What is diabetic retinopathy?
Retinopathy is a condition where a part of your eye, known as the retina, becomes damaged. Uncontrolled blood sugars, high blood pressure, and high cholesterol can cause changes to blood vessels in the retina. These changes may consist of swollen blood vessels that leak fluid into the rear of the eye. In other cases, it could be caused by blocked blood vessels or abnormal growth of blood vessels on the surface of the retina.
If left untreated or undiagnosed, retinopathy can cause vision impairment or sight loss. There are different stages of retinopathy; background, pre-proliferative, proliferative and diabetic maculopathy.
My recent diagnosis of background retinopathy
I recently went for my annual diabetic eye screening. My blood glucose levels have been controlled since September 2017 by following a low carb diet. My most recent HbA1C was 33 (taken on 27.04.2018), which is a non-diabetic result. My cholesterol and blood pressure have significantly dropped since last year, and although it hasn’t been smooth sailing, they are finally close to “target” levels. To help control my blood pressure and cholesterol, I take 5mg of Ramipril a day for my blood pressure, and, I take three statins a week for my cholesterol (at 5mg per tablet).
I was shocked to receive a letter a few weeks after my eye screening appointment explaining that I have background retinopathy. As I have been so strict and had such tight control of my blood glucose levels, I didn’t expect to receive this diagnosis.
It is possible that the retinopathy developed last year, around the time I was in the hospital for high blood glucose levels, high blood pressure and extremely high triglycerides. Or, as it has been a challenge to control my blood pressure and cholesterol recently, it could have occurred during this time.
Diabetic retinopathy stages
So, I have background retinopathy, what does this mean? And what are the other stages of retinopathy?
The early stage of retinopathy, known as background retinopathy, is when damage has occurred to the back of the eye (retina). Background retinopathy is usually determined when there is a presence of swollen blood vessels on the retina. These blood vessels may leak small amounts of blood. Generally, there are no changes to vision as there isn’t a large number of swollen blood vessels. If the blood vessels continue to change, this can lead to the progression of retinopathy.
A significant increase in damaged/swollen blood vessels and leaking of blood means that the retinopathy has further developed. This stage is known as pre-proliferative retinopathy and poses a high risk for vision impairment.
Proliferative retinopathy develops when new blood vessels grow on the retina. These “new” blood vessels are extremely delicate and can cause significant bleeding. Without treatment, the blood can create scar tissue. The scar tissue can eventually cause the retina to pull away from the back of the eye (retinal detachment). At this stage of retinopathy, there is high risk for vision loss.
Occasionally, the blood vessels in the central part of the retina (macula) become blocked or leak blood. These changes are known as diabetic maculopathy and pose a serious risk for vision impairment.
Causes of diabetic retinopathy
Retinopathy is most commonly caused by persistent high blood glucose levels, high cholesterol (particularly high triglycerides), or high blood pressure. The longer you have lived with diabetes poses a greater risk of developing retinopathy.
Diabetic retinopathy symptoms
In the early stages of retinopathy there are typically no symptoms and is usually detected through a routine diabetic eye screening.
With more advanced retinopathy, the individual may experience their sight gradually worsening, sudden vision loss, blurred vision, eye pain, floaters or redness of the eye.
Treatment for diabetic retinopathy
Treatment isn’t always necessary, particularly in the early stages of retinopathy. For example, I do not require any treatment at this stage. I was informed to keep my blood glucose, cholesterol and blood pressure within the target range and to continue attending my yearly diabetic eye screening appointments.
More advanced retinopathy poses an increased risk of vision loss, therefore, treatment may be required. The main methods of treatments are laser treatment, eye injections, or an operation which removes blood or scar tissue.
Is diabetic retinopathy reversible?
Diabetic retinopathy has been considered to cause irreversible damage. However, this is a question I have been seeking the answer to myself. I have read stories online where individuals had a similar result to mine (background retinopathy), and once they had all of their conditions under control (blood glucose, cholesterol, and blood pressure), they received a normal result on their next diabetic eye screening. I reached out to the diabetic forums I follow on Facebook, and, I was pleasantly surprised at the number of individuals that have experienced this. Many had gone from having background retinopathy to normal results just through lifestyle changes and controlling their conditions. These findings suggest that there is a chance to reverse the damage caused by the earlier stages of retinopathy. Although I am yet to speak to my eye specialist team to confirm these findings, I believe the proof is in the pudding. If others have managed to go from having background retinopathy to normal results, then I believe we all have a chance as well.
My plan to reverse background retinopathy
The aim is to continuously keep my blood glucose levels, cholesterol and blood pressure within the target range. By doing this, I should hopefully be able to reverse the damage done to my eyes.
What my blood glucose control is currently like:
I am fortunate to have full control of my blood glucose levels. Following a low carb diet has enabled me to have non-diabetic blood glucose readings and to come off all diabetic medication (I was on metformin and insulin). I will continue with a low carb diet to keep my blood glucose levels controlled. For more information on low carb diets, read our What food should diabetic eat guide. I also recommend reading our “Ten steps to help with managing diabetes” post.
