Diabetes I'm sweet, ESRD I'm salty

By TinaMarie Cerreta

LOOKOUT! I'M DOUBLE THE TROUBLE...

Hello Friends!

Today we're going to address the dual diagnosis of Diabetes and ESRD. Its much more common than you think both with dialysis and non-dialysis patients. The struggle is real! Below are some real facts about what its about and what some helpful solutions are, or where to find them.  There is a way to manage your diagnoses so that you live an optimal life. It just takes a lot of adjustments and help from others. You just have to look and ask for it. Its available to e everyone. Below are some resources you can access.

Diabetes is the most common cause of End-Stage Renal Disease (ESRD), the final stage of permanent kidney failure. When kidneys fail, they can no longer filter waste and fluids from the blood. Management shifts from trying to save the kidneys to doing the work for them, requiring either dialysis or a kidney transplant to survive. [1, 2, 3, 4, 5]

Here is the essential breakdown of how these two conditions interact, explained in layman's terms:

1. The Connection: How Diabetes Damages Kidneys
Think of your kidneys as millions of tiny, microscopic coffee filters. Their job is to keep good things (like blood and protein) inside your body while flushing out waste and extra water. [1, 2, 3]
  • The Overwork: High blood sugar forces your kidneys to filter too much blood. Over years, this overworking causes the tiny blood vessels inside the filters to clog and scar. [1, 2]
  • The Leak: Once the filters are scarred, they become leaky. They start letting protein pass into your urine, which is often the very first sign of kidney damage. [1, 2, 3, 4]
  • The Result: If blood sugar and blood pressure remain high, the scarring worsens until the kidneys stop working completely. [1, 2, 3]

2. What Happens at the ESRD Stage?
When a person reaches ESRD, about 85% to 90% of their kidney function is gone. This means waste products and fluid build up in the blood, leading to symptoms like: [1, 2, 3, 4, 5]
  • Extreme tiredness and weakness
  • Swelling in the feet, ankles, and legs (due to extra fluid)
  • Nausea and loss of appetite
  • Itchy skin [1, 2, 3, 4]

3. Diabetes Management on Dialysis
A common misconception is that when your kidneys fail, your diabetes goes away. In reality, diabetes still needs to be strictly managed even after starting dialysis. [1, 2]
  • Changing Needs: When kidneys are failing, they often process the body's insulin (or diabetes pills) much more slowly. Many patients find they actually need less insulin for a while because their body isn't getting rid of it normally. [1, 2, 3, 4, 5]
  • Dialysis and Blood Sugar: If you are on a specific type of dialysis called peritoneal dialysis, the cleansing fluid contains sugar. This can cause your blood sugar levels to spike, requiring adjustments to your diabetes medications. [1]

4. Treatment Options for ESRD
There is no cure for ESRD, but it is highly treatable. Patients must use one of the following options: [1, 2, 3, 4]
  • Hemodialysis: A machine acts as an artificial kidney, filtering your blood several times a week.
  • Peritoneal Dialysis: A special fluid is put into your belly to pull waste from the blood, which can often be done at home.
  • Kidney Transplant: A surgical procedure to place a healthy kidney from a donor into your body. [1, 2, 3, 4, 5]

What Everyone Should Know: Key Takeaways
  • You won't feel it early on: Kidney damage from diabetes happens silently over many years with almost no symptoms in the beginning. [1, 2, 3]
  • Testing is crucial: If you have diabetes, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends an annual urine test(if your still producing enough) to check for protein and a simple blood test to check your filtering rate. [1, 2, 3, 4]
  • Control slows the damage: Managing your blood sugar and blood pressure is the single most important thing you can do to prevent kidney disease from progressing to ESRD, or to keep yourself healthy if you are already on dialysis. [1, 2, 3]
**Note: Nutrition is highly specific when treating both diabetes and kidney failure. Always consult with a registered dietitian or your healthcare team to create a meal plan tailored to your specific needs. [1, 2]

To live a better life with diabetic End-Stage Renal Disease (ESRD), focus on coordinating your diabetes care with your dialysis or transplant schedule. This requires balancing complex dietary needs, monitoring fluid intake, staying physically active, and working closely with your healthcare team to maintain stable blood sugar levels. [1, 2, 3, 4]

