If you recall from our last blog article, it’s that one of the most important steps to take when you’re diagnosed with CKD is to make changes to your diet by adopting a kidney-friendly one that’s SPPP balanced.

But that raised a few questions that I’ve received via email:

But I’m also diabetic...what should I do?

I have both, what am I supposed to eat?

How do I balance a CKD diet and a diabetic diet?

I hear you. Which is why I also want to discuss that in today’s lesson so that those who have diabetic kidney disease will be able to learn more about their condition and what they can do to keep everything in check.

What’s the relationship between Diabetes and Chronic Kidney Damage?

Diabetes is actually one of the risk factors and leading cause of kidney failure.

High blood glucose (blood sugar) can damage the blood vessels in your kidneys. When the blood vessels are damaged, your kidneys cannot clean your blood properly. 

In turn, your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. 

Other health results include high blood pressure and having protein in your urine. 

What does that mean?

It means that if the urine stays in your bladder for a long period of time, you can develop an infection when your urine has a high sugar level (which encourages rapid growth of bacteria).

So...what are the symptoms of diabetic kidney disease?

Most people with diabetic kidney disease (diabetic nephropathy) do not have symptoms because the only way to know if you have diabetic kidney disease is to get your kidneys checked. However, for some, there are early signs such as:

• Increased excretion of protein in urine
• Weight gain
• Leg or ankle swelling/cramps
• Increased need to urinate (especially at night)
• High blood pressure

Before we continue, I want to discuss the differences between diabetic kidney disease with type 1 & 2 diabetes. People with type 1 diabetes do not produce insulin, while type 2 diabetes do not respond to insulin. 

Diabetic kidney disease is kidney damage that results from having diabetes. Because diabetes can cause high blood sugar, it can damage the part that filters the blood. For this reason, the damaged filter becomes leaky, and then it lets protein into your urine.  

Now, moving on...

What lab tests do I need to know that I have diabetic kidney disease?

First, take note of the signs or symptoms that you experienced since that will be the first thing that your doctor will ask you. Then, he or she will conduct a physical exam after which he or she will ask about your medical history. 

Once that’s done, they will then refer you to a nephrologist or a diabetes specialist (endocrinologist). 

To really determine if you have diabetic kidney disease, you may be advised to do these tests and procedures: 

• Blood tests. If you have diabetes, you will need blood tests to monitor your condition and determine how well your kidneys are working.
• Urine tests. Urine samples provide information about your kidney function and whether you have too much protein in the urine. High levels of a protein called microalbumin may indicate your kidneys are being affected by the disease.
• Imaging tests. Your doctor may use X-rays and ultrasound to assess your kidneys' structure and size. You may also undergo CT scanning and magnetic resonance imaging (MRI) to determine how well blood is circulating within your kidneys. Other imaging tests may be used in some cases.
• Renal function testing. Your doctor can assess your kidneys' filtering capacity using renal analysis testing.
• Kidney biopsy. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. You'll be given a numbing medication (local anesthetic). Then your doctor will use a thin needle to remove small pieces of kidney tissue for examination under a microscope.

Okay….how about medication?

In the early stages of the disease, your treatment plan may include various medications that will help: 

• Control high blood pressure. Medications called angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used to treat high blood pressure. Using both of these together isn't advised because of increased side effects. Studies support the goal of a blood pressure reading below 140/90 millimeters of mercury (mm Hg) depending on your age and overall risk of cardiovascular disease.
• Manage high blood sugar. Several medications have been shown to help control high blood sugar in people with diabetic nephropathy. Studies support the goal of an average hemoglobin A1C of less than 7% – I'll explain more about this in a later lesson.
• Lower high cholesterol. Cholesterol-lowering drugs called statins are used to treat high cholesterol and reduce protein in the urine.
• Foster bone health. Medications that help manage your calcium phosphate balance are important in maintaining healthy bones.
• Control protein in urine. Medications can often reduce the level of the protein albumin in the urine and improve kidney function.

Along the way, your doctor may recommend follow-up testing at regular intervals to see whether your kidney disease remains stable or progresses. 

Can diabetic kidney disease be treated?

Treatment for diabetic kidney disease include: 

• Controlling and managing blood sugar levels
• Controlling high blood pressure
• Reducing dietary protein intake
• Avoiding medications that may damage kidneys
• Treat urinary tract infections
• Exercise/Lose weight (under the supervision of a physician)

If I have diabetic kidney disease and CKD, how should I balance both diets

A lot of confusion comes in when one ingredient that may be good for diabetes, may not be good for CKD (and vice versa). 

Which is why you need to consult a registered renal dietitian who is trained in both diabetes and Chronic Kidney Disease nutrition for this one. 

Together you will create a diet plan that will help keep your blood sugar levels steady and reduce the waste and fluid your kidneys have to handle.

He or she will give nutritional guidelines to you on how much nutrients (SPPP) you can have each day and limit or avoid them while planning your meals. 

Remember that portion control is also important to do. 

