Table 6.
Approaches to incorporating diet patterns for diet management of DKD for type 1 and type 2 diabetes*
| Nutrient | Concept | How? | What? | Quantity |
|---|---|---|---|---|
| Protein | Explore/sample plant proteins | Incorporate vegan protein sources into meal plan, de-emphasize intake of fatty animal protein sources such as marbled red meats, poultry products with skin, shellfish | Dried beans and peas | Amount to maintain optimal glycemic control, as tolerated; maintain or obtain optimal nutritional status |
| Dairy products: emphasize nonfat and low-fat versions in diet, sample nondairy milk products | Legumes | |||
| Nuts and seeds | ||||
| Soy | ||||
| Quinoa | ||||
| Nonfat yogurts, milks, lower-fat cheese selections | ||||
| Include almond, rice, soy milk | ||||
| Carbohydrates: complex | Explore/sample | Include high-fiber, whole-grain products, de-emphasize refined white flour−based products | Whole/mixed-grain breads, pastas, cereals; wild, brown rice types | Within carbohydrate counting/diabetes management plan, as tolerated |
| Fruits and vegetables | High-fiber fruits/vegetables | Include as part of meals snacks and different formats such as smoothies | Fresh fruits and vegetables of choice, fresh cooked vegetables ideal, precooked choices available without seasonings | 6–8 servings per day as appropriate for meal plan and carbohydrate counting |
| Fat | Omega-9 and omega-3 fatty acids as a component of fat source | Enrich diet with olive oil, fish oil, and vegetarian sources of omega-3 fatty acids, de-emphasize saturated fat sources and generic vegetable oils that are enriched in omega-6 fatty acids | Include olive oil/canola oil−based margarines and fats, choose omega-3–enriched whole-grain breads and cereals when available | Within meal plan for calories and palatability |
| Sodium | Maximize approaches to lower sodium and salt intake | Reduce free salt use | Use sodium-free fresh and dried herbs, spices, and herbal blends, when available | 1,500–3,000 mg daily; transition toward lower range of intake |
| Use fresh cooked foods, purchase unseasoned options of foods, put sauces/flavorings on side | ||||
| Weight management | If overweight, work on weight reduction | Decrease calories, increase calorie utilization through a regular exercise program, avoid excessively high-protein diets (i.e., >20% kcal from protein) | Balanced proportions of protein, carbohydrate, and fat within individualized approach to maintain euglycemia | Based on individually determined ideal/healthy body weight, gradual weight loss toward goal to allow for altered eating pattern, ongoing modifications in diet as weight goal approached and glycemia management is modified |
*
Inclusion of vegan protein sources, complex carbohydrates, and increased intake of fruits and vegetables may increase serum levels of potassium and phosphorus in later stages of eGFR (i.e., GFR <30 mL/min/m2). Serum levels of these minerals will need to be monitored in those individuals.