n-acetylcysteine are identified for protecting the retina and choroid. Certain medical foods have been successfully used as therapy for retinopathy. Recommendations based on this review and our clinical experience are developed for clinicians to use to support conventional therapy for DR. DR from both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have similar retinal findings and responses to nutritional therapies.

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Welcome to TuD, @Yerachmiel. Looks like you have a deep interest in nutrition and diabetes health. Are you a doctor? If you have diabetes, perhaps you could introduce yourself and share a little of your life with diabetes. Have you used nutritional approaches to place any diabetes comorbidities into remission?

Looks like @Yerachmiel’s post is a copy of an abstract:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310218/

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@Yerachmiel, this website is a virtual place where we help each other live with diabetes. We do sometimes point to the medical literature to create discussions around a topic of personal interest. That works best when we weave in our personal experience.

Sometimes people show up here with the only intention to use it as a way to steer members in a commercial direction. We frown on that activity. If, however, you’re looking for some genuine support for living with diabetes, I invite you to interact with us.

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@Terry4 I’m not a doctor or nurse BUT I have taken the CDE course online (just to see how course is) and have been directly involved with the design, development and testing of diabetes technology since beta testing MDI in '79. [actually my doctor beta tested the a1c when I was pre-teen). I had hemorraging in both eyes in my 18th year of t1 (diagnosed age 2) and went on the pump in '81 as a last resort. Thank G-d eyesight OK after a few months of tight control and some changes to diet and living.

I’m an advocate for intelligent nutrition and eating => what works for you may NOT work for me (and so on). I don’t push any specific anything (except things that are basic for staying alive like insulin and blood sugar testing) but recommend doing things in moderation with an eye on how each thing affects one. I’m not going to publicly post my feelings on any given diet system as each system seems to work well for a portion of the population who are able to maintain that system and who’s bodies work well with it.

I am a long time pump user (39 years this month) and a long time t1 (58 years) so I guess there must be things I’m doing correctly. I have written four books for children with diabetes but I don’t think it would be proper to post them on a forum unless someone asks about them or wants to interview me (I have done a few podcast interviews over the years as well as presented pump and CGM technology to a few medical groups and medical & nursing students) Currently involved with education and support as I feel education for many t1 is not complete (I literally feel that if I hadn’t worked on pump protocol years ago I would not be under good control now)

I have diabetes but it WON’T stop me!!

It’s nice to see that you’ve taken your long time with diabetes and creatively turned it into inspiration for others, especially children.

I’m also a long-time pump user but not as long as you. I’ve been at it for 33 years. Insulin pumps were truly a novelty back then. I certainly appreciate all the improved features that have evolved since 1987.

I understand your reluctance to take a strong stance with regard to diet choices as that can get controversial in a hurry. Diet plays such a crucial role in how well we can manage our diabetes and I don’t think eating anything and everything with its requisite insulin dose is a good plan. I like keeping insulin doses on the lower side so that any inevitable dosing error I make can be treated without undue drama.

Anyhow, welcome to TuD.

@Terry4 I definitely agree that “moderation” seems to be a “negative” word in some circles “let them eat cake - (as long as they cover it)” only works for the first piece, not the desert table! Keeping things lower is certainly easier for us than children - but even breakdown of protein/fat/carb and level of vitamins has become major issues.

Curious how you find the current level of hardware (and associated software) as well as the level of training you’ve recieved => I’m finding so many people (even those with very long term type 1) have almost no idea how to adjust their meal and correction ratios or to correct basal doses (and thus end up in trouble on a regular basis)

Glad to be here - (actually I’m back - apparently already had an ID/password from a few years ago although any content or posts seem to have been “cleaned up”
Curious what you think of the picture (an attempt to explain insulin/food to children)

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Welcome to the forum. I remember you from here or somewhere?! IP list??? What I think we need is something to help our eyes absorb a bleed quicker. Mine , the last one, took a year. I could not drive, and my husband was dealing with a cancer diagnosis. Between the two of us it was just too much! Way too stressful. I had a couple injections of Avastin and I dont think they helped for much of anything. We need more!