What my cholesterol is currently like:
As I mentioned earlier, I have struggled with my blood pressure and cholesterol. I previously posted about a follow-up appointment that was coming up with the Lipids clinic at Hammersmith Hospital to review my blood profile, with emphasis on my cholesterol. This appointment was on the 27th April 2018, and I am happy to say that my total cholesterol was under 3mmol/L, and my liver function test has resumed to normal levels. The liver function issues were a result of the cholesterol medication I was on previously, so I am thrilled to have normal results again.
My HDL (good cholesterol) however, is a bit lower than I would like. I am going to review my diet to attempt to increase this. I would also like to decrease my LDL (bad cholesterol) further.
What my blood pressure is currently like:
My blood pressure is better than it was, but it can still reach levels higher than I would like. For example, at times I can get a reading of 135/90, which is considered pre-high blood pressure. My systolic blood pressure is often high (the upper figure). Systolic is the rate at which the heart is squeezing and pushing the blood around the body.
My ideal goal would be to bring my blood pressure and cholesterol into target range with diet alone and to come off all medication. However, at first, my main priority is to keep them controlled. I did some research on cholesterol and blood pressure to see how I could amend my lifestyle to achieve these goals. This has helped me form a plan to attempt to control these conditions.
Following a low carb diet to control diabetes, blood pressure and cholesterol
Many studies show that a low carb high-fat diet can improve blood glucose levels, blood pressure, and cholesterol. I can certainly testify for blood glucose levels, as mine went from being uncontrolled to controlled within just a few days of following a low carb diet. My blood pressure has also dropped significantly since last year. While my blood pressure can still be slightly high, my systolic level used to be around 200! I also had my blood pressure medication reduced after following a low carb diet. The only thing I cannot personally testify for is cholesterol. My triglycerides have certainly come down to the target range, but my LDL (bad cholesterol) is often too high.
Familial Hypercholesterolemia and high levels of LDL
There is a condition, called familial hypercholesterolemia, which leads to high LDL levels and is caused by variants of genes involved in cholesterol metabolism. Carriers of these gene variants cannot tolerate saturated fat and if they eat too much, their LDL cholesterol increases. There are many possible variants of these genes. I have been tested to see if I am a carrier of these known genes, but the tests came back clear. What I do know is, whenever I increase my saturated fat, my LDL creeps up. So I clearly cannot tolerate it very well.
On the topic of genes, the diabetes specialist clinic at St Mary’s hospital believe I have a rare gene causing all of my conditions. I’ve had high blood pressure since I was sixteen, and prediabetes since my mid-twenties, which is quite unusual. The doctors at St Mary’s have scheduled an appointment for me in June to undergo genetic testing, which will test for many rare genes. It will take four months to obtain the results of this test! I get the results at my follow-up appointment in September 2018. I’ll be eagerly awaiting that appointment. It would be great to know what the root cause of my conditions are.
How I aim to control my blood glucose levels, blood pressure and cholesterol
So with that said, I am going to do the following in an attempt to control all of my conditions:
Lower my saturated fat intake by reducing the amount of cheese, butter, coconut, and cream in my diet to hopefully lower my LDL (gutted!). I will also increase my polyunsaturated and monounsaturated fats, these include seeds, nuts, avocado and olive oil, to increase my HDL. Please note that following a low-carb high-fat diet normally means you can eat all types of healthy fats, so if you don’t have issues similar to mine, you should be able to eat saturated fat with no problem.
I recently read a book called, How Not To Die, by Dr. Michael Greger, which I highly recommend. Dr. Michael Greger explains which foods have been scientifically proven to cause many diseases. There is a section in the book about blood pressure and several discussions around cholesterol. The general message of this book is that animal products, such as meat, cheese, eggs, and milk, are major causes of most diseases and cancers, with uncountable studies to back these findings. Dr. Michael Greger recommends a plant-based vegan diet to prevent and reverse nearly all known conditions. While there are many conflicting medical opinions and studies to this theory, I don’t see any harm in trying to eat more of a plant-based diet. I don’t feel like it is realistic for me to give up animal products completely, but I would like to try reducing the number of times a week I eat animal-based foods to see if my blood pressure and cholesterol improves.
I will also increase my physical exercise, I already do a lot of walking, but, I am yet to commit to more intense and physical exercise.
For those of you that follow me on Instagram will have seen that I am also undergoing testing for digestive issues. I have been experiencing extreme bloating, issues with going to the loo… to put it politely, panic attacks, sleep issues and fatigue. My GP arranged for a blood test and an ultrasound to rule out ovarian cancer, coeliac disease, thyroid issues and any deficiencies. I haven’t had the appointment through for the ultrasound, but my blood test came back all clear for ovarian cancer, coeliac disease, and thyroid issues. The blood test did show that I have low vitamin D, and after a bit of research, it can cause a lot of the symptoms I have been experiencing. It can even cause depression, which, as some of you may know, I have been experiencing. There are still other conditions that need to be ruled out. If my digestive issues are due to the low vitamin D, I shouldn’t have to review my diet again. However, if it turns out that I have something like IBS, I will have to review my diet and reduce foods that fall into a high FODMAP category (foods that cause bloating). Once I have clarification on this condition, I will produce a monthly meal plan that I will follow to control my blood glucose levels, blood pressure, and cholesterol which I will, of course, share. If you would like to receive this meal plan when it becomes available, you can subscribe to the newsletter where I will share the meal plans.