Diabetes & dialysis - what does this mean for my diet?

The number of people suffering from diabetes is increasing worldwide. According to statistics, one in eleven adults in the world is diabetic - that's around 425 million people. Perhaps you are also affected by diabetes and already know that nutrition plays an enormously important role for all diabetics. But what changes in combination with kidney disease? Many factors are similar - for others, you should specifically pay attention to a few adjustments.

Carbohydrates

For diabetes…

…it is important to specifically avoid carbohydrates with a high glycemic index, i.e. those such as white bread, French fries or sweets.

In diabetes and dialysis….

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

Dietary fiber

For diabetes…

…as a diabetic carbohydrates with a low glycemic index and a high-fiber diet is recommended. You can achieve this by sticking to whole grain products, raw vegetables and legumes.

With diabetes and dialysis…

…fiber is also important for a healthy and wholesome diet. It should always be part of your diet even as a dialysis patient. However, you should eat whole grain products and raw vegetables in controlled quantities, as they can contain a lot of phosphate and potassium at the same time. If you are unsure, it's best to check this quickly in the Mizu app!

Fat

With diabetes…

…you should avoid foods with a high content of so-called trans fatty acids. When it comes to meat, you should opt for low-fat products. Fatty fish, on the other hand, is a good source of healthy omega-3 fatty acids.

**For diabetes and dialysis

…the choice of fat types remains the same. However, you can slightly increase the amount of fat, especially healthy cooking and spreadable fats, to achieve a calorie increase.

Protein

For diabetes…

… for chronic renal insufficiency without the need for dialysis, it is important to aim for values of 0.8 g protein per kg body weight per day. Above all, proteins ensure a longer feeling of satiety and can even have a positive influence on long-term blood glucose values.

In diabetes and dialysis…

…your daily protein intake increases compared to people with healthy kidneys. 1.0 - 1.2 g protein per kg body weight per day is recommended. However, as you probably already know, it is important to use products that are low in phosphorus. You can find a selection and more detailed information on this in your Mizu app. Phosphate points or the phosphorus-protein quotient (PEQ) for more than 6,000 foods, recipes and dishes will help you.

Energy intake

For diabetes…

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

With diabetes and dialysis…

…an adequate calorie intake is extremely important. Guideline values for dialysis patients without diabetes are often 25 - 35 kcal per kg body weight per day. If your treatment team recommends weight reduction, your target calorie intake may change.

Phosphorus

For diabetes…

…you can follow the normal amount and usual dietary recommendation of about 2000 mg daily.

In case of diabetes and dialysis…

…as you probably already know, a phosphorus-conscious diet and food selection is very important. It reduces your long-term risk of secondary health diseases. So for people on dialysis, severe restriction is often recommended. However, individual factors must be taken into account here, which is why you should definitely talk to your nephrologist about this topic. In the Mizu app, you will find a lot more information and help, such as the phosphate points or the phosphorus-protein quotient for foods.

Table salt

For diabetes…

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

In diabetes and dialysis…

…it is important to reduce your daily salt consumption. Specifically, you should aim for a maximum of 5 g of table salt per day. You can also find more detailed information and practical tips on a low-salt diet in the Mizu app.

Drinking liquid

For diabetes…

…you should make sure to drink fluids that are as calorie-free as possible.

With diabetes and dialysis…

…it can generally be said that you should pay more attention to your fluid intake and reduce it if the amount of urine is limited. It is one of the biggest challenges for many people on dialysis. European best-practice nephrology guidelines recommend consuming no more than half a liter more than your actual urine volume per day. The Mizu app gives you helpful tricks on how to achieve this.

General Dietary Styles

With diabetes…

…there are different dietary styles that have different advantages and disadvantages. Dietary advice gives a good overview here.

With diabetes and dialysis…

…there has been little research on the advantages and disadvantages of different dietary styles. In general, it can only be recommended that, under control of your blood sugar, phosphate and potassium values, you should pay attention to a sufficient protein and calorie intake. Unfortunately, HbA1c (long-term blood glucose) measurements are usually not reliable in dialysis patients. The "Glucose Management Indicator" can help you with your blood glucose control.

Food preparation

With diabetes…

…it is recommended that you prepare your food in a way that preserves the ingredients by using short cooking times and 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 choose fresh fruit and avoid juices and stewed fruit. You should also cut down on fruit depending on the fructose content. You should use cooking and spreadable fats sparingly if calorie reduction is your goal.

**In case of diabetes and dialysis…

…there are some differences in connection with the previously mentioned recommendations.

Cooking vegetables several times in plenty of water can lower the potassium content of the vegetables. You should not use the cooking liquid.

Raw vegetables and salads should be consumed in small quantities. For fruit, the recommendation is 1 fresh piece per day. Cooked fruit or canned fruit without using the liquid is generally lower in potassium and should be preferred. You should generally avoid juices due to their high potassium content.

One more thing!

Unlike with diabetes alone, you can use enough fat to meet the energy needs, as well as to prepare the taste of the dishes and ingredients such as cooked vegetables.

So you see, with the onset of dialysis, the diet doesn't really get any easier. At the same time, adaptation is incredibly important and essential for avoiding further secondary diseases. Talk to your dialysis team about practical tools, guides and tricks!