Renal diet plan for diabetics helps to keep the blood glucose in a normal range. This is your best way to stick to the diet because it includes all foods that either help in reducing blood glucose or those that are free of carbohydrates. The renal diet plan is the best way to keep blood glucose within normal levels. The diet has been proven highly effective in keeping high blood sugar levels under control.
Diabetic Renal Diet: What is Left to Eat?
Navigating how to eat healthfully for BOTH diabetes and chronic kidney disease (CKD) can be overwhelming. It is easy to feel like there is absolutely nothing left to eat on a diabetic renal diet. Which is frustrating and not the case…I promise!
A healthy diet for kidneys and diabetes really isn’t that complicated. Recommendations for kidney disease go right along with recommendations for diabetes. Don’t believe me? Keep reading!
The Science
Diabetes
The goal for healthy eating for people with diabetes is to control blood sugar (or glucose). Any food that has carbohydrate in it will break down to glucose during digestion. So, any food that has carbohydrate has potential to raise your blood sugar.
Foods that have carbohydrate include:
- Starches (bread, pasta, rice, bread, cereals)
- Fruit (and fruit juice!)
- Dairy (milk and yogurt)
- Starchy Vegetables (corn, green peas, potatoes)
- Sugar (desserts, sugar sweetened drinks like soda, lemonade or sweet tea)
Good news! You CAN (and should!) eat foods with carbohydrate if you have diabetes. The key is portion size of foods with carbohydrate and to avoid too many of these foods in 1 meal.
If you eat only 1 or 2 meals per day, you will eat more food at one time, which likely means eating too much carbohydrate at one meal. This large load of carbohydrate will break down into blood and cause a huge spike in your blood sugar. Also, especially for people who take insulin, going a long time without eating can cause blood sugar to go dangerously low.
Instead, our goal is to eat carbohydrate more consistently throughout the day. For most people, this means 3 meals per day with 1-2 snacks. Ideally, the amount of carbohydrate at each meal is the same. Most people should aim for 3-4 servings of carbohydrate at meals and 1-2 servings at snacks. These smaller loads of carbohydrate will cause small increases in blood sugar and help keep blood sugar steady in a healthy range.
One serving of carbohydrate is about 15 grams of carbohydrate. Check out the “Total Carbohydrate” line on Nutrition Facts Labels to determine how many servings of carbohydrate a food has.
Your dietitian will tell you exactly how many servings of carbohydrate are right for you based on your body, blood sugar history, insulin prescription and other medications.
Chronic Kidney Disease
The goal for healthy eating for kidney disease is to control the amount you eat of certain minerals and nutrients2. For example, diseased kidneys cannot get rid of phosphorus as well as they should. So, people with kidney disease should limit how much artificial phosphorus they eat.
People with kidney disease should limit sodium (or salt) to no more than 2,300mg per day2. A low sodium diet will help control blood pressure, which is very important as high blood pressure can hurt kidneys3. This is especially important because high blood pressure is both a symptoms and risk factor for kidney disease4. Edema (or fluid building up in the body in places like your ankles and calves) is common in kidney disease. A low sodium diet can help control edema and help people feel much more comfortable!
High protein diets have been associated with faster progression of kidney disease toward dialysis2,3,5. Our kidneys are responsible for getting rid of byproducts from the metabolism of protein (primarily acid), which makes them work harder. High protein diets can also contribute to symptoms of kidney disease such as acidosis and uremia.
Some people with kidney disease need to limit how much potassium they eat2. However, this is not the case for everyone! Learn more about potassium and kidney disease.
Going through all this science and which nutrients are important to avoid in kidney disease can be overwhelming. But, I have some good news! You CAN eat foods with these nutrients. Similar to diabetes and foods with carbohydrate, the key is portion size.
What to Eat on a Diabetic Renal Diet
Whew! Since we are through the science of healthy eating. Let’s get to the good stuff. What should people with both kidney disease and diabetes eat!?
The answer for both really boils down to this: eat mostly vegetables and fruit, some protein and some healthy whole grain carbohydrates. Really! That’s it!
