Diabetes and Kidney Disease – a challenging combination

by June Martin, RD

Diabetes is a serious chronic disease that happens when the pancreas does not produce enough insulin (Type 1 diabetes) or the insulin that is produced cannot be used properly (Type 2 diabetes). Type 2 diabetes is much more common (accounts for 90% of diabetes cases) and is considered by the World Health Organization to be a global epidemic stemming from less physical activity and a rise in obesity.

Over 3 million Canadians living with Diabetes
In Canada, diabetes is the leading cause of kidney disease and cases are expected to rise. According to the Canadian Diabetes Association there are over 3 million Canadians living with diabetes! The term “diabetic nephropathy” is often used to describe the damage high blood glucose can do to the tiny blood vessels in the kidneys. In the early stages of diabetic kidney disease there are often few or no symptoms, making it very difficult to detect without regular screening by a physician. Many people with diabetes also suffer from high blood pressure which can also contribute to kidney damage.

Control Blood Sugar and Blood Pressure
Controlling blood sugar and blood pressure are two important ways to prevent diabetic nephropathy. Medication, nutrition and exercise are all important for preventing and managing complications of diabetes. A good healthcare team can help make sure that all the pieces are in place for optimal care.

For those of you who are already living with diabetes and kidney disease, you are aware of how challenging it can be to manage both. Many patients who have been following a diabetic diet for years find it exceedingly frustrating to now try to adapt to a kidney diet too. It is important to get the help of a registered dietitian who can show you how to combine the two diets and make a single meal plan that works for you, on or off dialysis. Learning how to count carbohydrates will make the transition much smoother.

Cut back on salt
Cutting back on salt (sodium) is an important part of both diets. Avoid salty foods and don’t add salt at the table. Make sure to stay away from any salt substitutes that have “Potassium Chloride” as an ingredient list and check for it on the labels of any food listed as “low in salt”.

Choose white bread, pasta and rice
One of the most common questions we hear is about whole grains! Why is it that my diabetes diet tells me to eat whole grains and my kidney diet tells to eat white bread??? In fact, while whole grains have more fibre, they also have more potassium and phosphorus. Research shows that it is the total amount of carbohydrates that matters most in controlling blood sugar. Therefore, choose white bread, white rice and white pasta in the amounts recommended by your diabetic diet.

Tips for travel
Managing diabetes becomes even more challenging for those who must travel to and from dialysis several times a week. It’s important to always bring a snack (try not to go more than 4-6 hours without eating) and carry something to treat a low blood sugar. If you are on a fluid restriction bring hard candy or glucose tablets. Often people with diabetes are taught to treat a low blood sugar with orange juice but any juice will do! Ask your dietitian to help you with a meal plan for both dialysis days and non-dialysis days.

The recipes in Spice It Up! always include the carbohydrate content and diabetic exchanges so that you know how to include these foods in your diet. These recipes showcase how you can still eat well on a diabetic, renal diet.