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Diabetes & kidney insufficiency- what does this mean for my diet?

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In 30-40% of cases of chronic kidney disease (CKD), diabetes is the trigger. Are you a diabetic yourself? Has your medical team possibly already diagnosed or mentioned kidney disease? This article will give you more clarity. It explains what diabetes means for your kidneys and how you can adjust your diet for diabetes and kidney insufficiency.
Here's what you need to know
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Voici ce qu'il faut savoir
Esto es lo que debe saber
  • An existing diabetes disease can have a long-term negative effect on the functioning of your kidney. For this reason, there are several things to keep in mind when it comes to nutrition
  • Slightly different dietary recommendations apply depending on whether or not you already have chronic kidney disease
  • Have blood glucose and kidney values checked regularly by a doctor so that you can react to changes at an early stage
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The number of diabetes cases is increasing worldwide. Statistics show that as many as one in eleven adults in the world is diabetic - that's around 425 million people. Maybe you are affected, too. But how are diabetes and your kidney function related, and what does all this mean for your diet? That's what we're going to look at in this article.

Diabetes - what is it anyway?

In principle, the concentration of sugar (=glucose) in your blood increases with diabetes. If your medical team suspects that you are diabetic, they will first test your blood sugar in fasted state - i.e. after 8 to 10 hours without food. If it is significantly elevated, this indicates diabetes. The reasons for this can vary. For this reason, a distinction between type I and type II diabetes is made.

  • Type I diabetes: In order for sugar to enter your cells from your blood, it needs a key to "open the door."  This key is the hormone insulin. In type 1 diabetes, the insulin-producing cells of your pancreas are gradually destroyed until your body can no longer produce insulin itself. Mostly the reason for this is a malfunction of the defense system (=immune system), whereby the immune cells attack and destroy the insulin-producing cells (=beta cells). This is why type 1 diabetes is also classified as an autoimmune disease. If the key - insulin - for the cell door is missing, the sugar no longer enters the cells and remains in the blood. As a result, the blood sugar level increases.
  • Type II diabetes: Here, the body cells no longer respond as well to insulin. This is often due to the fact that the blood sugar - and thus also the insulin level - was previously too high too often. However, this type of diabetes also appears to have hereditary factors. In type II diabetes, your cells react slowly to the hormone insulin. This is also called insulin resistance. As a result of this insulin resistance, more sugar remains in the blood and your cells lack energy.

Diabetes and kidney insufficiency- how are they related?

With diabetes, the concentration of your blood sugar is increased. But how does this affect to your kidneys? If diabetes persists for several years, glucose is also deposited on your vessels. The vessels become hard and inelastic and the blood can't flow through them as easily. This leads to circulatory problems in the organs. The blood vessels in the legs, heart, brain and kidneys are particularly affected.

Diabetes can therefore damage the vessels in the kidneys over a long period of time, leading to kidney insufficiency. This is not at all uncommon. Almost 10% of all people with diabetes develop kidney weakness in the course of their disease. In addition, almost 50% of people on dialysis also have diabetes. As you can see, diabetes and kidney insufficiency are often closely linked.

It is also important to note that diabetes can not only lead to kidney disease, but can also significantly accelerate the progression to kidney failure. As such, it is very important to always pay attention to your blood glucose levels and to try to keep them in balance.

Diabetes & kidney insuffieciency - what should I pay attention to?

If you are already affected by diabetes, it is important that you have your kidney values checked regularly. This way, your medication can be optimally adjusted and you can react to changes in good time. Your family doctor should test for protein in the urine (=albuminuria) at least once a year. The more the kidney filters are damaged by diabetes, the more protein is spilled from the blood into the urine. This is exactly what can be determined by this test.

Your behavior then plays the decisive role in the treatment of diabetes. Good nutrition, a healthy weight and sufficient exercise are the basis for healthy blood sugar levels and thus also for good kidney function. As you may already know, there are also some things you should consider in your diet when you have kidney disease. But what changes now when you have diabetes in combination with kidney disease? Many factors are similar - for others, you should specifically look for a few adjustments. In the following section, we will take a closer look at some important food groups.

Carbohydrates

With diabetes…

...it is important to avoid carbohydrates with a high glycemic index, i.e. those such as white bread, French fries or sweets, in meals. The glycemic index is a measure used to determine the effect of a carbohydrate-containing food on blood sugar levels. The higher the value, the less suitable the food is for you.

In diabetes and chronic kidney disease…

...there are no additional guidelines or restrictions compared to diabetes. For your health, you should generally avoid carbohydrates that cause your blood sugar to rise rapidly and then drop again quickly. This way you relieve your organs and counteract cravings.

Dietary fiber

With diabetes…


...since you as a diabetic should rather rely on carbohydrates with a low glycemic index, a high-fiber diet is recommended. You can achieve this by giving preference to whole grain products, raw vegetables and legumes.

