food for dialysis patients

Diabetes and Kidney disease in Nigeria


The body has a complex and amazing way of controlling energy and chemical needs. One of the substances produced by the body to deal with the starch and sugars in food is insulin. Insulin is produced by an organ in the body called the pancreas whenever a starch or sugar containing food is eaten. The pancreas is located deep in the belly under the stomach and contains cells called islet cells that specifically produce insulin. The pancreas also produces other chemicals important in digesting the fat and proteins in food but the islet cells of the pancreas are responsible for insulin that in turn lowers blood sugar levels after a meal.

The pancreas is an important organ needed to digest food. It is found deep in the abdomen under the stomach.

The pancreas is an important organ needed to digest food. It is found deep in the abdomen under the stomach.

Diabetes is also called Diabetes Mellitus and is a disease that occurs when the body either does not produce enough insulin or cannot effectively use the insulin it already produces. This leads to an increase in blood sugar levels which over time leads to damage of many organs such as the heart, blood vessels, nerves, eyes and the kidney.

According to a 2014 International Diabetes Federation (IDF) report, approximately 46 out of every 1,000 adults in Nigeria between the age of 20 and 79 years have diabetes with an estimated 4 million cases many of which are undiagnosed. Several thousands are estimated to die from diabetes related conditions every year. Some women may develop diabetes during pregnancy resulting in large babies, or other problems in pregnancy. After the pregnancy, the diabetes may disappear but for some patients, it is the beginning of what will later present as full blown diabetes.

For the Nigerian score card from the International Diabetes Federation click here

For contact information of the nearest Diabetes Association of Nigeria representative near you, click here

For a clinical overview of diabetes mellitus in Nigeria, click here

Symptoms of uncontrolled diabetes   

Common symptoms of type 1 diabetes include:

Excessive thirst, frequent urination, sudden weight loss, severe tiredness and blurred vision.

People with type 2 diabetes may have the same symptoms but they may be less noticeable. Many patients have no symptoms and are only diagnosed after several years with the condition. In Nigeria over 50% of people with type 2 diabetes are are estimated to not be aware they have the condition at the time of the diagnosis.

There are two main types of diabetes:

  • Type 1 diabetes is an autoimmune disease that prevents the body from producing enough insulin. Type 1 diabetes occurs most often in children and young adults. Approximately 5 to 10 per cent of people with diabetes have type 1 diabetes.
  • Type 2 diabetes is a disease that results from the body’s inability to make effective use of the insulin produced. Genetics, obesity and lack of appropriate diet and physical activity are factors that appear to play a role in the development of type 2 diabetes. Type 2 diabetes occurs most often in adults over the age of 40 and accounts for up to 95 percent of all diabetes cases. However, as a consequence of increased obesity and inactivity among young people, type 2 diabetes is now affecting children and young adults.

Complications of diabetes. Without proper insulin production and action, sugar remains in the blood, leading to long term raised blood glucose levels. This can result in short and long-term complications, many of which, if not prevented and left untreated, can kill. All these complications have the potential to reduce the quality of life of people with diabetes and their families.

Diabetes can be a horrible disease but by paying attention you can overcome and avoid problems related to diabetes including stroke, heart attack, kidney failure, blindness, sexual problems wounds on the feed as well as amputation of the legs.

Diabetes can be a horrible disease but by paying attention to the disease, you can overcome and avoid problems related to diabetes. These problems including stroke and paralysis, heart attack, kidney failure, blindness, sexual problems, wounds on the feet that may require amputation of the foot or legsdiabetic-foot-ulcerdiabetic_gangrene

What does diabetes do to the kidneys?

With diabetes, the small and large blood vessels as well as the heart are injured. Small blood vessel damage over long periods of time eventually leads to poor function and eventually failure of the kidneys as well as other important organs such as the eyes. Because of the kidney damage from diabetes, waste products begin to accumulate in the blood and damage other body organs, the body will loose protein in the urine when there should be little to no protein in the urine and the body will retain more water and salt than it should, which can result in weight gain and ankle and eye swelling. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

How many diabetic patients will develop kidney disease?

Three out of every 10 patients with Type 1 diabetes and 1 to 4 out of every 10 patients with Type 2 diabetes eventually will suffer from kidney failure. It usually takes 10 or more years of uncontrolled diabetes to cause kidney disease but it could occur earlier

What are the early signs of kidney disease in patients with diabetes?

The earliest sign of diabetic kidney disease is an increased excretion of protein in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.

What are the late signs of kidney disease in patients with diabetes?

As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood. You may also experience nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count). You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. This does not mean your diabetes is getting better and you should not stop trying to treat your diabetes. If you develop any of these signs, call your doctor.

