An obese patient with type 2 diabetes whose diet was changed from the recommended high-carbohydrate, low-fat type to a low-carbohydrate diet showed a significant reduction in bodyweight, improved glycemic control and a reversal of a six year long decline of renal function. The reversal of the renal function was likely caused by both improved glycemic control and elimination of the patient's obesity.
Insulin treatment in type 2 diabetes patients usually leads to weight increase which may cause further injury to the kidney. Although other unknown metabolic mechanisms cannot be excluded, it is likely that the obesity caused by the combination of high-carbohydrate diet and insulin in this case contributed to the patient's deteriorating kidney function. In such patients, where control of bodyweight and hyperglycemia is vital, a trial with a low-carbohydrate diet may be appropriate to avoid the risk of adding obesity-associated renal failure to already failing kidneys.
Conclusion
The present case report shows that a low-carbohydrate, high-fat diet improves glycemic control, reduces body weight and may prevent the development of end-stage renal failure in an overweight patient with type-2 diabetes. Furthermore, it raises the concern that the obesity caused by the combination of a high-carbohydrate diet and insulin may have contributed to the patient's failing kidney function.
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Eddie
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