We examined the effectiveness and problems associated with a low-carbohydrate diet and whether or not patients can practice and continue such treatment based on the influence on the serum lipid profile and patients' psychological burden. The subjects were 30 patients with type 2 diabetes who were examined in a randomized cross over comparison study of an energy-controlled diet versus a low-carbohydrate diet. The amount of energy was set as equal to the standard weight × physical activity amount (25 to 30 kcal/kg) in the two diet regimen groups, and the PFC (protein: fat: carbohydrate) ratio in the low-carbohydrate diet group was set to 30:30:40. The energy intake did not markedly differ between the groups. The carbohydrate intake was significantly lower and the lipid intake significantly greater in the low-carbohydrate diet group than in the energy-controlled diet group. The improvement in the HbA1c was greater in the low-carbohydrate diet group than in the energy-controlled diet group. The serum lipid profile, including RLP-C, RLP-TG, GSES, and PAID, also did not differ markedly between the groups. These results suggest that a mild low-carbohydrate diet with a carbohydrate energy ratio of 45.6 % may be an effective treatment method that patients can practice and continue.

A 67-year-old man had been found to have hyperglycemia during a routine health examination at 40 years of age; however, he neither underwent treatment nor consulted a medical professional. He presented to our hospital with chief concerns of visual impairment and pain in the left eye. On an ophthalmologic examination, iris rubeosis and diabetic retinopathy were detected in his left eye. Carotid ultrasonography revealed obstruction of the left internal carotid artery; thus, the patient was diagnosed with ocular ischemic syndrome. Because of the untreated type 2 diabetes mellitus, he was admitted to our department, and insulin therapy was started; simultaneously, interventions for hypertension, dyslipidemia, and a smoking habit were initiated for the patient. Superficial cranial artery-middle cerebral artery anastomosis was performed at the Department of Neurosurgery in our hospital. Although the blood flow to the ocular artery improved, the left eye became blinded due to neovascular glaucoma and a hypermature cataract. The differential diagnosis of ocular ischemic syndrome is often difficult in patients with diabetic retinopathy or central retinal vein occlusion. Treating physicians should consider the presence of ocular ischemic syndrome if the severity of diabetic retinopathy differs in the right and left eyes or transient visual acuity declines.