If you have both kidney disease and diabetes, you’ve probably looked at a kidney-friendly meal plan and thought, not with my blood sugar. Maybe it was Day 1 of my free 5-day CKD meal plans, with toast and jelly, two pasta meals, and a chocolate chip cookie.
I hear that a lot. So I want to explain why I don’t build meal plans around cutting carbs as far as possible, even for people with diabetes, and why I think medication deserves a bigger role than a lot of people want to give it.
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Diabetes-friendly and kidney-friendly overlap more than you’d think
A diabetes-friendly way of eating and a kidney-friendly way of eating have a lot in common. Both lean on vegetables and fruit, fiber, whole or minimally processed foods, less added sugar, fewer refined grains, and less sodium.
My meal plans are built on that overlap. They’re moderate in carbohydrates rather than very low-carb, and that was intentional. The carbs are spread across the day, most of them come packaged with fiber, and nearly every meal and snack pairs its carbs with some protein, fat, or both.
A healthy day doesn’t have to look perfect
And yes, there’s a cookie on Day 1.
I’m a big believer that perfection is the enemy of progress. A day doesn’t have to look perfect to be healthy, kidney-supportive, and diabetes-supportive. A slice of toast with jelly, or a cookie, can fit into a day that’s built well overall.
You don’t have to eat perfectly to eat healthy.
Your blood sugar is supposed to rise after carbs
If you check your blood sugar after a bowl of oatmeal and see it go up, that’s normal. Carbohydrate raises blood sugar. That’s what it does.
A rise after eating isn’t automatically a problem. The better questions are whether the rise fits the goals your care team set for you, how long it stays up, and what the rest of your day looks like.
A reasonable portion of oats, beans, lentils, fruit, or sweet potato may raise your blood sugar more than eggs or chicken would. That doesn’t automatically make the eggs or chicken the better food. Your meter can tell you what happened to your glucose after a meal. It can’t tell you whether that meal was good for your kidneys, your heart, or your gut.
Why I don’t keep cutting carbs
When someone with diabetes and CKD tells me they can’t eat chickpeas, or whole grain toast, or rice, my first thought usually isn’t “let’s find a lower-carb option.” More often it’s, your pancreas may need more backup.
Type 2 diabetes is more than insulin resistance, and it isn’t a willpower problem. Over time, the pancreas often becomes less able to make enough insulin. A large British study of people newly diagnosed with type 2 diabetes found that blood sugar crept up over six years on every treatment, diet included, and that the rise went along with a gradual loss of the cells that make insulin.
So if you’re managing diabetes with food alone, you’re working against an insulin supply that tends to shrink. You can keep cutting carbs to keep up, and it may work for a while. But every time we cut carbs further, we narrow our options for what’s acceptable to eat. We also cut back on the very foods that support our kidney health and our heart health. It’s an uphill battle.
With kidney disease, what you do eat is just as important as what you don’t eat. When beans, oats, whole grains, fruit, and vegetables go, especially on top of other kidney restrictions like a potassium limit that may or may not actually be necessary, the gap usually gets filled with more meat, more cheese and eggs, more processed “keto” products, and fewer fiber-rich foods. That plate may keep your blood sugar lower in the short term. Over the long run, it usually pushes protein higher and leaves less room for the plant foods that help your kidneys. (Here’s how I think about protein when you have CKD and diabetes.)
And letting blood sugar run high isn’t the answer either. High blood sugar can damage the blood vessels in your kidneys, and diabetes is the leading cause of kidney disease.
That’s the squeeze a lot of people with both conditions are in. Food alone often can’t win it.
Needing medication doesn’t mean you failed
Somewhere along the way, a lot of people pick up the idea that needing diabetes medication, or more of it, means they did something wrong.
It doesn’t. Taking medication isn’t a failure, and it isn’t the easy way out. You don’t need to punish yourself with a smaller and smaller diet to prove you’re trying hard enough.
My personal philosophy as a dietitian is that once someone has diabetes, medication is usually an important part of treatment. I know that can be surprising coming from a dietitian.
Current guidelines see it the same way. The American Diabetes Association and KDIGO, the international group that writes kidney disease guidelines, describe care for people with diabetes and CKD as medicines proven to protect the kidneys and heart, layered on a foundation of healthy lifestyle.
The cool thing about some of today’s diabetes medications is that they help with blood sugar and protect your kidneys at the same time. In large trials of people with type 2 diabetes and kidney disease, an SGLT2 inhibitor and a GLP-1 medication each lowered the risk of kidney disease getting worse. That’s a two-for-one.
Food is still the foundation. Medication helps your body handle the glucose from that foundation when your pancreas can’t do the whole job on its own anymore. That medication might be metformin, an SGLT2 inhibitor, a GLP-1 medication, insulin, or something else. Which one is right for you depends on your kidney function, labs, other medications, side effects, cost, and goals, so that decision belongs between you and your prescriber.
Getting the medication right can open up a lot more options for what you can eat. It makes room for foods that help protect your kidneys in the long run, the ones that happen to come with carbohydrates your body couldn’t handle well without enough insulin.
If you’re eating a balanced, moderate-carb diet and your blood sugar is still running high, that’s often a sign your medication plan needs another look with your doctor.
What you eat is still important
None of this means food takes a back seat. Three things carry a lot of weight.
Portions. Most carb foods can fit. The amount is what changes. In my meal plans you’ll see one slice of toast, about a cup of pasta, a small banana, half a pizza.
How often. A cookie a day is a very different thing from a cookie at every meal and another at snack time.
The kind of carbs. Carbs that come with fiber, like beans, oats, whole grains, fruit, and starchy vegetables, raise blood sugar more gently than white bread, sugary drinks, or sweets eaten on their own. Fiber-rich carbs help in another way, too. In people with diabetes, eating more fiber has been linked to better blood sugar control and less insulin resistance, so your body makes better use of the insulin it has.
If you want the full picture, including how to read your blood sugar numbers, how glucose monitors fit in, and whether you should cut out carbs at all, that’s what the diabetes module inside Kidney Foodie Academy covers.
Use my meal plans as a starting point
My meal plans are there to give you ideas, and to serve as talking points with your doctor or dietitian. If you have CKD and diabetes, you may need to adjust portions or swap specific foods to suit your situation. That’s expected.
If you take insulin or another medicine that can cause low blood sugar, talk with your doctor before you change how many carbs you eat, since your dose may need to change too.
And if you’d like help making it all fit your labs, your medications, and the way you actually eat, that’s exactly the kind of thing I help patients sort out.
I see patients one-on-one through telehealth, and I’m in network with Aetna, Anthem, BCBS, Cigna, Humana, Medicare, and UHC. I can see you if you’re physically located in one of these places at the time of your appointment: Alaska, Arizona, California, Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Massachusetts, Michigan, New York, Oklahoma, Oregon, Pennsylvania, Texas, Utah, the US Virgin Islands, Virginia, Washington, and Wisconsin.
If you have Medicare, nutrition counseling for diabetes or kidney disease is a covered benefit. Your doctor needs to refer you, and if you qualify, you pay nothing for these visits.
Not in one of those states? The Academy works anywhere, and here’s how to find a kidney dietitian near you.
New here? Get my free 5-day CKD meal plans.