CKD, steroid induced T2 on insulin, and diet

[Royjk]

So, thanks for your replies to my question. I am lactose intolerant, which means for 67 years I have looked at labels and just not eaten things that contain milk, butter,margarine, and cheese, I never found replacements as I just did not eat food that triggered my intolerance/sickness. I do not eat pasta, spaghetti as I do not like the taste, Then 7 years ago with CKD, I reduced my protein input, cut out most red meat and switched to green veg. Then along came Type 2 diabetes at the start of 2025, where I cut out bread, potatoes, rice, and as many carbs as I could. It was good I use insulin, went from a HbA1c of 103 down to 36 in about 4months.


But I was forever hungry, and became increasingly ill through August when I finished with insulin because it was no longer needed, and when I could no longer walk, was admitted to hospital for two weeks in October, I had pneumonia, and a gastric bug, which had triggered my gMG as my body was so weak, so after 10 days on antibiotic, and IVIg I was 12 kg lighter than my normal weight. I recovered, but relaxed my low BG, instead of aiming for 4 –5 on blood tests I became happy with seeing 6 – 9, and that brought my HbA1c up to 38.


I dropped low carb, went back to insulin and included bread, jam, and potatoes back dayly into my diet, which brought my weight up by the 12 kg I had previously lost. So now I want to go back to reducing my carbs again but I do not want to suffer the weakness involved with a low carb diet, I am on low protein, very low dairy, so, where can I find help in choosing a good diet that will reduce my insulin and not send me back to hospital.


Royjk

 

[Antje77]

So now I want to go back to reducing my carbs again but I do not want to suffer the weakness involved with a low carb diet, I am on low protein, very low dairy, so, where can I find help in choosing a good diet that will reduce my insulin and not send me back to hospital.

There are 3 macro nutrients you can get the necessary calories for fuel from.
Carbs, proteins and fats.
So if you want to eat low carb, low protein, you'd have to seriously up the fats to meet your calorie needs to sustain you.

Tagging @Ushthetaff and @Grant_Vicat who both have experience with dietary advice for CKD. However, they haven't followed a low carb plan as far as I'm aware.

Then along came Type 2 diabetes at the start of 2025, where I cut out bread, potatoes, rice, and as many carbs as I could. It was good I use insulin, went from a HbA1c of 103 down to 36 in about 4months.

Your hba1c is pretty much perfect (if you're not having lots of hypos), and from what I understand, you're not overweight either.
If insulin works well to manage your numbers, upping the carbs and dosing for them is a possibility as well. Your on a basal and bolus regime, right?
Is your T2 diagnosis simply assumed because of age or have you been tested for T1?

 

[Royjk]

Hello @Antje77 So, diet is a balance and I now have high cholesterol, even though I have meds for that. So I would not want to try increasing fats.
With insulin I am up to about 85 fiasp units with meals and 25 Tresiba overnight, and I suspect that is a bit high, but necessary to drop my BG, I start in the mornings at about 6mmol/
Last year I did go through a period of hypo's and to get though those 4 months I reduced first, then stopped insulin completly, starting again in November.
I arrived with diabetes, while taking high doses of prednisone, 5 years ago, then it went out of control at the start of 2025. Diagnosis was with a two hour glucose test and bloods, confirmed type 2.
Royjk

 

[Grant_Vicat]

So, thanks for your replies to my question. I am lactose intolerant, which means for 67 years I have looked at labels and just not eaten things that contain milk, butter,margarine, and cheese, I never found replacements as I just did not eat food that triggered my intolerance/sickness. I do not eat pasta, spaghetti as I do not like the taste, Then 7 years ago with CKD, I reduced my protein input, cut out most red meat and switched to green veg. Then along came Type 2 diabetes at the start of 2025, where I cut out bread, potatoes, rice, and as many carbs as I could. It was good I use insulin, went from a HbA1c of 103 down to 36 in about 4months.


But I was forever hungry, and became increasingly ill through August when I finished with insulin because it was no longer needed, and when I could no longer walk, was admitted to hospital for two weeks in October, I had pneumonia, and a gastric bug, which had triggered my gMG as my body was so weak, so after 10 days on antibiotic, and IVIg I was 12 kg lighter than my normal weight. I recovered, but relaxed my low BG, instead of aiming for 4 –5 on blood tests I became happy with seeing 6 – 9, and that brought my HbA1c up to 38.


