I am a 37 year old type 1 diabetic on an insulin pump. My control is good (last A1C was 6.0). My husband recently started on a diet his doctor recommended that is basically 40% carbohydrates, 40% protein and 20% fat. He is eating it to try to reduce his cholesterol, high blood pressure, and weight. The diet emphasizes high quality (complex) carbohydrates and lean protein, and requires eating approximately the 40/40/20 ratio at each of five or six “mini-meals” per day. Overall, this seems like a fairly healthy diet, so I decided to shift to eating this way as well (makes it easier to cook!). Then, I saw where you answered another question and stated that eating more than 20% of total calories as protein may accelerate a decline in kidney function for diabetics. Could you please explain further? Is this diet ill advised for someone like me? My blood glucose control has been great since I started on it, and my husband is definitely losing weight, so I would really like to stick with it if I’m not likely to damage my kidneys prematurely. Thanks in advance for your answers.

My concern is that the enthusiasm for the high protein diet is greater than the metabolic effects it may cause. Specifically, in patients with diabetes, the excretion of increased albumin into the urine can be a marker of diabetes-related kidney disease. Regardless of the high-protein diet, it is thought that increased blood flow in the kidneys that is associated with diabetes causes an acceleration of diabetes-related kidney problems. When you add a high protein diet onto the changes associated with diabetes, there is potential for accelerating any changes. In some of our patients who have been on high protein diets, they have had increased albumin excretion that has gone away when the high protein diet was stopped. This is not enough to state categorically that all patients with diabetes should not eat this diet, but it does say there may be some potential danger. If you really feel like you want to continue this diet, have your physician check a baseline albumin level in your urine and then after you have been on the diet to see that this does not increase. Personally, I feel this diet is hard to continue long-term and results in only short-term changes.

JTL