Is Your Diet for Diabetes and Kidney Health Missing Key Nutrients?

What nutrients need to be supplemented with this diet?

Hello, my mother-in-law has been diabetic for over 10 years.
Recently, she had to undergo amputation and is unable to move freely, which has forced her into a passive dietary control.
Her daily diet consists mainly of a mix of barley, wheat, oats, millet, rye, buckwheat, water chestnut, red quinoa, brown rice, wild rice, black glutinous rice, foxtail millet, amaranth seeds, snow lotus seeds, yellow soybeans, black beans, green beans, and mung beans.
Except for oats, which are consumed in larger quantities, the other grains are mixed in equal amounts to make a ten-grain rice, which she has as her staple food, one bowl per meal.
She also consumes about two servings of vegetables, and for protein, she has fish, meat, or a serving of herbal chicken soup for two meals.
Between meals, she has one date, 11 cherries, a quarter of an apple, unsweetened white fungus (which contains red dates, etc.), and various mushrooms cooked with ginger to make soup, taking one serving as a snack.
Occasionally, she has two pieces of biscuits with buckwheat tea.
Is there anything lacking in this diet? Since my mother-in-law cannot exercise at all, and to take care of her gastrointestinal issues, aside from occasionally consuming chicken breast, her other meat source is fish.
She eats 2-3 eggs a week.
In addition to diabetes, my mother-in-law also has poor kidney function, which causes swelling in her remaining foot due to her consumption of tomatoes, so she cannot freely change her fruit intake.
She also has high blood pressure, eye diseases, and a bad temper! With this diet, she often questions if it’s enough.
However, in reality, I can't finish all of it myself, so how could it be insufficient? Is it a psychological issue? Am I providing enough to meet her daily nutritional needs? My mother-in-law currently needs to inject insulin twice a day, 29 units in the morning and 25 units in the evening (I am unsure of the units).
Is it possible that if her blood sugar is well-controlled, she could stop the injections one day? Three months ago, her blood sugar was 400-500, but in the last three months, it has only occasionally spiked to 170-180, with most days being between 100-130.
I know this is within the normal range, but I am genuinely concerned if this dietary approach might lead to malnutrition.
My mother-in-law is approximately 158 cm tall and weighs between 75-80 kg, and she has lost a little weight.
She cannot stand, and I am unsure if I should help her lose weight...
Is it necessary at 65 years old? Besides the knowledge that exceeds my understanding, I also have to face the doubts of others and my mother-in-law's temperament.
I hope you can help me confirm if my approach is okay, as it would at least give me peace of mind.
I even believe that the dietary content for diabetes is very suitable for the general adult population! I just lack a definitive endorsement.
Please take a look and let me know what is lacking or what should be changed.
The key concern is that I am afraid my mother-in-law might really become malnourished...
Thank you for your help.

Sincerely,
Ms.
Chen from Hsinchu

Chen, 30~39 year old female. Ask Date: 2009/02/23

Dr. Cai Xiuwen reply Nutrition

Hello, Ms.
Chen! I understand the challenges of caring for a diabetes patient, and I can imagine that you have put in a lot of effort and are under considerable stress.
For diabetes patients with poor kidney function, dietary restrictions can be particularly difficult, but the most challenging aspect is ensuring patient compliance.
A diabetes diet requires calorie control and balance, meaning that all types of food can be consumed, but portion sizes must be controlled.
Given that your mother-in-law has had diabetes for many years and has poor kidney function, it is advisable to use insulin because it does not require hepatic or renal metabolism like oral medications, thus not burdening liver or kidney function.
Whether or not insulin can be avoided should be assessed by a physician based on your mother-in-law's fasting and postprandial blood glucose levels and dietary control.
However, it is likely that long-term diabetes patients with poor kidney function will need insulin for management.
Currently, your mother-in-law has low physical activity, and based on your description, it seems her portion sizes may be a bit excessive.
I imagine it must be challenging for you to manage portion control! I recommend taking your mother-in-law to a hospital nutrition consultation, where a dietitian can provide personalized guidance based on her dietary habits and health status.
This way, the adjustments can be tailored to her needs, and the dietitian's direct explanation may improve her compliance.
Since dietary adjustments for diabetes patients with poor kidney function should be based on her blood test results, it would be better to discuss specific food items and quantities directly with the dietitian.
For example, if potassium levels are high, foods like tomatoes, legumes, and pumpkin should be limited, and there are also restrictions on fruits.
If phosphorus levels are too high, brown rice and barley should be restricted as well.
I hope this information helps alleviate some of your concerns.
This response is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Department of Health.

