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Diet Tips for People with Diabetes and Kidney Disease

Diet is one of the most important treatments in managing diabetes and kidney disease. If you have been diagnosed with kidney disease as a result of diabetes, you’ll need to work with a dietitian to create an eating plan that’s right for you.

This plan will help manage your blood glucose levels and reduce the amount of waste and fluid your kidneys process. Your dietitian will set the amount of daily calories you should consume. This will be further broken down into the right amounts of protein, fat and carbohydrates your body needs, at the same time lowering the amounts of sodium, potassium, phosphorus and fluids you will eat. This may sound complicated, but here are some tips to help you get the most out of your eating plan.

Know how much and how often

Your dietitian will give you specific nutritional guidelines to follow. Not only will these instructions tell you how much protein, fat and carbohydrate you can eat, these instructions will tell you how much potassium, phosphorus and sodium you can have each day. Because your diet needs to be lower in these minerals, you’ll be limiting or avoiding certain foods, while carefully planning your meals from the food choices recommended by your dietitian.

Read food packages carefully and make notes in your food diary. Patients are sometimes surprised at the amounts of hidden sodium in seemingly healthy choices like soup and low-fat frozen entrees. Popular diet colas, some teas and lemonades have sodium as well as phosphorus. Keeping track of this information can help you plan your meals faster and make better choices when you eat out, because you’ll know what you can safely eat.

Portion control is also important. Your dietitian will talk to you about the importance of serving size. Sometimes a patient eats what he believes is one “serving,” but it may actually count as three servings on the kidney diet. Your dietitian can give you tips about accurately measuring serving size.

Your doctor and dietitian will also recommend you eat meals and snacks of the same size and calorie/carbohydrate content at certain times of the day. This will help you keep your blood glucose at an even level. Your dietitian will have you space out foods throughout the day. For example, you can’t eat all your carbohydrates at one meal. This would cause your blood glucose levels to rise above acceptable levels. You’ll have a balance of carbohydrate, protein and fat for each meal.

Often people with diabetes have lower blood sugar levels as kidney failure progresses, especially with certain diabetes medications. Your dietitian may recommend between meal snacks to prevent low blood sugar. If you are having problems eating enough, your dietitian may recommend adding foods with extra sugar and fat to prevent low blood glucose and help maintain body weight. Your doctor may make adjustments in diabetes medication. It is important to check blood glucose levels often and share the results with your doctor, especially if you are having low blood sugars.

What can I eat?

Your dietitian knows the importance of variety and will give you options on the types of foods you can eat. Your diet will include a list of foods from different food groups to help you plan meals. Below is an example of food choices that are usually recommended on a typical renal diabetic diet. This list is an example only. It is based on sodium, potassium, phosphorus and high sugar content of foods included. Your own individualized diet may include additional foods or limit some of these recommended foods. Your blood test results, stage of kidney disease, size, nutrition status and dietary goals help determine your exact diet therapy. Remember to always ask your dietitian whether or not you can have any of these listed foods and make sure you know what the recommended serving size should be. Do not make any changes to your diet without your dietitian’s approval.

Carbohydrate foods
  Recommended Avoid

Milk and nondairy

skim or fat-free milk, non-dairy creamer, plain yogurt, sugar-free yogurt, sugar-free pudding, sugar-free ice cream, sugar-free nondairy frozen desserts*

*Portions of dairy products are often limited to 4 ounces due to high protein, potassium or phosphorus content

chocolate milk, buttermilk, sweetened yogurt, sugar sweetened pudding, sugar sweetened ice cream, sugar sweetened nondairy frozen desserts

Breads and starches

white bread, unsweetened, refined dry cereals, cream of wheat, grits, malt-o-meal, noodles, pasta, rice, bagel (small), hamburger bun, unsalted crackers, cornbread (made from scratch), flour tortilla

whole wheat bread, frosted or sugar-coated cereals, bran, granola or whole wheat cereals like wheat flakes and raisin bran, oatmeal, instant cereals, whole grain hot cereals, gingerbread, pancake mix, cornbread mix (Jiffy®), biscuits, salted snacks including: potato chips, corn chips and crackers