Prevention of diabetic kidney disease

The prevention of diabetic kidney disease starts with

  • Control your diabetes- daily checking blood sugar and hemoglobin A1c every couple of months  to see how well your blood sugar is controlled is important
  • Checking your blood sugar levels regularly will help you know how well you are doing in controlling diabetes.

    Checking your blood sugar levels regularly will help you know how well you are doing in controlling diabetes.

  • Control high blood pressure- target systolic blood pressure should be 130/80 or less
  • Get treatment for urinary tract infections
  • Correct any problems in your urinary system such as obstruction by kidney stones
  • Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications)
  • Get check ups and blood tests of your blood and urine to assess your kidney function at least once a year
  • Get enough exercise and control your weight.

Treatment of diabetes

  • Treatment of type 1 diabetes typically includes a carefully calculated diet, physical activity, blood glucose testing and daily insulin injections. Some patients may be candidates for islet cell or pancreas transplant
  • Treatment of type 2 diabetes typically includes appropriate diet, exercise, home glucose testing, oral medication/tablets and/or insulin. More recently medications that are not insulin but are injectable have become available and are useful in controlling blood glucose. Pancreas or islet cell transplant is not usually given to patients with type 2 diabetes.

Currently the only known cure for diabetes is a pancreas/islet cell transplant. For patients not receiving a transplant, taking medications along with diet and exercise is very effective in controlling blood sugar and avoiding complications.

Remember That Good Care Makes a Difference

People with diabetes should

  • have their doctor measure their A1C level at least twice a year. They should aim to keep it at less than 7 percent.
  • work with their doctor regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
  • have their blood pressure checked several times a year. If blood pressure is high, they should follow their doctor’s plan for keeping it near normal levels. They should aim to keep it at less than 130/80.
  • ask their doctor whether they might benefit from taking an ACE inhibitor or ARB.
  • ask their doctor to measure their kidney function at least once a year to learn how well their kidneys are working.
  • ask their doctor to measure the amount of protein in their urine at least once a year to check for kidney damage.
  • ask their doctor whether they should reduce the amount of protein in their diet and ask for a referral to see a registered dietitian to help with meal planning.

Food and the patient with Kidney disease or Kidney failure


Kidney function is essential for removing the waste material and some toxins from food that you eat. The kidneys excrete a dietary protein called urea, as well as excess amounts of sodium, potassium, and phosphate. These substances can build up in the body if kidney function is impaired and cause harm.

Following a strict diet can lessen the excessive accumulation of these substances and their bad effects on the body.

what-is-a-renal-diet-will-depend-on-the-foods-we-eat-300x195

A kidney diet has to be balanced and take into account the stage of the patients disease. Taking too much fluid, salt or potassium may be very harmful. Read below for more details.

 

Controlling your phosphorus (Phosphate)

Excess phosphorus is a mineral that healthy kidneys get rid of in the urine. In kidneys that are failing, phosphorus builds up in the blood and may cause many problems including muscle aches and pains, brittle, easily broken bones, calcification of the heart, skin, joints, and blood vessels. To keep your phosphorus levels in check, consider the following tips:

    1. Intake of foods low in phosphorus

  •      Grape
  •      Vegetables: cabbage, green beans, spinach, lettuce, carrot, cucumber, pear, plum, Pineapple, apple, mango, white bread, pasta, watermelon, potatoes
  1. Moderate intake of high phosphorus foods such as:
  • Meats, poultry, dairy and fish
  • Milk and other dairy products like cheese
  1. Avoid high phosphorus foods such as:
  • Black Beans, Red Beans, Black-eyed Peas, White Beans, and Garbanzo Beans, nuts
  • Dark, whole or unrefined grains, whole wheat, Rice, corn
  • Cheese (low fat cheese), Wara (yoruba)
  • Low fat yoghurt
  • Dried vegetables and fruits, Garlic
  • Chocolate, peanut butter,
  1. Don’t forget to take your phosphate binders with meals and snacks.
  • Your doctor may or may not prescribe a medication called a phosphate binder. You need to take your phosphate binder as prescribed by your doctor. Often you will take a phosphate binder with every meal and snack you take. This reduces the amount of phosphate you absorb from food while allowing you to absorb other important nutrients. Phosphate binders do not prevent absorption of all phosphate.

Controlling your Potassium

Potassium is an element that is necessary for the body to keep a normal electrical activity and water balance between the cells and body fluids. All foods contain some potassium, but some contain larger amounts.

Normal kidney function will remove potassium through urination. Kidneys that are not functioning properly cannot remove the potassium in the urine, so it builds up in the blood. This can be very dangerous to your heart. High potassium can cause irregular heart beats and can even cause the heart to stop if the potassium levels get to high.