In diabetes and chronic kidney disease…

...fiber is also important for a healthy and wholesome diet. You should not do without it even if you have kidney disease. However, depending on the severity of your kidney disease, you should eat whole grain products and raw vegetables in controlled amounts, as they can contain a lot of phosphate and potassium at the same time. You should discuss your current potassium and phosphate blood levels with your medical team, as the doctor's recommendation may vary. You can easily check the potassium and phosphate levels of foods in the Mizu app!

Fat

When you have diabetes…

...you should avoid foods with a high content of trans fatty acids. Trans fats are also called unsaturated fatty acids. They are formed when originally healthy vegetable oils are industrially processed. When it comes to meat, you should opt for low-fat products. Fish, on the other hand, is a good source of healthy omega-3 fatty acids.

For diabetes and chronic kidney disease…

…nothing changes in the preferred choice of fat types.

Protein

In diabetes…

...a high-protein diet is often recommended. Experts suggest that a diet high in protein and low in calories at the same time may be beneficial for people with type II diabetes.

In diabetes and chronic kidney disease…

...when dialysis is not required, it is often necessary to aim for values of 0.8 - 1.0 g protein per kg body weight per day. This form of nutrition is called a low-protein diet. However, you should be careful not to consume too little protein. The right measure is therefore crucial. Above all, proteins ensure a longer feeling of fullness and can even have a positive effect on long-term blood sugar levels. You can find a selection and more detailed information in your Mizu app.

Are you starting dialysis soon?

Then your daily protein intake will increase compared to people with kidney disease without dialysis. The recommended daily protein intake is 1.2 g per kg body weight. However, as you probably already know, it is important to use products that are low in phosphates and potassium. It is best to discuss your recommended daily intake of protein with your health care team. As you can see, this can vary from person to person.

Caloric intake

With diabetes…

…it is important to eat a calorie-conscious diet and achieve controlled weight loss.

In diabetes and chronic kidney disease…

…a calorie target of 25 – 35 kcal per kg of body weight per day usually applies. If your treatment team recommends that you lose weight, your target calorie intake may change.

Phosphorus

With diabetes…

…you can follow the normal amount and…usual dietary recommendation of about 600 to 1,000 mg daily

In diabetes and chronic kidney disease…

…depending on the severity, a phosphate-conscious diet and food selection is important. Especially in later stages of kidney disease, a low-phosphate diet is generally recommended. It will greatly reduce your long-term risk of developing secondary health conditions. However, individual factors must be taken into account, which is why you should talk to your nephrologist about this topic.

Table salt

With diabetes…

…there are no differences from the commonly recommended low-salt diet with a maximum of 5 to 6 g of table salt daily.

In diabetes and chronic kidney disease…

…it is important to reduce your daily salt consumption. Specifically, you should not exceed the recommended daily maximum amount of 5g of table salt. You can also find more detailed information and practical tips on the low-salt diet in the Mizu app.

Drinking amount

With diabetes…

…you should make sure to drink calorie-free liquids as much as possible. If you get bored with water in the long run, that's not a problem. There are many tricks you can use to spice up the taste without sugar. For example, add a few leaves of peppermint and slices of lemon or lime. Or refine your water with frozen berries. In summer, they also keep your drink pleasantly cool.

For diabetes and chronic kidney disease…

...your dialysis center may already impose restrictions on the amount you drink per day, especially in the late stages of kidney disease. This applies especially if your daily urine volume decreases and prevents overhydration in the body. However, you should always discuss the exact amount you should drink with your nephrologist.

General dietary habits

With diabetes…

…there are different dietary habits that have different advantages and disadvantages. A dietician can give you a good overview.

For diabetes and chronic kidney disease…

…the Mediterranean diet is the most recommended. You should always make sure that you keep your protein and calorie intake in the green zone while controlling your blood sugar, phosphate and potassium levels. Your HbA1c (=long-term blood glucose) value offers you a good reference point for controlling your blood glucose values.

Food preparation

When you have diabetes…

...it is recommended that you prepare your food in a way that preserves the ingredients by cooking it for a short time and using as little water as possible. You should also eat salads, raw vegetables and high-fiber foods frequently. As far as fruit is concerned, you should give preference to fresh fruit and avoid juices or stewed fruit. You should also cut back on fruit depending on the fructose content. You should try to use cooking and spreadable fats very sparingly if calorie reduction is your current dietary goal.

With diabetes and chronic kidney disease…

... fruit and vegetables are also part of a healthy diet. In the advanced stage of kidney disease, however, your potassium and phosphate levels can rise. This is because your kidneys can no longer regulate these two nutrients properly. In these cases, you should therefore make sure that you do not consume too much potassium and phosphate in the form of fruits and vegetables.

For example, cooking vegetables several times in plenty of water can lower the potassium content. You should not continue to use the cooking liquid. Raw fruit can also contain a lot of potassium. Cooked fruit or canned fruit is generally lower in potassium. You can find out more about this in other articles on the Mizu app.

Talk to your medical team

So you see, with a few tricks, your diet can be easily adjusted for diabetes and kidney disease. At the same time, an adjustment is incredibly important and indispensable for the prevention of further secondary diseases. Be sure to talk to your medical team about your personal nutritional situation. As you can see, your optimal diet also depends strongly on your current health status and your blood values.

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References
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