Implementation of Low-Protein Diets for Treatment of Persons With Early Diabetic Nephropathy

Low-protein diets are being increasingly used as a treatment for early nephropathy associated with diabetes. Recent research studies have shown a decrease in proteinuria while serum albumin levels and weight have been maintained. A level of 0.6 g protein/kg ideal body weight has been suggested. In structuring these diets, fat should be restricted to approximately 30% of calories, with the remainder supplied as carbohydrate calories after the protein content has been calculated. In some persons, simple sugars need to be included to avoid excessive amounts of high-bulk, high-fiber carbohy drate foods. Insulin and oral agent dosages may need adjustment to compensate for increased glucose levels. Self- monitoring of glucose levels can provide valuable feedback for medication adjustment. Intensive dietary education is needed with these patients, as the diet is sometimes radically different from diets previously used. A hypothetical patient is described and diet calculations provided using the ADA Exchange Lists with accompanying menus.