Stage 4 kidney +type 2 diabetes

[Lmfro0308]

I was diagnosed with stage 4 kidney failure last Monday. I left the office with a short list of foods I can and cannot eat. The problem is half of that list I can't eat on my diabetic diet. I called the office to see if they could make an appointment with a dietician for me only yo be told they aren't affiliated with any. I called my gp and they set up an appointment with their dietician but they said she specializes in diabetes and they don't know how much she knows about kidney care, and oh yeah she can't see me til JULY 6. I've looked around but can find no one in my area to help. I'm starting to lose it. I need help now not in 3 monthes. Can anyone direct me toward something that can tell me what I can eat on BOTH diets and how much of each item I can have???
Thank you, lisa

[pitapan]

I have the same problems. I started t write you a long reply last night but then lost it. writing on the forum is sketchy. sit tight. I'm working on it. you are nt alone. just talked to dietician. I'll try to write more later, sugars crashing at the moment

[pitapan]

First Lisa, relax a bit. If you are old enough to have stage 4 CKD you are old enough to have worked through many problems in your life. You will work through this one.

If your nephrologist doesn't work with a dietician and didn't give you specific targets for sodium, potassium, phosphorous, protein, etc. based on your labs then they are incompetent. Fire them and go elsewhere. I have fired a number of incompetent doctors. Don't let the silly lab coats fool you, that's why they wear them, to look like they know something. When I was diagnosed with T2 diabets I knew nothing and didn't take a HIGHLY active role in my treatment. I got badly damaged by the stupidities of the medical profession. I have watched things evolve in diabetes treatment for more than 20 years and it's getting better but they still don't get it. When insulin becomes a first line treatment They will get it. Read Berstien. Finest diabetes education I have ever gotten. But he is a lifelong T1 and knows nothing about good food. Still you can pick up some carb saving tricks from his cookbook.

You can get lists of "good" and "bad" foods anywhere on the web. You can also get generic targets to shoot at. But in my discussion with the dietician tonight she remarked that people respond differently to what they eat. You need to be guided in your choices by your labs.

I don't need to know about foods so much as recipes. They need to be simple, very fast and very tasty as I am a foodie. I need to highly control all the renal factors, the carbs , and protein (which the liver will convert to carbs, a chunk of meat will spike my sugars) and lastly calories. I am seriously overweight which Is a big deal. My next nephrology appointment is 3 weeks out and from the web I have a LOOOOONG list of foods to limit and avoid. For 3 weeks I can just avoid. Won't kiil me. Failed kidneys will.

I haven't salted my food since I was 18. I am 62. Takes a bit of getting used to. Throw out all the salt in the house and the shaker too. You will never need it again. Eat no junk food. None, zero, zilch. You are going to be on a very limited diet.. You need maximum nutrition from ever bite you eat. Focus on salads madewith "good" veggies. Amazing spice blends from Whole Spice Napa Valley are a whole different discussion but delights await you. Do not despair. I like my food seriously flavorful, and it is. I have an advantage in that I can cook. If you can't plan on learning. I also live alone, I just cook for me. If you have to cook for the family then cook what you need for you and let 'em order a pizza. When they get tired of pizza they might want to try your stuff.

I looked high and low and didn't find a both-diets cookbook but there are thousands (I kid you not) for each diet. I figured I would just go through a bunch of recipes for the renal diets and pick the diabetic friendly ones, then make them more so. Poked around DaVita and after 5 or 6 found a diabetic friendly-ish one and if I substitute my home made sesame seed crust for the store bought graham cracker one at would be perfect. (a trick from Bernstien, the crustless pumpkin pie is another but doubt it renal friendly except in small doses).

A lot of recipes are more elaborate than I want to bother with. I'm a two or three ingredient kind of guy and like at least two to be in shaker bottles. I have been cooking a long time. It's gotten old and I hate doing dishes anyway.

I do have a collection of recipes I make for others. I am known for them. And I get to have a nibble. So there are diabetic horrors like white flour and renal awfulness like baking powder in the cupboard.

