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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.

Eating enough

In short

A kidney diet limits several things at once, and with type 1 diabetes you also count carbohydrate. It is easy to end up eating too little. Too few calories break down muscle, make you weak and tired, and make lows more likely. Aim for 25–35 kcal per kg a day (KDOQI 2020, statement 3.1.1). If you need more energy, add it with fats and measured starch covered by your usual insulin plan, not with more meat (KDIGO 2022).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

60 kg 70 kg 80 kg
25–35 kcal/kg a day 1,500–2,100 kcal 1,750–2,450 kcal 2,000–2,800 kcal
The app's starting goal (30 kcal/kg) 1,800 kcal 2,100 kcal 2,400 kcal
  • Peritoneal dialysis: the glucose in the dialysis fluid adds calories, often 400 kcal or more a day, so food calories are lower (DaVita).
  • Age, sex and how active you are change how much energy you need; they do not change your protein, potassium, phosphorus or sodium limits (design note 05).

Warning signs

Tell your team if any of these happen (design note 05, from the GLIM and ISRNM criteria it cites; KDOQI 2020):

  • You lose more than 5 % of your weight in 6 months without trying (for 70 kg, about 3.5 kg or 8 lb).
  • Your BMI falls below 20 (below 22 if you are 70 or older).
  • Your clothes are loose, your arms and legs look thinner, or you are weaker climbing stairs.
  • You are not hungry for days or feel sick after eating: poor appetite and nausea can be signs that kidney function has fallen further (KDIGO 2024).

What to do

  • Eat three meals and planned snacks; do not skip meals (it also helps prevent lows).
  • Add energy with olive or canola oil, unsalted butter, mayonnaise, cream cheese or sherbet.
  • Add measured starch (rice, pasta, bread) when your team agrees, and count it for insulin.
  • Do not add energy with extra meat, cheese or milk: they raise protein, phosphorus and potassium.
  • Weigh yourself weekly (daily on dialysis) and write it down.
  • Ask for a renal dietitian if you are losing weight or eating less.

Examples

The original sample day in the diet guide (stage 3b–4, 80 kg) came to about 1,470 kcal, which is about 530 kcal under the 25 kcal/kg floor (2,000 kcal for 80 kg). Each of these adds about 100–120 kcal with no protein, potassium or phosphorus to speak of (USDA FoodData Central):

  • 1 tablespoon of olive oil (119 kcal) or canola oil (124 kcal) in cooking
  • 1 tablespoon of unsalted butter (102 kcal)
  • 1 tablespoon of mayonnaise (94 kcal)
  • ½ cup of sherbet (107 kcal and 22 g carbohydrate)

The sample menus use these to reach at least 1,750 kcal a day for 70 kg (less on peritoneal dialysis, where the dialysis fluid adds calories).

Ask your care team

  1. How many calories should I eat a day?
  2. I am losing weight: can I see a dietitian, and should my targets change?
  3. On peritoneal dialysis: how many calories am I getting from my bags?
  4. Should I use a nutrition supplement drink, and which one fits my potassium, phosphorus and fluid?

Get help now if…

  • You cannot keep food or fluids down, or you are vomiting with high glucose or ketones: start your sick-day plan and call your team (Sick days; Get help now).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-05.