What is diabetic nephropathy

Diabetic nephropathy is a common chronic complication of diabetes mellitus, and diabetic nephropathy occurs in about 20-40% of diabetic patients [1]. Diabetic nephropathy is a refractory microvascular complication and one of the main causes of incapacitation and cause of death in diabetic patients.

Unfortunately, diabetic nephropathy cannot be cured, only controlled. Therefore, it is especially important to control blood glucose in patients with diabetic nephropathy by improving lifestyle and adjusting dietary structure. For patients with diabetes combined with nephropathy, a low-salt, high-quality, low-protein, diabetic diet is recommended.

How to choose staple food

Patients with diabetes mellitus with renal disease can take the following two approaches when choosing staple food: first, choose more coarse grains, such as buckwheat, oat, oat, corn, etc.; second, it is recommended that patients with diabetes mellitus with renal disease stage 3-5 to replace part of the staple food with wheat starch in order to reduce dietary non-high quality protein intake and ensure adequate energy.

Wheat starch is made by extracting and separating the proteins from wheat flour, corn flour, and sweet potato flour, and the protein content drops from 9.9% to less than 0.6%. Commercially available are finished low-protein rice, low-protein noodles, low-protein flour, and low-protein cookies, all of which are made from wheat flour, cornstarch, and sweet potato flour, and are rich in flavor and easy to cook and prepare.

The specific diet needs to be individualized and formulated, taking the medium-sized people with a height of 165cm and CKD3-5 as an example: in the morning, you can drink a glass of 200ml milk, 75g of hair cake, and 1 egg; for lunch, you can eat 100g of wheat starch pancake, 25g of shredded lean meat, and 500g of stir-fried vegetables; and for dinner, you can eat 100g of rice, 40g of fish, and 250g of stir-fried vegetables.

How to choose protein

Patients with diabetic nephropathy need to pay attention to the kind and total amount of protein intake.

Intake: Excess protein can increase glomerular filtration rate, promote glomerular basement membrane thickening, and aggravate the condition. The daily protein intake of diabetic nephropathy patients is not more than 15% of the total calories, and the daily protein intake of those with microalbuminuria is controlled at 0.8-1.0g/kg; those with overt proteinuria is controlled at 0.6-0.8g/kg[2]. A low-protein diet reduces urinary protein excretion and delays the progression of renal damage.

Types of intake: It is recommended to consume more high-quality protein. High-quality protein is mainly based on animal protein. Such as fish, lean meat, beef and lamb, milk, eggs. 50g lean meat = 80g fish = 60g eggs (1), which contains 9g of protein per serving; 160ml whole milk = 250ml skimmed milk = 130g yogurt, which contains 5g of protein per serving.

Non-quality protein refers to the lesser amount of essential amino acids. less, such as rice, noodles, fruits, beans, vegetables in the plant protein. The relative low utilization of protein will increase the burden on the kidneys. Because the total daily protein intake is limited, we should try to increase the proportion of high-quality protein intake and reduce the proportion of non-quality protein intake.

Strictly limit salt intake

Patients with diabetes mellitus combined with renal disease are prone to generalized edema due to the decrease in glomerular filtration rate, which leads to a decrease in the renal excretion of sodium and water. A high salt diet will increase blood pressure and proteinuria, increasing the burden on the kidneys. The daily salt intake depends on the edema, if there is no edema, it is recommended that the daily salt intake of 3-4 g. You can use a salt-control spoon to determine the amount of salt, a flat spoon for 2 grams of salt.

Low salt rationing

Every morning, the salt needed for the day is weighed and placed in a fixed special small bowl, when the family cooks the dishes[l1], first do not add salt, the portion that the patient eats is served, and a portion of the salt is taken from the small bowl and added to the dishes, in this way, it is possible to do rationing and not overdose.

Pay attention to cooking methods

For example, 10 ml of soy sauce contains 1 g of salt. Cooking methods such as braising and saucing as well as the intake of seasoning sauces should be minimized, and soy sauce, sweet noodle sauce, seafood sauce, and chili sauce are not recommended. Some pickled foods and invisible salt-containing foods should not be eaten, such as salted eggs, pickles, kimchi, hanging noodles, cooked food or semi-finished products.

In addition, patients with diabetes mellitus combined with nephropathy must not use low-sodium salt to replace common salts, as low-sodium salt is high in potassium and prone to hyperkalemia