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Diabetic Retinopathy & CKD conditions can be reduced and even reversed for a senior citizen.

Updated: Nov 15, 2022


Name: Varalakshmi
Age: 65 yrs
Gender: Female
BMI: 32 kg/m2

Case History: Partha (Varalakshmi’s son) approached us for help with his mother’s health conditions. Partha is in the USA and his 65-year-old mother lives in India. She had Type 2 Diabetes, Hypertension and Diabetic Retinopathy and her CKD was in stage 4. She was an insulin-dependent diabetic for several years, was on 36 no units of insulin, and her fasting sugar levels would be in the 146-160 range. He wanted help in reducing her sugar levels, getting her HbA1C to a healthy range, improve her CKD condition as she was in the verge of getting into the dialysis zone. She is a vegetarian, staying by herself in India and therefore Partha reached out to us to provide a meal plan and suggest her the lifestyle changes that his mother could do independently at her age. Varalakshmi had diabetes for the past 10 years and was on 18 units of day and night insulin. She developed retinopathy because of her constant diabetic condition.

Analysis: Past history, blood analysis, dietary recall and lifestyle choices. Her HbA1C level was at 8.8%, her creatinine level was outside of the range at 2.1 and her eGFR was at 28. Her elevated sugar levels and hypertension had caused her nerve in the eye to burst and there was bleeding which required her to go for a medical intervention once her sugar levels reached a healthy range with medications. Her vitamin profile was low as per her recent medical checkup and therefore recommended regular use of supplements for multivitamins and vitamin D to improve her overall energy levels and gain some strength, under the supervision of her doctor.

Approach by best clinical nutritionist / dietician Telangana, India: We first analyzed her food diary, and observed that she was on a regular Indian grammarian diet. A diet that largely comprised of an assortment of refined cereals & lentils was devoid of the cell walls, fibre, fats and adequate protein that was required to improve her CKD condition. She was consuming several meals in a day out of which 90% of the meals were grain-based since she was a vegetarian which explains the constant spike in her blood sugar levels, increasing her retinopathy condition and aggravating her CKD conditions. We suggested she take stomach-friendly whole grains like hand pound rice, instead of jowar roti as jowar in powdered form lead to spike in insulin levels, Further, we included lots of vegetables in different forms like soups, steamed vegetables and stir-fried vegetables to provide her adequate fiber and comfortable for her digestive health. We kept potassium and phosphorous-rich food items like tomato, cabbage etc. to the minimum so that it does not impact her creatinine levels. We also advised her to avoid gluten for a short period of time to keep her insulin levels in check. Real-time support along with recipes and pre-preparation methods were provided to her. We regularly kept a check on her energy levels and ensured that she ate whatever we gave her in terms of taste and liking to ensure sustainability. CKD patients avoid protein as they believe it would aggravate her medical condition. We gave her adequate lean, efficient & dense protein split throughout the day that was as per norms for a CKD stage 4, stomach-friendly, reducing her sugar levels while ensuring the overall potassium and phosphorus consumption was within the prescribed norms. We also educated and monitored her water intake and exercise like walking, yoga etc on routine basis in order to improve her gut health with better absorption.

Results: Just in a week into the program, her insulin dosage decreased from 18 to 12 and her average blood sugar level which were 145 reduced to 100 within 40 days the insulin intake reduced from 36 units to 10 units and within 2 months she did not take any more insulin as suggested by her doctor. During her routine retinopathy check, her ophthalmologist did not observe any more bleeding from the eye blood vessels and mentioned that she did not have to go through any more procedures to reduce the condition. Once she made a few lifestyle changes, she started feeling better and was able to notice that she was eating better without feeling bloated. Her HBA1c reduced from 8.8 to 6.7%. Her creatinine levels reduced from 2.1 mg/dL to 1.7 mg/dL. Her doctor, who was monitoring her sugar levels and medications, suggested some changes in her medication list and mentioned that if she continues the same then her blood sugar levels and creatinine levels will keep on improving further. Her doctor for diabetic retinopathy mentioned that her eye blood leak stopped and her eye condition improved than before. He further mentioned that she did not need any injections for her eye and that a minor laser therapy would work for her.

Deepika Chalasani is a Clinical Nutritionist, Mind and Body Transformation Coach and co-founder of Fit4Life India, an integrated nutrition and wellness organization for Indians that provides complete solutions, addressing health and wellness challenges of individuals by working on their overall well-being. Deepika, the best nutritionist in Hyderabad for weight loss and online dietician can be contacted via email or Mobile +91 9491011202
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