Reply Date: 2009/02/23

More Info

Managing a diet for someone with diabetes and kidney issues, especially in the context of your mother-in-law's situation, requires careful consideration of various nutritional factors. Given her long-standing diabetes, recent amputation, and kidney function concerns, it’s crucial to ensure that her diet is not only balanced but also tailored to her specific health needs.

Nutritional Overview
1. Carbohydrate Management: Your mother-in-law's diet appears to be rich in whole grains, which is beneficial for managing blood sugar levels due to their high fiber content. However, it's essential to monitor the total carbohydrate intake to prevent spikes in blood glucose. The goal is to maintain stable blood sugar levels, ideally between 100-130 mg/dL, as you've noted.

2. Protein Sources: Since she has kidney issues, protein intake should be moderated. Fish is a good source of protein and is generally easier on the kidneys compared to red meat. However, the total protein intake should be monitored, especially if her kidney function is compromised. The recommendation for protein intake in chronic kidney disease (CKD) is often around 0.6-0.8 grams per kilogram of body weight, depending on the stage of kidney disease.

3. Fruits and Vegetables: While fruits and vegetables are essential for providing vitamins and minerals, some may need to be limited due to potassium and phosphorus content, which can be problematic for kidney health. You mentioned avoiding tomatoes due to water retention, which is wise. It’s crucial to choose low-potassium fruits and vegetables, such as apples, berries, and leafy greens, while being cautious with portion sizes.

4. Fluid Intake: Given her kidney condition, fluid intake may also need to be monitored. If she experiences swelling, it could indicate fluid retention, which is common in kidney disease.
5. Sodium and Blood Pressure: Since she has high blood pressure, a low-sodium diet is essential. This means avoiding processed foods and being mindful of salt in cooking. Herbs and spices can be used for flavoring instead of salt.

6. Insulin Management: The fact that her blood sugar levels have improved significantly (from 400-500 to 100-130) is a positive sign. However, the goal should be to maintain this control consistently. It’s important to work closely with her healthcare provider to adjust insulin dosages as her diet and blood sugar levels stabilize.

Potential Nutritional Gaps
1. Micronutrients: With a limited diet, there may be a risk of deficiencies in certain vitamins and minerals, particularly if she is not consuming a variety of foods. Consider incorporating a multivitamin or specific supplements as advised by her healthcare provider.

2. Fiber: While whole grains provide fiber, ensure that she is also getting enough soluble fiber, which can help with blood sugar control. Foods like oats, beans, and certain fruits (like apples and pears) are excellent sources.

3. Caloric Intake: If she is losing weight unintentionally, it may be necessary to increase caloric intake without compromising her dietary restrictions. This can be achieved through healthy fats (like olive oil or avocados) and nutrient-dense foods.

Psychological Factors
It’s understandable to feel concerned about whether her diet is sufficient. Psychological factors can play a significant role in managing chronic conditions. Encouraging her to engage in discussions about her dietary preferences and involving her in meal planning can help improve her outlook and compliance.

Conclusion
In summary, your mother-in-law’s diet seems to be on the right track, but it’s essential to ensure it is balanced and meets her specific nutritional needs. Regular consultations with a registered dietitian who specializes in diabetes and kidney disease can provide personalized guidance and reassurance. Monitoring her blood sugar levels and kidney function regularly will also help in making necessary adjustments to her diet. Your proactive approach to her nutrition is commendable, and with the right support, you can help her maintain a healthy and satisfying diet.

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