Table 6

Approaches to incorporating diet patterns for diet management of DKD for type 1 and type 2 diabetes*

ProteinExplore/sample plant proteinsIncorporate vegan protein sources into meal plan, de-emphasize intake of fatty animal protein sources such as marbled red meats, poultry products with skin, shellfishDried beans and peasAmount 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 productsLegumes
Nuts and seeds
Nonfat yogurts, milks, lower-fat cheese selections
Include almond, rice, soy milk
Carbohydrates: complexExplore/sampleInclude high-fiber, whole-grain products, de-emphasize refined white flour−based productsWhole/mixed-grain breads, pastas, cereals; wild, brown rice typesWithin carbohydrate counting/diabetes management plan, as tolerated
Fruits and vegetablesHigh-fiber fruits/vegetablesInclude as part of meals snacks and different formats such as smoothiesFresh fruits and vegetables of choice, fresh cooked vegetables ideal, precooked choices available without seasonings6–8 servings per day as appropriate for meal plan and carbohydrate counting
FatOmega-9 and omega-3 fatty acids as a component of fat sourceEnrich 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 acidsInclude olive oil/canola oil−based margarines and fats, choose omega-3–enriched whole-grain breads and cereals when availableWithin meal plan for calories and palatability
SodiumMaximize approaches to lower sodium and salt intakeReduce free salt useUse sodium-free fresh and dried herbs, spices, and herbal blends, when available1,500–3,000 mg daily; transition toward lower range of intake
Use fresh cooked foods, purchase unseasoned options of foods, put sauces/flavorings on side
Weight managementIf overweight, work on weight reductionDecrease 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 euglycemiaBased 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.