Essential Dietary Guidelines for Managing Diabetes and Kidney Disease

Diet for Kidney Disease

I would like to ask: My mother has had diabetes for 25 years, developed hypertension two years ago, and has had kidney disease for the past six months.
Her blood sugar level is 200 mg/dL (fasting), blood pressure is 150 mmHg, B.U.N.
is 35 mg/dL, and creatinine is 2.8 mg/dL.
My mother is somewhat aware of how to follow a diabetic diet, but her kidney function continues to decline.
When I consulted a nephrologist, the doctor said that she doesn't need to pay too much attention to the dietary restrictions for kidney disease, as long as her blood sugar is well controlled.
However, I have read that patients with kidney disease should monitor their intake of sodium, potassium, and protein.
What dietary considerations should my mother follow to avoid the need for dialysis? Thank you!

katty, 20~29 year old female. Ask Date: 2005/07/16

Dr. Cai Xiuwen reply Nutrition

The doctor's advice is generally correct.
In individuals with long-standing diabetes, some complications may gradually appear, with diabetic nephropathy being one of them.
The dietary principles for diabetes emphasize low salt, low sugar, and low fat.
Adhering to these dietary guidelines helps control blood glucose levels, which is essential to avoid putting a strain on kidney function.
If blood glucose levels are poorly controlled, dietary management for kidney issues will not be effective.
However, it is important to note that when diabetic nephropathy is present, greater attention should be paid to limiting salt intake.
It is advisable to consume fresh foods and avoid processed foods.
The dietary plan for kidney disease should be adjusted according to individual circumstances.
I recommend consulting with a dietitian at the treating hospital to gain a comprehensive understanding of your mother's condition, which will allow for the most appropriate recommendations.
Wishing you health and safety.
This response is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Department of Health.

Reply Date: 2005/07/16

More Info

Managing diabetes and kidney disease simultaneously requires a careful and individualized dietary approach. Given your mother's long history of diabetes, recent hypertension diagnosis, and current kidney issues, it is essential to focus on a diet that supports both her blood sugar control and kidney function.

Key Dietary Guidelines
1. Carbohydrate Management: Since your mother has diabetes, controlling carbohydrate intake is crucial. Aim for complex carbohydrates with a low glycemic index, such as whole grains, legumes, and non-starchy vegetables. These foods help maintain stable blood sugar levels. It is advisable to work with a registered dietitian to create a meal plan that balances carbohydrates throughout the day.

2. Protein Intake: With a creatinine level of 2.8 mg/dL, your mother is experiencing some degree of kidney impairment. While protein is essential for health, excessive protein can strain the kidneys. The general recommendation for someone with kidney disease is to limit protein intake to about 0.6 to 0.8 grams per kilogram of body weight, depending on the stage of kidney disease. However, this should be personalized based on her overall health status and dietary needs.

3. Sodium Control: High sodium intake can lead to increased blood pressure and fluid retention, which can further damage the kidneys. It is recommended to limit sodium intake to less than 2,300 mg per day, or even lower (1,500 mg) if hypertension is present. This can be achieved by avoiding processed foods, canned soups, and adding minimal salt to meals.

4. Potassium Management: Depending on her kidney function, potassium levels may need to be monitored closely. Foods high in potassium, such as bananas, oranges, potatoes, and tomatoes, may need to be limited if her potassium levels are elevated. Regular blood tests can help determine if potassium restriction is necessary.

5. Fluid Intake: Depending on her kidney function and whether she is experiencing any swelling or fluid retention, fluid intake may need to be adjusted. It is essential to consult with her healthcare provider about the appropriate amount of fluid she should consume daily.

6. Healthy Fats: Encourage the consumption of healthy fats, such as those found in olive oil, avocados, and nuts, while limiting saturated and trans fats. This is particularly important for managing cholesterol levels and overall cardiovascular health, which is crucial for individuals with diabetes and kidney disease.

7. Regular Monitoring: Regular monitoring of blood glucose levels, blood pressure, and kidney function tests (BUN, creatinine) is vital. This will help in adjusting dietary recommendations as needed.

8. Education and Support: It may be beneficial for your mother to attend diabetes education classes or work with a dietitian who specializes in renal nutrition. This can provide her with the knowledge and tools necessary to manage her conditions effectively.

Conclusion
While managing diabetes is critical, it is equally important to pay attention to kidney health, especially given her elevated creatinine levels. A balanced diet that considers carbohydrate control, protein restriction, sodium and potassium management, and overall nutritional adequacy is essential. Encourage your mother to maintain regular follow-ups with her healthcare team to monitor her conditions and adjust her dietary plan as needed. This comprehensive approach can help prevent further kidney damage and improve her overall health outcomes.

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