From the Desk of our Renal Dietitians

BY JUNE MARTIN, RD (Spice It Up! Issue Spring 2010)

Diabetes is a serious chronic disease that occurs when the pancreas does not produce enough insulin (Type 1 diabetes) or the insulin that is produced cannot be used properly (Type 2 diabetes). Type 2 diabetes is much more common, accounting for 90% of all cases of diabetes.The World Health Organization considers diabetes to be a global epidemic that stems from less physical activity and a rise in obesity.

Over 3 million Canadians are living with diabetes
In Canada, diabetes is the leading cause of kidney disease and cases are expected to increase sharply. The term “diabetic nephropathy” is used to describe the damage high blood glucose can do to the tiny blood vessels in the kidneys. In the early stages of diabetic kidney disease there are often few or no symptoms, making it very difficult to detect without regular screening by a physician. Many people with diabetes suffer from high blood pressure, which can also contribute to kidney damage.

Control blood sugar and blood pressure
Controlling blood sugar and blood pressure are two important ways to prevent diabetic nephropathy. Medication, nutrition and exercise are all important for preventing and managing the complications of diabetes. Your healthcare team can help make sure that all the pieces are in place to assure that you receive optimal care. Those of you who are already living with diabetes and kidney disease are aware of how challenging it can be to manage both. Many patients who have been following a diabetic diet for years find it difficult and frustrating to try to adapt to a kidney diet too.It is important to get the help of a registered dietitian who can show you how to combine the two diets and make a single meal plan that works for you, whether or not you are on dialysis.
Learning how to count carbohydrates is one of the ways to help make this important transition much smoother.

Cut back on salt
Cutting back on salt ( sodium ) plays an important role in the success of both diets. Avoid salty foods and don’t add salt at the table. Make sure to avoid any salt substitutes that show Potassium Chloride on their list of ingredients, and make sure to look for it on the labels of any foods listed as “low in salt”.

Choose white bread, pasta and rice
One of the most common questions we hear as dietitians concerns whole grains! Why is it that a diabetes diet tells me to eat whole grains while a kidney diet tells me to eat white bread??? In fact, while whole grains have more fibre, they also have more potassium and phosphorus. Research shows that it is the total amount of carbohydrates that matters most in controlling blood sugar. Therefore, choose white bread, white rice and white pasta in the amounts recommended by your diabetic diet.

Tips for travel
Managing diabetes becomes even more challenging for those who must travel to and from dialysis several times a week. It’s important to always bring a snack ( try not to go more than 4-6 hours without eating ) and carry something to treat low blood sugar. If you are on a fluid-restricted diet, carry hard candy or glucose tablets. Often, people living with diabetes are taught to treat low blood sugar with orange juice, but any juice will do! Ask your dietitian to help you with a meal plan for both dialysis and non-dialysis days.

It is important to note that the recipes in Spice it up! always include the carbohydrate content and diabetic food exchanges so that you will know how to include these foods in your diet. These recipes show you how to make great meals that allow you to ontinue eating well on a diabetic/renal diet.

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