Check out this table for more specifics about what foods are healthy to eat.
| Foods to Eat | Foods to Avoid | Portion Size & Comments | |
|---|---|---|---|
| Grains | Whole Grain Bread Brown Rice Whole Grain Pasta Non-Sugary Whole Grain Cold Cereals (bran flakes, wheat chex, etc.) Hot Cereals (oatmeal, cream of wheat) Corn tortillas | White bread White pasta Biscuits, cornbread Commercial breadcrumbs Flour tortillas Grains with “phos” ingredients | Kidney Disease: no strict limit on portion size. Diabetes: 1/2 cup or 1 slice = 1 serving of carbohydrate. |
| Dairy | Skim or low fat milk Soy and nut milks Low-fat or fat-free yogurt Low sodium cottage cheese Small amounts of natural cheese (cheddar, mozzarella, Swiss, etc.) | American cheese, Velveeta, nacho cheese Buttermilk Whole milk | Kidney disease: with advanced disease (GFR <20ml/min), consider limiting daily dairy to 1 serving per day or choosing rice milk instead of cow’s milk. Diabetes: 1 cup of milk or yogurt = 1 serving. |
| Protein | Fresh meat, poultry, fish and seafood. Starchy beans (black, pinto, kidney, garbanzo beans) Lentils Unsalted nuts and seeds Low sodium canned fish Eggs | Deli or lunch meat Fried meats Processed meats (bacon, sausage, bologna, salami, corned beef, ham Products with “phos” ingredients | Kidney disease: limit animal proteins to 3-4oz or 1-2 eggs per meal. Consider choosing more plant-based proteins such as nuts, beans or lentils instead of animal proteins. Diabetes: 1/2 cup starchy beans or lentils = 1 serving carbohydrate. |
| Vegetables | |||
| Non-Starchy Vegetables | Low Potassium: asparagus, bell peppers, broccoli, cabbage, carrots, cauliflower, celery, corn, cucumbers, eggplant, green beans, kale, lettuce, mushrooms, okra, onions, spaghetti squash, turnips, yellow beans High Potassium: artichokes, avocado, beets, Brussels sprouts, greens, kohlrabi, spinach, tomato, zucchini Fresh or frozen vegetables are great choices! Low sodium or no salt added canned vegetables are great too! | Frozen vegetables with added cheese or sauce. Canned vegetables with salt | Kidney disease: if the amount of potassium in your blood is high, choose mostly low potassium vegetables. No strict limit on portion size. Enjoy lots of these! Diabetes: no strict limit on portion size. |
| Starchy Vegetables | Low Potassium: Turnips High Potassium: acorn squash, butternut squash, pumpkin, parsnips, rutabaga | Kidney disease: if the amount of potassium in your blood is high, choose mostly low potassium vegetables. No strict limit on portion size. Diabetes: 1/2 cup cooked or 1 cup raw = 1 serving of carbohydrate. | |
| Fruit | Low Potassium: apples, apricots, berries, cherries, cranberries, fruit cocktail, grapes, honeydew lemon, lemons, limes, peaches, pears, pineapple, plums, rhubarb, tangerines, watermelon High Potassium: bananas, cantaloupe, dates, figs, kiwi, mango, nectarines, papaya, pomegranate, prunes, raisins Fresh, frozen or fruit canned in “lite syrup” or “juice” are great choices! | Fruit canned in heavy syrup. | Kidney disease: if the amount of potassium in your blood is high, choose mostly low potassium fruits. No strict limit on portion size. Diabetes: 1/2 cup cooked or 1 cup raw = 1 serving of carbohydrate. |
| Fats | Olive or canola oil Small amounts of unsalted butter | Salted butter Coconut oil Lard | Kidney disease & diabetes: no strict limit. Generally try to include a little fat with each meal for flavor and to help you feel full! Aim for 1-2 teaspoons of fat with meals. |
| Dessert | Enjoy your favorite dessert in moderation! | Be mindful that ice cream and pudding are dairy desserts. If you have a GFR of less than 20ml/min, these would count as your dairy serving for the day. Commercially prepared desserts with “phos” ingredients | Kidney disease: enjoy your favorite desserts 1-2 times per week. Diabetes: 1/2 cup of ice cream/sherbet/sorbet, 2-inch piece of cake or 2 oreo-sized cookies = 1 serving of carbohydrate. |
| Condiments & Flavorings | Lemon, lime juice Pepper Dry or fresh herbs such as basil, oregano, parsley or cilantro Salt-free seasoning mixes such as Mrs. Dash Vinegar (white, red/white wine, balsamic, apple cider) | Large amounts of: Ketchup, mustard, BBQ sauce Gravy Soy or Worcestershire sauce Commercial salad dressing Salt, onion, salt, garlic salt Seasonings and condiments with “phos” ingredients. | Kidney disease & diabetes: no strict limit on portion size. All of the flavorings in the “foods to eat” column are freebies! Go crazy with them to add tons of flavor to your food! |
| Beverages | Water Diet clear sodas (7-Up, Sprite) Sugar-Free Flavorings (i.e Crystal Light) Unsweetened Iced Tea | Cola Drinks with “phos” ingredients. | Kidney disease: if the amount of potassium in your blood is high, avoid juices. Diabetes: 1/2 cup of any sugar sweetened drink (regular soda, juice, sweet tea, punch, lemonade) = 1 serving carbohydrate. |
| Work with your dietitian to determine how many servings of carbohydrate at meals is right for you if you have diabetes. Your dietitian can also help you figure out if you should be eating high or low potassium fruits and vegetables. |
Putting Together a Healthy Meal on a Diabetic Renal Diet
For a general guideline about what a healthy plate should look like, I love using the general recommendations from the USDA. You may have seen this image before, which provides guidelines on what healthy people should eat. The same is true for people with kidney disease and diabetes!