So cheer up, eat small, eat green and be very wary and skeptical of those who call themselves medical professionals.

[BabyTee]

My first bit of advice is to write down every thing you eat for a week. Then you have to figure out how many carbohydrates (minus fiber), fiber, protein, and fat you eat. If you change any of these too fast, your digestive tract will punish you with either diarrhea or constipation. For instance, don't start with 10g of fiber a day and go to 25 the next day.

My next advice is to not stress out about being 100% perfect every single day, or you might have a meltdown. You still have to be good, just not perfect.

Another tip is if you go walking more than 20 min at a time, keep an eye on your blood sugar, becuase mine starts dropping after about 20 min of walking. If I walk for 30 minutes, I get a free 2" diam apple.

Side note:
In 2007, I went out with some friends to Applebee's for dinner. I told my dr that I went into the bathroom and cried after I looked at the menu, because I realized there was nothing I could eat on the menu, and I was embarrassed and felt sorry for myself. In 2007 (it's not the same anymore), the "steamed" veggies came frozen with some sauce on it that could not be removed. You couldn't get a plain chicken breast or steak, because they were marinated before they were shipped to the location. My doctor told me that the stress from trying to be perfect is worse on the body than letting loose for one meal every other week, and the worse that would happen would be I would swell up for a couple of days, but within a few days, I should return to normal. If not, call him. Try to allow yourself some slack every couple of weeks.

A while ago I found sodium girl.com, and I felt inspired. She helped pull me out of my depression and exhaustion of trying to figure out what to eat. I recommend checking her webpage out for ideas, or just inspiration. Of course, as a diabetic you will have to modify the diet for carbohydrates, but it is a good place to start. She has to keep below 500 mg of sodium a day, so if you don't have to restrict sodium, take that into account. Also, she loves avocados, so if you are watching your potassium, beware of the avocados.

I started limiting my sodium below 800 mg/day 5 to 6 days a week, and below 2000 mg one day a week, because I honestly couldn't figure out how to keep it at 1200, like I was directed. It worked for me, BUT you need to figure out what works for you.

Another good resource I found was a cookbook I liked called "The No-Salt, Lowest-Sodium Cookbook" that is actually written for patients with congestive heart failure. Various cardiac diets try to keep your sodium at a reasonable level and your carbs at or below 100 g of carbs per day, so with my research, cardiac diet advice was more helpful than the kidney diets I saw, if you are diabetic.

Tips:
I learned that for me, I feel full at a meal if I eat broccoli or cauliflower, so discovering that made it easier to reduce carbohydrates. No other veggie works for filling me up long term, but as the experienced docs say, "every patient is different, so you need to figure out what works best for you."

I love potatoes, but have to watch how many I eat, so I will slice and fry up one 1" to 1 1/2" potato and fry it up to add to my breakfast. Not many carbs, and not too much potassium, but a little potato, which I love. Also, if you only cook one, you only eat one.

If you have a pizza craving, I suggest the Davita pizza recipe, or a recipe I can't find anymore called "easy gluten-free pizza crust". The following recipe is NOT the same as eating pizza, but my pizza craving is satisfied by eating it.

It is the following:
1. c cooked and cooled chicken chunks (or shredded chicken)
1. c shredded mozzarella cheese
italian seasoning to taste (which I don't use, because I don't like it)

Pulse ingredients in a food processor until chicken is about half the diameter of a pea and cheese is incorporated. If you don't have a food processor, you can also chop to get the effect.
Smash out to 10" diameter and bake at 425 for 10 to 15 min. Cool for 5 min add about 1/4 cup tomato sauce, and low fat, low water toppings,( or the crust will get soggy).
Put back into over and bake for another 5 minutes.
We have also cooked this in a frying pan and it worked fairly well.

That recipe above is pretty versatile if you eat chicken and cheese. My husband likes it more than me. You can also make with low fat shredded pork or beef.

Good luck with your diet quest.
I will pray for you to be inspired and clear minded in this frustrating time. If you are not religious, my prayer won't hurt.