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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Carb counting on a kidney diet

No doses on this page

This handbook never gives insulin or medicine doses and never tells you to change one. Your prescriber sets every dose and every change, and writes down when to pause a medicine and when to restart it. A low blood glucose is always treated straight away: see Treating a low and Get help now.

In short

Nothing about kidney disease changes carb counting: rapid-acting insulin is still matched to grams of carbohydrate, and people on fixed insulin plans keep carbohydrate consistent "with respect to time and amount" (ADA 2026 §5, recommendations 5.27–5.28). What changes is the food. Kidney swaps (white rice for brown, white bread for whole-wheat, canned fruit for a banana) lower potassium and phosphorus but cut fiber and can make glucose rise faster, so your insulin-to-carb ratio may need re-tuning with your diabetes team (KDIGO 2022; PLADO).

Your numbers
1 carbohydrate choice 15 g of carbohydrate (NKF)
Per meal typically 3–6 choices (45–90 g), set by your dietitian (NKF)
Per snack typically 1–3 choices (15–45 g) (NKF)
Fiber at least 14 g per 1,000 kcal (ADA 2026 §5, recommendation 5.24)

The app's starting carbohydrate goal is 45 % of your calories, split evenly over the meals; your diabetes team sets the real number. The sample menus keep about 55 g at each main meal (50 g on peritoneal dialysis) so a fixed plan or ratio works the same way every day.

About 15 g of carbohydrate: kidney-friendly portions

One carbohydrate choice is 15 g (NKF). These portions are close to one choice and low in potassium and phosphorus. The last rows show what the same carbohydrate costs from higher-potassium foods.

Food Portion Carb g Potassium mg Phosphorus mg
White bread 1 slice 14 37 28
White rice, cooked ⅓ cup 15 18 23
Pasta, cooked ½ cup 19 28 36
Cream of Wheat, cooked ½ cup 13 20 19
English muffin ½ 13 38 38
Saltine crackers 6 13 28 18
Corn tortilla, 6 inch 1 12 40 82
Popcorn, air-popped 3 cups 19 79 86
Applesauce, unsweetened ½ cup 14 90 6
Blueberries ¾ cup 16 86 14
Pineapple, canned in juice ⅓ cup 13 101 5
Grapes ½ cup (about 15) 14 144 15
For comparison: banana ½ medium 14 211 13
For comparison: potato, boiled ½ cup 16 256 31
For comparison: sweet potato, baked ½ cup 21 475 54

USDA FoodData Central values through the app's food list (FDC). Milk alternatives differ a lot: unsweetened almond milk has about 3 g of carbohydrate a cup, rice milk about 22 g.

Swaps: what they cost or save

Swap Carb g Fiber g Potassium mg Phosphorus mg What it costs or saves
White rice 1 cup → brown rice 1 cup 45 → 52 0.6 → 3.2 55 → 174 68 → 208 brown costs about 120 mg potassium and 140 mg phosphorus
White bread 1 slice → whole-wheat 14 → 14 0.8 → 1.9 37 → 81 28 → 68 +45 mg potassium, +40 mg phosphorus per slice
Cream of Wheat 1 cup → oatmeal 1 cup 26 → 28 1.3 → 4.0 40 → 164 38 → 180 oatmeal costs about 125 mg potassium and 140 mg phosphorus
Banana, small → blueberries ½ cup 23 → 11 2.6 → 1.8 362 → 57 22 → 9 saves 305 mg potassium and half the carbohydrate
Potato, baked → white rice ½ cup 37 → 22 – 926 → 28 121 → 34 saves about 900 mg potassium

Per serving, USDA FoodData Central (FDC).

