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Type 1 Diabetic on dialysis

Discussion in 'Ask A Question' started by Redrav, Jun 1, 2017.

  1. Redrav

    Redrav Type 2 · Active Member

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    Hi all. Please assist my brother in law who is on dialysis. He has been advised by his dietitian to eat white bread, white rice, and it is ok for him to have diet soda!! I am concerned that this advice is incorrect. Help!!
     
  2. catapillar

    catapillar Type 1 · Well-Known Member

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    Is your brother in law type 1? Does he carb count?

    A type 1 diabetic who carb counts and appropriately boluses can eat white bread and white rice. I think the advice from the dietician was probably more aimed at avoiding whole grain bread and brown rice because patients on dialysis aren't supposed to have these because they are too high in phosphorus.

    Diet soda is, obviously, sugar free soda. Which is fine for diabetics.
     
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  3. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

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    Redrav -I'm sorry your brother in law is having dialysis. I would just like to add that the members of this forum are unlikely to be experts in dealing with diabetes whilst undergoing dialysis. Of course, there may be members in that situation, but they would be very few in number.

    It feels like people will give their opinions, based on their best efforts, but his situation is very specialised.
     
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  4. himtoo

    himtoo Type 1 · Well-Known Member
    Retired Moderator

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    hi there
    I am not sure on this myself and would also ask if your brother in law is diabetic ??
    I will tag @pleinster and @Tanny35 and @paulliljeros for any assistance they may be able to provide.

    with almost any issue involving us as diabetics there is usually somebody that can give some knowledgeable support.

    all the best !!!!
     
  5. pleinster

    pleinster Type 2 · Well-Known Member

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    Hi. I avoided dialysis through live donor transplant but did an awful lot of research in preparation.

    My mother has been on dialysis since back in the 70s (when the NHS advice was to eat a high protein diet!!!) save for a 9 year period with a transplanted organ. She doesn't eat much these days but never eats rice. She avoids foods with high potassium (bananas, avocados and other high potassium fruits an veg...and limits the amount of spuds) and is supposed to avoid those high in phosphorus (processed meats, fish, dairy products)...but they also tend to contain the protein needed too. it's about limiting portion size really.

    There is absolutely no reason at all why a dialysis patient has to eat white bread or white rice. I agree with @catapillar that it is probably said to steer patients way form brown bread and brown rice...and that - if a Type 1 with insulin involved - the right kind of balance will allow for some higher carbs. Is this dietitian a specialist renal dietitian? With a good understanding of diabetes? That said, I would bear in mind that most of the advice we get generally as diabetics is the basic "healthy" non individual specific rubbish.

    We all know that cutting carbs helps whatever some less than up-to-date health professionals are saying. My advice would be not to eat any bread or rice at all. I would say he should limit portion size (if he even has the appetite), avoid sugar and very obviously starchy foods.

    I would also completely avoid the soda for two reasons 1] the sugar or sugar replacements in them will cause spikes in the blood sugar (dialysis or not) and 2] more immediately relevant - dialysis patients have very strict limits on fluid intake per day so make it water or tea...and if needs be some very very diluted no sugar juice (bear in mind the limit is on all fluids in foods not just in drinks).

    Finally, it is important to remember that dialysis can be pretty brutal really and quality of life is of some significance. I would say that it is dependant on just how bad his sugar levels are (is he self-testing)..and whether he is on other meds for diabetes. I got diabetes from steroid treatment after my transplant! I think if I had had that and the prospect of dialysis, I would have probably toned everything down but still allowed myself to breathe. I suggest he draws up a list of what he thinks he can handle and asks for approval, while keeping an eye on his levels so he can modify things if he has to. He also needs to enjoy his days "off" from the damned machine.
     
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  6. gavin86

    gavin86 Type 1 · Well-Known Member

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    If he's been type 1 for a while he probably already knows how his body reacts to things, if he actively manages it.
    I would focus on the kidney diet unless he's not taking care of his blood sugar.

    Haven't been on dialysis, but almost was, and spent a month in the renal ward surrounded by dialysis patients recently.

    As others have said, the white bread thing is probably more about avoiding other things. Avoiding potassium and getting enough protein were the main worries I heard about from nurses/patients.

    Some type 1s prefer to eat less carbs in general, or prefer low GI, but that varies from person to person.

    As for diet/sugar free drinks, I'm not aware of anything kidney health related. In terms of blood sugar, I did read a recent study that said some subjects may suffer high blood sugar from them, due to the particulars of their gut bacteria. It was a small study though and that result didn't apply to all subjects.
    It seems reasonable enough, I would want to see the methodology/study's design before I put my faith in it though.
     
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  7. Tanny35

    Tanny35 Type 1 · Well-Known Member

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    This info is correct. I stick to a strict renal diet - and everything we would usually choose to eat that is good for us normally e.g. Wholegrain/brown can actually be bad for us renal patients. As a renal patient he will need to watch his pottasium and phosphate intake . The NHS can give him leaflets and advice on what he should and should be be eating - hope this helps. If u need any more info feel free to inbox me
     
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  8. paulliljeros

    paulliljeros Other · Well-Known Member

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    So far, I have avoided dialysis, but with my eGFR down to 9, I fear it is not far away. I was advised against diet coke and I think it was because of phosphorus, but am not sure. I have found this link if it helps https://www.kidney.org/news/kidneyCare/spring10/DietSoda
    As for white bread, I have not had any comments for or against, and most of my advice has been regarding avoiding potassium, lowering and controlling BG and blood pressure. Has he specifically been advised to eat white bread, or is that just the best carb on offer, with the assumption from the dietitian that "he is diabetic, he must eat carbs"? I have tried maintaining a low carb diet, and that has helped tremendously with bringing my BG's into line, but as I am sure you will be aware, there are so many low carb foods that must be limited or avoided because of potassium so it makes it very difficult. Happy to help wherever I can if you have any other questions. As @Tanny35 says, it feels quite counter-intuitive as everything that's good for diabetes seems to be bad for CKD !
     
    #8 paulliljeros, Jun 8, 2017 at 12:40 PM
    Last edited: Jun 8, 2017
  9. paulliljeros

    paulliljeros Other · Well-Known Member

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    Sorry for the poor quality, but in case this helps, this is the dietary advice I was given for eating a lower potassium diet
     

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  10. Tanny35

    Tanny35 Type 1 · Well-Known Member

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    With regards to Fozzy soft drinks - I was informed soda is fine but to avoid Coke. Any other fizzy was on the green list in the leaflet I was given (green is fine to consume). My egfr is down to 5 and I have just had a PD tube inserted (yesterday) ready to start dialysis. But have seen the dietician in advance with what can and can't be eaten.
    As stated above potassium is a big no no, this can cause cardiac arrest if levels are too high.
    However, he can still eat it in low levels. And ensuring potatoes and all veg are boiled for at least ten mins removes the majority of potassium in these foods.
     
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