This graphic highlights the most important thing to remember when meal planning: make ½ of your plate fruits and vegetables. If you have diabetes, really focus on those non-starchy vegetables to avoid using up all your carbohydrate servings on fruit. Meals should also include some protein and some grain.
Diabetic Renal Diet Meal Ideas
You may be thinking: “Great, Melanie. I know I should eat more vegetables, but how can I make a meal out of those!” Here are some ideas for building a healthy meal that fits with making ½ of your plate vegetables along with a little grain and a little protein.
- Stir fry your favorite vegetables (I love broccoli, carrots, bok choy and onions) with a small amount of chicken or shrimp. Serve over brown rice or whole grain pasta.
- Stuff bell peppers with a mix of whole grains (try couscous, brown rice or quinoa) and veggies.
- Make pizza! Make your own whole grain pizza crust and top it with vegetables. My favorite veggie pizza toppings are zucchini, tomato, onion, mushrooms and arugula. Choose low sodium cheese such as fresh mozzarella or swiss and go easy on the sauce to avoid too much salt!
- Spice up your salad! Salads are the obvious way to eat your vegetables. Make them exciting! Add a little pasta to your salad. Throw on some toasted nuts or a little fancy cheese to make the salad extra special. I also love adding fruit to salads: try blueberries, strawberries, grapes or pineapple. Make your own dressing out of olive oil and flavored vinegar or lemon/lime juice. Or, you can even make your own ranch dressing!
- Try spiralizing. If you haven’t jumped on the zoodle craze yet – try it! Spiralizing zucchini, yellow squash, sweet potatoes, beets or carrots is a fun way to prepare a vegetable heavy meal.
- Make a bowl. Top your favorite whole grain with tons of delicious vegetables and a little of your favorite sauce.
- Sneak veggies into breakfast. Never miss an opportunity to get in more vegetables! Mix 1-2 eggs with vegetables to make an omelet. Try a savory oatmeal. Or, try some (very trendy!) avocado toast by mashing 1/4-1/2 an avocado on whole grain bread and top it with some vegetables. My favorite toppings for avocado toast are chopped tomato and feta cheese. I also love pickled shallots and balsamic drizzle.
Check out my recipes for more meal ideas for people with kidney disease and diabetes.
Renal Diabetic Diet Grocery List
Eggs are part of a renal diabetes diet grocery list.
There are a lot of foods to avoid with kidney disease and diabetes. According to the Centers for Disease Control and Prevention (CDC), one in three American adults with diabetes also has chronic kidney disease (CKD). A renal diet grocery list that’s also diabetes-friendly helps with meal planning.
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Renal Diet Grocery List
For the best results, plan on meeting with a registered dietician who understands nutrition for both diabetes and CKD. Together, you can create a plan that not only keeps your blood sugar levels stable but also reduces the amount of waste your kidneys handle on a daily basis.
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The good news is, your rental diet grocery list will contain CKD-diet-friendly foods because many of them are the same. Beware, however — there are some differences that should be considered. According to the American Kidney Fund, your CKD diet may be adjusted depending on the stage you’re in. The further the condition progresses, the more strict you can expect your diet to be.