Three practical rules

  1. Whole grains are not automatically off the table. Their phosphorus is bound as phytate and only about 20–50 % is absorbed (vs about 40–60 % from meat and 90–100 % from additives), and KDIGO 2022 recommends a diet "high in vegetables, fruits, whole grains, fiber, legumes" for diabetes with CKD (KDIGO 2022, practice point 3.1.1; Kalantar-Zadeh 2010; Noori 2010). If your potassium and phosphate are in range, one or two whole-grain servings a day is a fair trade for fiber and flatter glucose; decide it with your dietitian.
  2. Portion the starch, do not just swap it. ⅔ cup of white rice is about 30 g of carbohydrate and keeps the count where your ratio expects it.
  3. Get fiber from low-potassium produce: berries, apples, green beans, cauliflower, cabbage, cucumber, peppers, zucchini and onions (NKF). Berries and applesauce are the best value: low in potassium and low in carbohydrate per cup.

A worked example

A dinner of the lemon-garlic chicken recipe (3 oz chicken, ¾ cup rice, ½ cup green beans) has about 41 g of carbohydrate. Add ½ cup of canned peaches in juice (14 g) and the meal is about 55 g, the amount the sample menus use. Chicken, oil and butter have almost no carbohydrate, so they do not change the count. Your plan, not this page, says how much insulin goes with 55 g. The app shows a carbohydrate total for each meal as you log it (app contract).

Special cases

  • Peritoneal dialysis. The glucose in the dialysis fluid is absorbed and adds calories, often 400 kcal or more a day, and raises glucose (DaVita). Your team counts it in your insulin plan; food carbohydrate is counted as usual.
  • Hemodialysis days. Glucose often falls during a session, and most lows come within 24 hours of one, so your team may plan different carbohydrate or insulin for dialysis days (JBDS 2022; Dialysis days).
  • Slow stomach emptying (gastroparesis). If your glucose rises hours after meals, or you feel full quickly, tell your team. Small, regular, low-fat and low-fiber meals are the usual advice (JBDS).

Labels and "diabetic" foods

  • Count Total Carbohydrate × the servings you actually eat, and check what "one serving" means first. Since the 2020 label rules, a package that holds one to two servings, such as a 20-oz soda or a 15-oz can of soup, is labeled as one serving: the numbers already cover the whole bottle or can, so do not multiply them. Bigger packages often show two columns, per serving and per package (FDA). A bowl of cereal is often 1½–2 label servings.
  • Sugar alcohols are still carbohydrate. One common method is to subtract half of the sugar alcohol grams from Total Carbohydrate (Medtronic). Ask your diabetes team which method they want you to use, and watch your CGM.
  • "Diabetic" cookies, bars and shakes often add phosphate or potassium salts (DaVita).
  • Diet colas still contain phosphoric acid (about 27 mg phosphorus per 12 oz measured, 41–68 mg for some brands); clear diet sodas have none (measured beverage phosphorus; FDC).
  • A sugar-free sweet will not treat a low: use glucose (Treating a low).

What to do

  • Keep carbohydrate at each meal about the same from day to day, as your plan says.
  • When you switch to kidney-friendly starches, check your CGM after meals for a week or two and take the pattern to your diabetes team.
  • Log meals with their carbohydrate in the app, and record the glucose pattern around them. With kidney disease A1c is less reliable, so your team leans on CGM patterns as well (CGM metrics).
  • Measure starches with a cup for a week until you can judge portions by eye (Portions).

Ask your care team

  1. My carbohydrate per meal: how many grams, and does it change on dialysis days?
  2. I have switched to white bread and rice: should my insulin-to-carb ratio change?
  3. Can I keep one or two whole-grain servings a day with my current labs?
  4. How should I count sugar alcohols with my CGM and pump?

Get help now if…

Call 911 (or your local emergency number)

Someone with a low cannot swallow safely, is very drowsy or confused, or has a seizure: give glucagon if you have it, turn them on their side and call (ADA 2026 §6). Also call for blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath (NHS; 2024 consensus).

Call your care team today

Glucose stays high after the correction your plan tells you to take: check ketones and call your diabetes team. Blood ketones of 1.6–2.9 mmol/L: call now; if you cannot reach the team quickly, or you are vomiting, go to the emergency department (NHS; ADA). Follow your sick-day plan. Also call about lows that keep coming back after you change foods. Full list: Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.