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Combining Renal & Diabetic Diets. Emily Cannon RD , CDE. What is the Need?. According to NIDDK, 44% of kidney failure is caused by DM National Kidney Foundation states that 1/3 of people with diabetes will get chronic kidney disease Who do you know that teaches both diets together well?.

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Combining renal diabetic diets
Combining Renal & Diabetic Diets

Emily Cannon RD, CDE


What is the need
What is the Need?

  • According to NIDDK, 44% of kidney failure is caused by DM

  • National Kidney Foundation states that 1/3 of people with diabetes will get chronic kidney disease

  • Who do you know that teaches both diets together well?


My goals for today
My Goals for Today

  • Help all disciplines understand the basic dietary restrictions involved in Renal and Diabetic diets

  • Help RDs learn to teach the combination diet more simply and effectively to their patients


Whose job is it
Whose Job is it?

  • A. The dialysis RD

  • B. The CDE

  • C. The RN

  • D. The patient

  • E. Any RD that sees the patient


Medical nutrition therapy
Medical Nutrition Therapy

  • Medical Nutrition Therapy is defined as: nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a registered dietitian or licensed nutrition professional


Why is it so hard
Why is it So Hard?

  • Specialty practitioners focus only on specialty

  • Restrictions seems to conflict

  • Complicated recommendations

  • Limited good resources

  • Limited time

  • Less educated or motivated patients


Renal dietary recommendations
RenalDietary Recommendations

  • Restrict Protein

  • Limit Sodium

  • Limit Potassium

  • Limit Phosphorus

  • Fluid Restriction

  • Extra Fat and Sugar for calories


Translated into foods
Translated into Foods

  • Restrict Protein

  • Limit Sodium

  • Limit Potassium

  • Limit Phosphorus

  • Fluid Restriction

  • Extra Fat and Sugar for calories

Less meat/cheese/fish/eggs

No salty snacks

Less boxed/canned foods

Limited fruits/veggie choices

No whole grains-only white

Limited milk/yogurt

No cola drinks or beans

Limited beverages

Extra butter, oil, dressings

sugar, candy, desserts


Diabetes dietary recs
Diabetes Dietary Recs

  • Smaller, consistent meals

  • Controlled carbohydrate amounts

  • Limited simple sugars

  • Low fat choices

  • More produce and whole grains


Translating into food
Translating into Food

  • Smaller, consistent meals

  • Controlled carbohydrate amounts

  • Limited simple sugars

  • Low fat choices

  • More produce and whole grains

Limited amounts of Starch/Fruit/Milk at meals

Only small desserts/candy

Avoid drinks with sugar

Choose lean beef, poultry, fish,

Low fat milk, yogurt and cheese

Limited oils/dressings/butter

More whole fruits/vegetables

Whole grain bread/crackers

Choose beans/starchy vegetables


Compare the recommendations
Compare the Recommendations

RENAL

Less meat/cheese/fish/eggs

No salty snacks, boxed, or canned food

Limited fruits/veggie choices

No whole grains-only white

Only 1 milk or yogurt per day

No cola drinks or beans

Limited beverages

Extra butter, oil, dressings

sugar, candy, desserts

DIABETES

Choose lean beef, poultry, fish,

More whole fruits/vegetables

Whole grain bread/crackers

Limited amounts of starch/fruit/milk at meals

Low fat milk, yogurt and cheese

Choose beans/starchy vegetables

Limited extra oils/dressings/butter

Only small desserts/candy

Avoid drinks with sugar


Sample menu
Sample Menu

Lunch

1 hamburger bun

2 oz hamburger patty

1/2 C mushrooms

½ C potato salad

1 whole tomato

1 dill pickle

ketchup and mustard

Dinner

3 oz pork chop

1 sweet potato

1 dinner roll

1/2 C unsweet. applesauce

1 C cooked spinach

2 TBSP low fat margarine

Breakfast

1 scrambled egg

2 sl. whole wheat toast

1/2 banana

1 C skim milk


Sample menu1
Sample Menu

Lunch

1 hamburger bun

2 oz hamburger patty

1/2 C mushrooms

½ C potato salad

1 whole tomato

1 dill pickle

ketchup and mustard

Dinner

3 oz pork chop

1 sweet potato

1 dinner roll

1/2 C unsweet. applesauce

1 C cooked spinach

2 TBSP lowfat margarine

Breakfast

1 scrambled egg

2 sl. whole wheattoast

1/2 banana

1 C skimmilk


Sample menu2
Sample Menu

Lunch

1 hamburger bun

2 oz hamburger patty

1/2 C mushrooms

1/3 C pasta salad

1 cucumber with vinegar

mayo and mustard

Dinner

3 oz pork chop

2/3 C rice

1 dinner roll

1/2 C unsweet. applesauce

1 C cooked green beans

2 TBSP margarine

Breakfast

1 scrambled egg

2 sl. whitetoast

1 C berries

1 C 2%milk


How to simplify
How to Simplify

  • Combine lists for them

  • Use only 1 method of meal planning

    • Exchanges, plate method, pick from simple lists, etc.

  • Focus on those foods with lowest sources of offending nutrients


How to simplify1
How to Simplify

  • Make sure you aren’t over-restricting for patient needs

  • Focus on foods patient eats and enjoys

  • Focus on what they can eat, rather than what they can’t eat


Special issues
Special Issues

  • Food Group Inconsistency

  • Uncontrolled Blood Glucoses (thirsty)

  • Starfruit

  • Malnourished patients

  • Salt Substitutes (K)

  • Obesity


Other resources
Other Resources

  • www.AAKP.org “How Can I Follow My Diabetic and Renal Diet Restrictions?” article

  • www.foodfitnessfirst.com “Renal Diabetic Diet Plan” (has picture versions of the lists for less literate)

  • American Dietetic Association (Nutrition Care Manual) for CKD Nutrition Therapy

  • www.kidneyschool.org (patient learning modules)



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