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The CDC says there are many foods someone with both diabetes and CKD can eat, so you’ll want to add all of them to your renal diet grocery list. These include:
- Proteins: eggs, lean meats (poultry and fish) and unsalted seafood
- Fruits: plums, apples, berries, cherries and grapes
- Vegetables: eggplant, bell peppers, garlic, carrots, onions, turnips and cauliflower
- Carbohydrates: white bread, pasta, unsalted crackers, bagels and sandwich buns
- Drinks: water, unsweetened tea and clear diet sodas
Your dietician can provide additional safe foods and help you find recipes that taste good while allowing steering you away from foods to avoid with kidney disease and diabetes.
For instance, if you’re used to drinking orange juice to address low blood sugar, opting for apple or grape juice is the more kidney-friendly option. You’ll be able to boost your blood sugar without the high potassium.
When you are dealing with an emergency where you may be unable to travel to dialysis and dealing with power outages, the National Kidney Foundation recommends that you have some things at hand.
With the meal plan they provide, you’ll be on a stricter version of your usual diet. However, the plan is intended to keep the buildup of fluid and toxins at bay while you’re going without dialysis appointments. You should have:
- Plenty of distilled/bottled water
- Two weeks worth of all prescription medications
- Extra insulin and batteries for your meter
- List of names and phone numbers for your doctor, dialysis center and local hospital
- Measuring cups and scale
- Disposable plates and utensils
During this time, you’re advised to limit your fluid intake to only 16 ounces per day. If you feel thirsty, chew gum to help you.
Don’t use salt or salt substitutes with your meals. Avoid high-potassium foods. People with diabetes should keep instant glucose tablets, hard candy and low-potassium fruit juices on hand to address low blood sugar. Follow the renal diabetes diet sample menu for three days, and if the disaster keeps you from attending dialysis longer than that, repeat the meal plan.
Renal Diet Foods to Avoid
According to the CDC, It’s important to avoid foods that are high in sodium. It’s not only a good move for your diabetes, but it’s crucial for CKD because, over time, your kidneys may lose their ability to control the sodium-water balance. When you consume less sodium, you’ll lower blood pressure and decrease fluid buildup in the body.
Aim for mostly fresh and homemade food, eating only small portions of packaged and restaurant foods because those are fairly high in sodium. Ideally, packaged food should contain 5 percent or less sodium per serving.
Depending on the stage of your kidney disease, you may also need to limit the phosphorus, potassium and protein in your diet. This means avoiding things like:
- Whole grains
- Tomatoes
- Potatoes
- Oranges
- Dairy
- Beans
- Nuts
- Dark-colored soda
- Meat
Your body will still require protein, but eating too much of it will make your kidneys work harder than they need to and worsen your CKD. Your dietician will help you determine the optimal protein intake and guide you with both plant and animal sources.
According to the National Kidney Foundation, if you both have diabetes and are on dialysis, the key is to balance your carbohydrates. Everybody needs carbs, so it’s not a good idea to cut them out completely. Instead, focus on portion size and limit your overall intake.
A slice of bread, one-half cup of pasta, one-half cup of cooked cereal (oatmeal, grits) and one-half cup of cereal all count as one serving of carbohydrates.
In late-stage CKD, you need to limit the amount of liquid you consume to prevent swelling. Your nutritional needs will also change, possibly requiring you to eat more. Your blood sugar may improve with late-stage CKD, likely due to changes in how the body uses insulin.
However, when you’re on dialysis, blood sugar may increase because the fluid used to filter your blood is high in sugar. The need for insulin and other diabetes medications will be hard to predict, meaning that your doctor will have to closely monitor you.
Renal Diabetes Diet Sample Menu
If you’re struggling to come up with ideas for things to eat that are acceptable for your diet, here’s a day’s worth of meals and snacks to get you started:
- Breakfast:
- Two scrambled eggs with sautéed peppers and onions
- Piece of white bread toast
- Glass of water
- Snack: Bagel with low-fat cream cheese
- Lunch:
- Chicken salad made with low sodium chicken breast and light mayonnaise.
- Add grapes into the chicken salad if desired, and serve on a sandwich bun or two slices of bread.
- If grapes aren’t part of the salad, have them on the side, or swap for another CKD and diabetes-friendly fruit option.
- Snack: Strawberries with unsalted pretzels
- Dinner:
- Roasted turkey breast, carrots and rice
- Unsweet tea
Check in with your dietician as recommended to keep your diet where it needs to be as your conditions change. She’ll also ensure you’re not stuck eating the same meals all the time so you can still get the flavor and variety you crave by providing you with a renal diabetes diet sample menu at each visit.