Typically, there are no symptoms for someone with a high potassium level. If you are concerned about your potassium level, check with your doctor, and follow the tips below.

  • The following foods are high in potassium and intake of these foods should be limited:

Bananas, Avocado, Oranges, Orange Juice, Prunes, Prune Juice, Tomatoes, Tomato Juice, Tomato Sauce, Tomato Puree, Melon, Nuts, Pawpaw, Chocolate, Red Beans, Milk White Beans, cabbage, onions, groundnut, walnut, mushrooms, corn, potatoes

  • Dark leafy vegetables e.g tete, soko,ugu, green, okro,

Potatoes and vegetables can also contain a lot of potassium but can be specially prepared to reduce the amount of potassium contained in them. For potatoes, 

1. Peel and slice into 1/8 inch pieces.

2. Soak 1 cup potatoes in 5 cups of water for 2 hours.

3. Drain and rinse and drain.

4. Cook in a large amount of water.

5. Drain and mash, fry or serve plain.

For vegetables,

1. Slice and wash in plenty water,

2. Drain the water

3. Cook in plenty water

4. Drain the water

5. Use vegetables to cook food or cook vegetables with other ingredients

Foods Low in Potassium

White bread

White rice

Eggs

Apples ( limited amount)

 

Controlling your sodium (salt)

Sodium, or sodium chloride is an element that is used by all living creatures to regulate the water content in the body. Usually a sodium restriction comes in the form of “No Added Salt.” This is necessary because a greater intake of sodium will result in poorly controlled blood pressure and excessive thirst which can lead to difficulty adhering to the fluid restrictions in your diet. However, your doctor can allow you a limited amount of sodium which can vary between 2-6gms per day

To limit your sodium, you should:

  • Avoid table salt and any seasonings that end with the word “salt”

 

  • Avoid salt substitutes (they contain potassium)
  • Avoid salty meats such as bacon, ham, sausage, hot dogs, lunch meats, canned meats
  • Avoid salty snacks such as cheese curls, salted crackers, nuts, and chips
  • Avoid canned soups, frozen dinners, and instant noodles
  • Avoid bottled sauces, pickles, olives, and MSG

. Salted Butter, milk, carrot, spinach, legumes

 

Foods Low in Sodium

Sugar

Onion, ginger garlic, mushrooms

Pasta, Rice, Macaroni

Tomatoes, plum,

Fresh fruits and vegetables except those listed above

 

Cooking Instructions for low sodium.

1. Cook meat / poultry / fish with recommended allowance of sodium

2. Then use the stock to cook soup / food

 

Controlling your protein

Protein is important to aid in growth and maintenance of body tissue. Protein also plays a

role in fighting infection, healing of wounds, and provides a source of energy to the body.

  • For patients with advanced kidney disease not yet on dialysis, it is important that you take some protein but do not take too much. Remember, you need protein for all of the functions above. The reason for asking patients to reduce their protein intake when they have significant disease but are not yet on dialysis is that an excessive protein load can accelerate the path to kidney failure. However note that many other aspects of care are likely more important than protein intake to reduce the progression of kidney disease such as control of blood sugar, control of blood pressure and relief of any obstruction.                                                                                   
  • For patients with kidney failure, there is absolutely no need to restrict protein as the kidneys have failed and protein restriction will not restore kidney function that has been lost. 
  • You should make sure to eat one tenth of a kilogram of protein every day.
  • Foods that are high in protein include beef, pork, veal, chicken, turkey, fish, seafood, and eggs.
  • 1 average sized egg for example is equal to one-twentieth of a kilogram of protein.

     

    How to be successful on a renal diet

    Moderation

    Dietary Guidelines emphasizes the importance of eating a variety of foods. This applies to dialysis patients, too. You can enjoy all foods in moderation while following a renal diet. One of the guidelines states:

    “Be sensible: Enjoy all foods, just don’t overdo it.”

    We Encourage You To:

    • Slow down while eating. Avoid anxiety and worry at meal times. It takes 20 minutes to send the signal that you’ve had enough to eat.

    . Put down fork between bites

    . Do not put bowls of food on the table

    • Stop eating when full. Patients should walk away from the table feeling that they can eat a little more.

    . Leave the table as soon as eating is done

    • Have one small helping of that chocolate cake once in a while and enjoy every bite.
    • Enjoy that piece of sphagetti twice as much. Eat half in the restaurant and take the rest home to enjoy the next day.

    The Goal

    The goal for our patients should be to achieve optimal nutritional status, a healthy lifestyle, that can be maintained rather than a short-term diet that will most likely be abandoned and produce psychological discomfort and metabolic imbalance.