Fruits and juices

apples, apple juice, applesauce, apricot halves, berries including: strawberries, raspberries, cranberries, blackberries and blueberries, low sugar cranberry juice, cherries, fruit cocktail, grapefruit, grapes, grape juice, kumquats, mandarin oranges, pears, pineapple, plums, tangerine, watermelon

Note:  Fruit canned in unsweetened juice is usually recommended.

avocados, bananas, cantaloupe, dried fruits including: dates, raisins and prunes, fresh pears, honeydew melon, kiwis, kumquats, star fruit, mangos, papaya, nectarines, oranges and orange juice, pomegranate

Note:  Fruit canned in syrup is usually avoided.

Starchy vegetables

corn, peas, mixed vegetables with corn and peas (eat these less often because they are high in phosphorus), potatoes (soaked to reduce potassium, if needed)

baked potatoes, sweet potatoes, yams, baked beans, dried beans (kidneys, lima , lentil, pinto or soy), succotash, pumpkin, winter squash

 

Nonstarchy vegetables

asparagus, beets, broccoli, Brussel sprouts, carrots, cabbage, cauliflower, celery, cucumber, eggplant, frozen broccoli cuts, green beans, iceberg lettuce, kale, leeks, mustard greens, okra, onions, red and green peppers, radishes, raw spinach (1/2 cup), snow peas, summer squash, turnips

 

artichoke, fresh bamboo shoots, beet greens, cactus, cooked Chinese cabbage, kohlrabi, rutabagas, sauerkraut , cooked spinach, tomatoes, tomato sauce or paste, tomato juice, vegetable juice

Higher protein foods

 

Recommended Avoid

Meats, cheeses and eggs

lean cuts of meat, poultry, fish and seafood; eggs, low cholesterol egg substitute; cottage cheese (limited due to high sodium content)

 

bacon, canned and luncheon meats, cheeses (including American, cheddar and Swiss), hot dogs, organ meats (liver, brains), nuts, pepperoni, salami, salmon, sausage

Higher fat foods
  Recommended Avoid

Seasoning and calories

soft or tub margarine low in trans fats, mayonnaise, sour cream, cream cheese, low fat mayonnaise, low fat sour cream, low fat cream cheese

bacon fat, back fat, butter, Crisco®, lard, shortening, margarines high in trans fats, whipping cream

Beverages
  Recommend Avoid

Beverages

water, Crystal Light®, diet clear sodas (Diet Sprite®, diet gingerale), homemade tea or lemonade sweetened with an artificial sweetener

regular or diet dark colas like Coke®, Dr. Pepper®, Pepsi®; beer,

fruit juices (such as Sunny Delight®), fruit-flavored drinks (such as Hawaiian Punch®) or water sweetened with fruit juices, Gatorade®, Powerade®, bottled or canned iced tea or lemonade containing sugar, syrup, or phosphoric acid; any tea or lemonade sweetened with real sugar

Other foods you may be instructed to limit or avoid are sweets and salty foods such as the following:

  • Candy (candy bars, hard candy, chocolate, jelly beans, gum drops)
  • Regular sugar
  • Syrup (maple, chocolate)
  • Honey
  • Molasses
  • Pies, cakes, cookies, donuts
  • Ice cream
  • Canned foods
  • BBQ sauce, ketchup
  • Onion, garlic or table salt
  • TV dinners
  • Meat tenderizer
  • Marinades
  • Nuts
  • Pizza
  • Salted chips and snacks
  • Soy Sauce
  • Worcestershire sauce

Your unique diet plan when you have diabetes and kidney disease

Because each patient has different needs, you should always follow your dietitian’s recommendations. Your dietitian will create a diet that addresses your condition. Your dietitian will help by providing sample menus, grocery lists and a meal plan based on your food preferences and designed to meet your individual nutrient needs. A diet that works well for one patient may not work well for another. From time to time, your diet may change due to changes in kidney function or therapy. If you want to change your diet or introduce new foods into your diet, speak with your dietitian first. Any changes you make without your dietitian’s approval may make you feel ill, may affect your blood sugar control or worsen your condition.

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