I dropped low carb, went back to insulin and included bread, jam, and potatoes back dayly into my diet, which brought my weight up by the 12 kg I had previously lost. So now I want to go back to reducing my carbs again but I do not want to suffer the weakness involved with a low carb diet, I am on low protein, very low dairy, so, where can I find help in choosing a good diet that will reduce my insulin and not send me back to hospital.


Royjk

Hi @Royjk and thanks for the tag @Antje77 Sorry to hear your news. Bearing in mind current views on the Eatwell Plate, it would be better to ignor the recommendations along those lines in this link. The importance of this link is the information on foods to avoid and phosphates in particular. I got to a stage where I was prescribed phosphate binders to make sure they weren't absorbed into the blood stream. This is the link:

Healthy eating for people with chronic kidney disease (CKD) Stages 1 to 3

Chronic Kidney disease is a long – term condition where the kidneys do not work well. It does not usually cause symptoms until later stages. CKD is normally found at earlier stages by blood and urine tests. Your GP can tell you what stage of kidney disease you have.

www.kidney.org.uk

From the point of view of energy from fats, I used to make casseroles using chicken breasts. In your case I would use those with the skin still on. You could of course buy a whole chicken and cut whatever you want to add fat content, freezing the rest. Maybe you could use goose fat for frying or adding to homemade soups, stews and casseroles? I also used celery, onion, white cabbage, pepper, and basil., whatever your preferences. Spinach is rich in phosphates as are mushrooms, lentils and kidney beans.I was told not to drink coffee back in 2012, but it seems allowable now. To be safe I started drinking peppermint tea which I came to appreciate. I notice that berries are now allowed, but they used to be on the banned list. If you eat fish, most white fish is okay. Here is another link ;

Fish

Fish is a high-protein, low-fat superfood rich in omega-3 fatty acids, vitamins, and minerals. Learn how fish benefits kidney health and find a tasty salmon recipe.

www.kidney.org

What it doesn't tell you is that the bones and skin in sardines are the greatest source of phosphates.
I was not lactose intolerant or on a low carb diet, which makes this more challenging. If there's anything further you wish to know please don't hesitate to contact me. The very best of luck.

 

[Antje77]

Hi @Royjk , again you add some interesting information, and again I can only share my own experiences, coming from a different background, so what applies to me won't necessarily apply to you (cross posting).

Last year I did go through a period of hypo's and to get though those 4 months I reduced first, then stopped insulin completly, starting again in November.
I arrived with diabetes, while taking high doses of prednisone, 5 years ago

Prednisone can induce diabetes, and for most (if not all?) diabetics, steroids will increase blood glucose.
Did your period of hypos coincide with a change in prednisone dose?

Diagnosis was with a two hour glucose test and bloods, confirmed type 2

A 2 hour glucose test can only diagnose diabetes, it doesn't tell you anything about the type of diabetes.

With insulin I am up to about 85 fiasp units with meals and 25 Tresiba overnight, and I suspect that is a bit high, but necessary to drop my BG, I start in the mornings at about 6mmol/

This is an interesting ratio between basal (Tresiba) and bolus (Fiasp).
There is a rule of thumb (a very loose one, things can be very different between individuals) that on a regular diet, basal and bolus usually are about the same amount per day.
I'm low carb, so I use significantly more basal than bolus. For years I've needed 100-120 units of Tresiba but only 20-60 (mostly in the middle) units of Fiasp. I need less now (lost weight) but the ratio between the two has stayed about the same.
Still, if you wake up in the 6's, your basal seems to work for you.

Hello @Antje77 So, diet is a balance and I now have high cholesterol, even though I have meds for that. So I would not want to try increasing fats.

When I was first diagnosed (as a T2 initially), all my lipids were out of whack. I chose to ignore this and focused on diabetes, including more fats and not caring about saturated fats at all. When my BG normalised, so did my lipids.
It's not that way for all, but at least for me increasing fats and lowering BG went nicely together with getting all my lipids in the green. I think the medical world just doesn't know half of how cholesterol works, and I know even less.

