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Dietary Adjustments for the Chronic Hypertensive Type two Diabetic-Nephropathy Patients: 

Getting a Foothold in the Nephronic Syndrome

By:  Dr. Gary D. Goldberg, PhD

Clinical Professor of Medical Education, and Consultant

Angeles College of Nursing, 

Los Angeles, California

E-Mail:  g.goldberg@live.com

____________________________________________________

Abstract:  

Background:  Dual Dilemma

     Moderate and/or severe protein restrictions may indeed, be proposed in chronic renal failure both to fight its symptoms and to slow its progression.  In diabetic patients, whether insulin-dependent or non-insulin-dependent, have a chronic disease that has generally existed for a number of years before the onset of renal failure.  Dietary protein restrictions are effective in the progression of diabetic nephropathy, but many such patients have been observing dietary recommendations.  Usually the registry dietitian and/or treating physician will instruct the patient on the intake of both carbohydrates and fats.  In addition, there is a growing population that are unwilling to give-up their eating habits and progress from mildly obese tomorbid obesity.  Furthermore, when renal failure develops, the patient may get the strong impression that the different specialists managing his or her health have contradictory objectives and give opposing nutritional advice.  It is highly important that the patient not to imagine that the diabetologist and the nephrologist are giving conflicting dietary directives when, in fact, most of the time their objectives converge.  

     Notes:  The registered nurse and/or nurse practitioner should communicate directly(e.g., add 15 min. of personalized teaching with your patient), understanding and having him and/or her repeat back the dietary information given and or explain through environmental aids that they understand and are willing to comply toward the life-style change and regiment prescribed.  Also, have your physicians’ assistant (P.A.) and /or clinical social-case-worker, involved with the support group meetings, or committee ethnic groups, that are approved through the American Diabetes Association/National  Kidney Foundation and the American College of Nutrition.        

Basic Nutritional Rules for Patients with Uncomplicated Insulin Dependent Diabetes –

     As a registered nurse, you may be aware that insulin-dependent diabetes is characterized by a loss of endocrine pancreas function; and there is no interference with the peripheral action of insulin.  In most cases studies, there appears to be a complete diminishing of production in insulin, although there is no peripheral insulin resistance.  Under such conditions, treatment simply consists of insulin therapy, covering the entire circadian cycle.  However, this insulin therapy imposes regularity in food intake, and particularly the intake of carbohydrates.  In addition, the importance of patient’s nutritional education may be limited in teaching him and/or her how to keep the same amounts of food and the same ratio balance of carbohydrate at each meal.  The other dietetic rules concerning fats and proteins are close to the same as those patients on a regular diet guideline of productive calorie usage and portion size.  [1]  The outcome is an attempt to balance the carbohydrate-lipid protein provisions and of course, an appropriate caloric intake to maintain a stable body weight as well as to foster the best possible state of health and to preserve the vascular walls which ultimately serves to protect renal function. [2] 

Basic Rules for Non-Insulin-Dependent Diabetic Patients-

     With these patients, the disease is characterized by disturbances of pancreatic function.  Sometimes consisting of a lost synchronism of secretion, this may no longer adapt to the level of circulating glucose. 

     Note:  Abnormal circulating glucose levels exist, but without exhaustion of insulin supply at least early in the course of the metabolic disorder. 

     In addition, there is indeed, an impaired response to the action of insulin, called ‘insulin resistance.’  This impairment is a hallmark of the metabolic disease.  The treatment of non-insulin-dependent diabetes consists in trying to achieve a balance between the rate of pancreatic secretion and the degree of insulin sensitivity.  The main objective is to lift the inhibition to the action of insulin, since little can be done to restore the faulty pancreatic secretion. 

     Note:  The means of going about this action mainly involves measuring militating (e.g., this action must include your complete clinical staff of trained nurses and treating practitioners), against sedentary life-style, onset of obesity (i.e., BMI of 35% or higher), and an unbalanced daily diet.  

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