My current level of hardware/software doesn’t represent the diabetes community well but It’s thankfully becoming more common. It uses a pump and CGM wirelessly connected together with an algorithm that resides on my phone. It’s the do-it-yourself open source system known as Loop.

The training I received over the years has been spotty and my best lessons were self-taught during periods of high motivation, especially when faced with a secondary complication. I did attend a week-long training session put on by a university diabetes clinic and that was helpful. Most of what was presented there, however, reinforced things I previously learned reading books by John Walsh and Gary Scheiner.

I suspect that only patients motivated to learn on their own are confident and competent enough to make changes to correction factors and basal rates. I find it amusing when the form I fill out at my quarterly endo visits asks if I’ve made any changes to my insulin program since my last visit 90 days ago. I always smile and think to myself, “Of course I’ve made changes to my insulin regimen; I live with type 1 diabetes!”

It’s a rare week that goes by that I haven’t made some insulin delivery changes. The only constant in diabetes management is its dynamic nature. A “set-it-and-forget-it” attitude is an anachronism that never served patients well. A diabetes patient who doesn’t own his/her diabetes is one who doesn’t do well or enjoys uncommon luck.

I think your graphics work well for children. I believe children can learn more than we give them credit for. I wouldn’t use a cookie to illustrate that point but it effectively shows the concept.

Not sure what age range you’re aiming at, but when I was diagnosed at age 5, this would not be helpful. All I wanted to know was why I had to do shots (1/day Lente in 1965), and my siblings didn’t. So I needed to hear that something changed in my body (eg pancreas was broken in 5 yo terms), that was not my fault. Then told that injected insulin is doing what my body could no longer do.
I recall several books using the key analysis of how insulin works.

It’s kind of interesting choosing something to show a carb: who says it can’t be a cookie made from alternative flour? I’m NOT giving specific diet advice other than insulin needed to metabolize food and that different types of food provide different things to the body (I have wanted to do a nutrition book for children for the longest time).

I’d be happy to email you the whole book if you need something for "fun"reading…

just msg your email (not safe putting in public IMHCO) [In My Humble Cyborg Opinion]

True - I do cover that issue in other places (how we don’t make insulin which we need) but idea of that page is to show what insulin DOES. (obviously question becomes does one say the body doesn’t make ‘X’ so need to replace it prior to explaining what ‘x’ does).
I appreciate what your saying: remember starting off with Lente and Regular as daily shot - eventually was using Lente, UltraLente and regular to maintain health (prior to getting first meter in '79 when started MDI)
We’ve come a long way, but not anywhere near far enough (or accurate enough)

Agree everything self taught - and REALLY self-taught as none of the “standard” books existed back when I started searching and doing. Double major chemical engineering and computing gave me enough background into biochem to figure out insulin and MDI/pumping (funny when having conversations with doctors as a professional works differently than as a patient - even in the same office setting for some of them. Finally thank G-d I again have a doctor I can work with and speak to professionally even when my it concerns my own care)

I think that loop technology is great but the number of devices and care of each (feeding and handling) as well as the need to do it yourself prevents many from adopting but as time goes on the software will move into devices (or programmable updatable devices that WE can choose programming for will become available). Wonderful that Omni is now loop device and tandem claims they are moving in that direction (when is the magic question as always)

I unfortunately know the eye issues - it’s actually what kick started my move to pumping 39 years ago!! We need something to PREVENT the eye issues from occurring but agree that IF they G-d forbid do need quicker methods of remediation (and safer ones as well)

We could have met on IP list (i was pretty early on the list and stayed until it became less and less used and other things in life took priority). I’m getting back into fold but I’ve run a facebook diabetes technical support group for a few years (idea is posting medical studies as well as company and FDA announcements & warnings & recalls as the majority of the web sites and forums and groups focus on support from a personal or issue standpoint (and we NEED to know what is going on in R&D as well as what drugs and hardware in development, released and recalled => and what issues are now becoming major and how to take advantage of various savings plans and rebates and pricing
Insulinopoly - Company, Insurance and FDA approvals, recalls, announcements, specials

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