But if you want, you could talk to your dietitian regarding tips to accurately measure a serving size because what may be measured as one serving size on a regular diet may count as three times more on a kidney diet. 

The meal planning also includes eating meals and snacks that have the same size and calorie/carbohydrate content at certain times of the day in order to keep your blood glucose at an even level. Again, it’s important to check your blood glucose levels often and share the results with your doctor. 

Believe it or not, diabetes and Chronic Kidney Disease share a lot of the same food BUT of course, there are some important differences. 

So, what can I eat then?

What I will list down below are examples of food choices that are usually recommended on a typical renal diabetic diet since this list will be based on sodium, potassium, phosphorus, protein, and high sugar content of foods. 

CARBOHYDRATE FOODS

Milk and non-dairy products

• Skim/Fat-free milk
• Non-dairy creamer
• Sugar-free yogurt
• Sugar-free ice cream
• Sugar-free non-dairy frozen desserts

BREADS AND STARCHES

• Whole wheat
• Whole grain
• Unsalted crackers
• White/Whole Wheat Pasta
• Grits

FRUITS AND JUICES

• Apples/Applesauce/apple juice
• Raspberries
• Blueberries
• Low-sugar cranberry juice
• Grape/grape juice
• Grapefruit

STARCHY VEGETABLES

• Corn
• Peas
• Potatoes (soaked in order to reduce potassium)

NON-STARCHY VEGETABLES

• Asparagus
• Beets
• Broccoli
• Brussels sprouts
• Cauliflower
• Cabbage
• Cucumber

HIGH-PROTEIN FOODS

Meats, cheeses, and eggs

• Lean cuts of meat
• Eggs
• Poultry
• Low-cholesterol egg substitute

HIGHER-FAT FOODS

Seasonings and calories

• Sour cream
• Low-fat mayonnaise
• Low-fat cream cheese

Again, these are all just recommendations on a typical diabetic kidney disease diet. You need to ask your nutritionist if you can have any of these listed foods and make sure that you ask your recommended servings size as well. 

To put theory into practice, the next section includes 4 Tips For Dealing With Diabetes and CKD. 

Success means preventing diabetic kidney disease from progressing further. You know you're successful when you reach your blood glucose and blood pressure goals.

Healthy lifestyle habits and taking in your prescribed medications can help you achieve those goals and at the same time, improve your overall health.

  Tip 1: Reach your blood glucose goals

A healthcare professional will need to test your A1C. This is a blood test that will show your average blood glucose level over the past three months, which is different from the blood glucose checks that you may do yourself at home. 

The higher your A1C number, the higher your blood glucose levels have been during the past three months. 

The goal for many people with diabetes is to have their A1C below 7 percent. However, you may ask your health care team what your goal should be since reaching it will help protect your kidneys. 

After which, you will use those results to discuss with your healthcare team that will help decide on food, physical activity, and medicines. 

One more thing to ask your healthcare team is how often you should check your blood glucose level. 

Tip 2: Control and manage your blood pressure

High blood pressure (hypertension) happens when the pressure of your blood against the walls of your blood vessels increases. If left uncontrolled, it could cause stroke, heart attack, and Chronic Kidney Disease. 

For this reason, ask your health care team to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90mmHg. 

Taking prescribed medication that can help lower blood pressure and slow down kidney damage is also important. 

As we have discussed on Week 6 - Lesson 1, medications such as Angiotensin-Converting Enzyme Inhibitor (ACE Inhibitor) or Angiotensin Receptor Blockers (ARBs) showed to be more effective at reducing the risk of complete kidney failure. 

Tip 3: Develop or maintain healthy lifestyle habits

Forming healthy lifestyle habits can help you reach your blood glucose and blood pressure goals. Following these steps below will help you keep your kidneys healthy: 

• Stop smoking.
• Work with a nutritionist to develop a diabetes meal plan and limit salt and sodium.
• Get physical! Make it part of your routine (with the supervision of a physician).
• Stay at or get to a healthy weight.
• Get enough sleep. Be sure to aim for 7-8 hours of sleep each night.

  Tip 4: Take prescribed medications

Taking in medications may be an important part of your treatment plan as your health care professional will prescribe them based on your specific needs and can help meet your blood glucose and blood pressure goals. 

And those are the 4 Tips For Dealing With Diabetes and CKD. Now, like most life modifications to be made, it’s not going to be easy at first, but with your dedication and guidance from us, you’ll get to where you need to be…even better 

Just like Cleo for her husband here…

We’re still waiting for his lab results but we’re happy that we were able to find out that with the information and guidance that they received from us, he’s more active and working harder than he did 3 months ago. 

And if there’s one thing that I learned from successfully working with more than 33,000+ CKD patients, it’s that those who are actively engaged are the ones who get the most positive results.

And with active engagement, you can get positive results too!

Here’s what you can do starting today:

If you want to learn more about more about how Cleo and her husband did it, you can click here to watch: How to achieve the same results as Cleo and her husband.