Diabetes and Kidney Disease: What to Eat?

Type 2 diabetes can cause kidney problems that slowly get worse. About 1 in 3 adults with diabetes have chronic kidney disease (CKD).^1-3

A big part of managing type 2 diabetes is controlling your blood sugar. And CKD comes with symptoms that can improve with better nutrition and fluid intake. If you have kidney disease, you need to reduce how much waste and fluid your kidneys have to process. This makes your diet an important factor in managing both diabetes and kidney disease.^2,3

However, it can be tricky to learn how to eat with both conditions. Working with a registered dietitian who understands how to meal plan for both diabetes and CKD is very helpful.^3,4

Why nutrition matters with diabetes and kidney disease

If you have diabetes, high blood sugar can slowly damage blood vessels in the kidneys. Inside your kidneys are millions of tiny filters called nephrons. Over time, the nephrons also stop working as they should. And high blood pressure related to diabetes can damage kidneys as well.¹

Normal kidney function helps balance salts and minerals in the blood. As the kidneys become damaged and begin to work less well, they cannot keep up with filtering your blood.⁴

What you eat and drink impacts how your kidneys work. It can also make your treatments for kidney disease less effective. Maintaining a healthy balance of salts and minerals is important to help you feel better and prevent swelling and other symptoms.⁴

A dietitian can help you understand how calories, fats, protein, and liquids affect the body. Nutrition therapy can help improve diabetes to delay CKD progression and improve your quality of life.^1-4

Eating healthy to control diabetes

Whether you have diabetes, kidney disease, or both, it is important to follow a healthy diet. You can help keep your kidneys healthy by:¹

• Managing blood sugar
• Controlling blood pressure
• Balancing cholesterol levels

Diet plays a big role in keeping all of these numbers in the normal range. When you have a chronic health condition, changing your diet may reduce or improve symptoms. Following a healthy diet has even been shown to reverse chronic disease in some cases.^1-4

Meal planning

A key factor in managing diabetes and CKD is keeping your blood sugar stable or in your target range. A meal plan can help you stay on track with when, what, and how much to eat.²

A good meal plan considers your:²

• Goals – Do you want to lose weight or lower your A1C?
• Tastes – Can you tolerate spicy foods or swap salt for herbs?
• Lifestyle – If you have a busy schedule, you may need to meal prep on weekends or find quick meals to make in the crockpot or air fryer.
• Medicines – Are there certain foods you need to avoid that may interact with medicines you take?
• Overall health – Can cutting out sugar, salt, or red meat improve other chronic conditions?

A good meal plan is one you will follow and incorporate into your life. General tips for good meal planning include:^1-4

• Cook from scratch as much as possible. Avoid or limit fast food, packaged foods, and processed foods.
• Eat a colorful variety of foods, including lots of fruits and vegetables.
• Read labels, and choose sodium-free or low-sodium foods when possible.
• Add herbs and spices instead of salt to flavor food (though you may need to avoid herbal supplements with kidney disease).
• Reduce or limit sugar intake.
• Avoid sugary drinks and fruit juices. Drink mostly water or low-calorie drinks such as unsweetened iced tea.
• Eat on a regular schedule to reduce blood sugar spikes and dips.
• Focus on portion control.

What to eat with diabetes

Giving up sweets, carbs, high-fat foods, and highly processed foods can be difficult at first. But it is important to help manage blood sugar levels and improve your overall health. A healthy diet also can give you more energy, improve sleep, and reduce pain and inflammation.²

Eating regular, balanced meals helps avoid high or low blood sugar levels. Since carbohydrates raise your blood sugar levels, you need to educate yourself on them if you have diabetes. You may want to talk to your doctor or a dietitian. They can help you learn more about how many you can eat each day and at each meal.²

Tips for eating well with diabetes include:^2-4

• Aim for a mix of healthy protein, fiber, and fat.
• Reduce or cut out sugars and refined grains, such as donuts, cakes, white bread, and white rice or pasta.
• Avoid highly processed foods such as chips, soda, and packaged or GMO foods.
• Focus on whole foods, such as fruits, vegetables, and lean proteins.
• Fruits – Berries, grapes, cherries, apples, plums
• Veggies – Cauliflower, onions, eggplant, turnips
• Proteins – Lean meats (poultry, fish), eggs, unsalted seafood
• Replace saturated fats and trans fats with healthier fats from nuts, oatmeal, olive oil, and salmon.
• Keep track of carbs with carb counting or the plate method.
• Eat the same amount of carbs at each meal.

What to eat with chronic kidney disease

Meal plans for CKD may differ from meal plans for diabetes. You may need to avoid or limit certain foods to protect your kidneys. An appropriate diet also depends on whether you are in early-stage or late-stage kidney disease and whether you are on dialysis.^3-4

Most people with kidney disease should avoid or reduce foods high in:^3-4

• Sodium
• Potassium
• Phosphorus

When meal planning for CKD:^3-4

• Focus on fresh, homemade food.
• Limit restaurant food and packaged food.
• Look for low sodium – 5 percent or less – on food labels.
• Add flavor with herbs, spices, and flavored vinegars.
• Discuss salt substitutes with your doctor or dietitian.
• Discuss foods high in potassium and phosphorus with your dietitian.
• Eat the right amount of protein for you.
• Drink water, unsweetened tea, or kidney-friendly apple or grape juice.

Because your nutritional needs change as CKD advances, a registered or renal dietitian should be part of your healthcare team. A dietitian can help you understand how many calories you need, healthy versus unhealthy fats, and the best types and amounts of protein to meet your needs.⁴

Add in exercise

Beyond diet, physical activity can help improve your blood sugar, control your weight, and help prevent kidney disease. Try to exercise a few times a week. Regular exercise helps improve all your important numbers: A1C, blood sugar, cholesterol levels, and blood pressure.¹

Aim for 150 minutes of regular exercise each week. You can:¹

• Take a brisk walk.
• Work in the garden.
• Attend a water aerobics class.
• Try yoga or gentle stretching.

It is important to get your heart rate up, but do not overdo it. Go at your own pace and listen to your body. Every little bit of activity helps.¹