 

[Royjk]

Hello @Grant_Vicat, and thanks for the link to the kidney org. I have been stage 3b for a long while, and 7 years ago when I first went to see the nephrologist he pointed me to this info. But I was only half a unit under the red line, so I just stuck to the reduce red meat, increase green veg, do mint tea, and cranberry tea. With diabetes at 103 I did low carb for a while which brought down the A1c to 36, but I became ill, So I upped my target levels from 4 - 5 mmol/ to 6-8 mmol/. Now of course I am too high on insulin because I am too high on carbs. So I look for a diet that takes care of my low dairy, low protein , and low fat needs, while giving enough energy for walking and gMG.
So I willl look further at the kidney org info, thanks for pointing me in that direction.
As for food I cut red meat by swapping mince beef with diced chicken in my stews, and have at least 5 veg a day. At my local hospital they do the dialisis in the same beds as PLEX, so I know what I am trying to avoid.
Royjk

 

[Royjk]

Hello @Antje77, so my neurologist put me on prednisone 5 years ago, and told me I will need to be under a diabetic doctor as my BG will be all over the place. The hypo's came by strict low carb carb diet, and close BG control with insulin. I was very ill with a hypo, then insulin stopped working, my doctor put me on a very low dose, which was too high. That all resolved after 5 months, with a two week hospitalisation with antibiotics and IVIg. Since then weight went back up, to normal, bread and potatoes came back on the plate, and insulin was adjusted for higher BG levels. But my last A1c was still 38. I am type 2. I feel I need the low carb diet but am not sure it is a good idea anymore.
Royjk

 

[JudiP]

Hello @Antje77, so my neurologist put me on prednisone 5 years ago, and told me I will need to be under a diabetic doctor as my BG will be all over the place. The hypo's came by strict low carb carb diet, and close BG control with insulin. I was very ill with a hypo, then insulin stopped working, my doctor put me on a very low dose, which was too high. That all resolved after 5 months, with a two week hospitalisation with antibiotics and IVIg. Since then weight went back up, to normal, bread and potatoes came back on the plate, and insulin was adjusted for higher BG levels. But my last A1c was still 38. I am type 2. I feel I need the low carb diet but am not sure it is a good idea anymore.
Royjk

I too developed diabetes after being on a prolonged dose of steroids. Is there a different classification for this I wonder? I was classed as type 2 from the beginning. When I was put on insulin (basal & bolus) I was told ‘you can now eat anything because the insulin will control it’! I must say I am not too careful with low carbs now and I am told I control my diabetes well. My HbA1c is 7 (or 52). The one thing which concerns me is I feel I am not as good as I should be regarding control because even after all these years I still often forget to take my insulin before my meal. This does tend to cause peaks and troughs which I think is not good? I was fortunate in being prescribed a FreestyleLibre sensor on the NHS despite being type 2 and not type 1, who are usually automatically eligible. I find the sensor to be invaluable because it is so much easier to track which way the BG is going. Also I find my BG drops overnight so I frequently get low BG warnings early mornings, other people I know seem to find their BG rises overnight.

 

[Kimble73]

I too developed diabetes after being on a prolonged dose of steroids. Is there a different classification for this I wonder? I was classed as type 2 from the beginning. When I was put on insulin (basal & bolus) I was told ‘you can now eat anything because the insulin will control it’! I must say I am not too careful with low carbs now and I am told I control my diabetes well. My HbA1c is 7 (or 52). The one thing which concerns me is I feel I am not as good as I should be regarding control because even after all these years I still often forget to take my insulin before my meal. This does tend to cause peaks and troughs which I think is not good? I was fortunate in being prescribed a FreestyleLibre sensor on the NHS despite being type 2 and not type 1, who are usually automatically eligible. I find the sensor to be invaluable because it is so much easier to track which way the BG is going. Also I find my BG drops overnight so I frequently get low BG warnings early mornings, other people I know seem to find their BG rises overnight.

 

[Kimble73]

I was on Hydrochlorothiazide a high blood pressure medication and developed Type 2 diabetes from being on it. Some say it doesn’t cause diabetes and some say it does. But I say it did.

 

[Antje77]

Hi all, the posts above were moved from the thread https://www.diabetes.co.uk/forum/threads/low-carb-diet-and-lactose-intolerance.211291/ to keep the other thread on the topic of lactose intolerance and give the more broad discussion on diet with diabetes and CKD a place of its own.