Actionable strategies to optimize your quality of life include:
1. Master the Renal-Diabetic Diet
Balancing both conditions requires a customized meal plan created alongside a renal dietitian. [1, 2]
  • Limit Sodium: Keep blood pressure in check and reduce fluid retention by avoiding packaged, processed, and restaurant foods. [1, 2]
  • Control Fluids: Strictly monitor fluid intake (including ice and soups) based on your doctor's exact daily allowance. [1]
  • Manage Potassium & Phosphorus: Limit high-potassium foods (like bananas and oranges) and phosphorus-rich foods (like dark colas and nuts) as directed by your labs. [1, 2, 3]
  • Carb Counting: Focus on complex, high-fiber carbohydrates to manage blood sugar, being careful not to replace simple sugars with high-potassium alternatives. [1, 2]
  • **For personalized advice and meal-planning tools, visit the American Diabetes Association or explore the National Kidney Foundation for detailed nutritional guides and emergency planning tips. [1, 2, 3, 4]
2. Medication and Blood Sugar Management
  • Coordinate Medication: Track and take diabetes medications consistently. Because dialysis can clear certain medications from your blood, always review your medication schedule with your nephrologist or endocrinologist.
  • 5Frequent Monitoring: Check blood sugar levels regularly, particularly before, during, and after dialysis treatments. [1, 2, 3]
3. Stay Active
Physical activity improves insulin sensitivity, energy levels, and heart health. [1, 2, 3, 4, 5]
  • Timing is Everything: Many patients find it easiest to exercise on non-dialysis days, or incorporate light movement (like stretching or walking) on dialysis days. [1, 2]
  • Start Small: Aim for a total of 150 minutes of moderate activity per week, breaking it down into manageable 10-minute sessions. Always get clearance from your care team before starting. [1, 2, 3, 4, 5]
4. Prioritize Mental and Emotional Health
Managing two chronic illnesses can be emotionally exhausting, and fatigue from dialysis is common. [1]
  • Find Support: Speak with a mental health professional or join local support groups to build emotional resilience. [1]
  • Simplify Your Routine: Organize medications and medical supplies in one dedicated place, and use mail-order pharmacies to limit errands. [1]
  • Explore Transplant Options: For patients fit for surgery, kidney transplantation is the gold standard of treatment and is generally associated with an improved quality of life compared to lifelong dialysis. [1, 2]



  • Here's what I think about this:
I'm a diabetic with ESRD, so I have a lot of restrictions and limitations. I have to keep track of my bloodwork, maintain my weight, and deal with my many other health issues and of course comply with all medical request and go to dialysis on time to every session.
Some of my medical diagnoses are a result of my diabetes and ESRD. Because of long term diabetes and insulin use I have diabetic retinopathy (my eyesight is slowly getting worse, and I can no longer drive), diabetic neuropathy (my right leg has lost some function, so I use a walker and meds for restless leg syndrome), atherosclerosis (the membrane around my arteries are hardening like bone, but some of this is just age related), coronary artery calcification, spinal stenosis, of course, ESRD and complete kidney failure. I'm sure there are other health aspects involved, but that's the main idea.
It wasn't until 3 years ago when I started taking a GLP-1 for my diabetes that my health really changed. At first, I was apprehensive about it. But I had to admit it helped tremendously with controlling my bloodsugars and I even started losing weight. But, I was not happy with the doctor I had so I ended up switching endocrinologists to find a better fit.


My new one was a lifesaver! She saw that I needed help with my insulin dosing, how to treat it regularly, and how to manage it. What I really needed was knowledge. She got me started with a smart insulin pen which is an electronic dosing unit. Its called "InPen(minimed)", which tells me how much insulin to take based on my current blood sugar and even identifies any residual insulin in my system. There are charts and you can even send your reports to your doctor(s).


So, she hooked me up with a continuous glucose monitor (CGM), which showed me my blood sugar all the time (I use the G7 from Dexcom). It was a total lifesaver. I never realized how helpful this thing could be in my daily life. It told me when my sugars were getting low, were too low and I needed to take fast-acting glucose, getting high, and too high where I had to take insulin. I found that, for me, it was a lifesaver at night because my sugars would sometimes drop dangerously low and this would wake me up. (If not, I could have had serious health problems)


She told me some new stuff, like if my blood sugar is super low (under 70 for me), I should take 4 glucose tablets (that's the serving size on the bottle) or 1 gel pack (I use "Transcend"), and that'll bump it up 15-45 points in about 5 minutes. She also said I should take my fast-acting insulin 15 minutes before every meal to get ready for the carbs and sugars. The goal, she said, was to keep things steady, no big ups or downs.

Most insurance plans cover these gadgets, but you should check with yours to be sure. If not, maybe your doctor can get an override for you.


I had no idea about any of this. The GLP-1 I was taking worked pretty well, but she switched me to a different one that ended up working way better for me. As a result, over 3 years, I've lost a whopping 210 lbs! (THIS IS NOT TYPICAL)To be fair, almost half of that weight loss was because of health problems. I was in the hospital for 17 days (04/01/25-04/17/25), started dialysis on 04/02/25, then went to a rehab facility for a month for my neurological damage in my foot/leg. I dropped a lot of weight during that time.

In a lot of ways that GLP-1 has been life-changer. (***DISCLAIMER:Its not for everyone and it isn't a quick fix for weightloss. If you haven't been diagnosed as diabetic, your insurance might not cover it. It must be under close doctor's supervision at all times.***)  It helped me manage my diabetes and gave me the freedom to make better choices without feeling hungry.


It wasn't a magic bullet, and there were side effects. I have to remind myself often that I shouldn't keep eating after I'm "full" because I might not be able to keep it down and to be mindful of exactly when I am actually "full". You had to make sure to eat several small snacks throughout the day to keep your stomach filled with food. But it really helped distract my brain from food since my hunger just disappeared. 

My diabetes has gotten so much better. I'm off long-acting insulin. Just 1.5-2 units of quick-acting in the afternoon and early evening. But to be totally honest, it's a daily challenge I tackle head-on because my life and future depend on it. I just try to keep my numbers (blood sugar, insulin, and everything else) and my diet, plus daily walks in check. 

I am constantly refocusing my thinking so that when I'm off the GLP-1 for good, I can keep the weight off. The last thing I need is to backslide. I really think losing all that weight (210 lbs total!) was the best thing for my body. It mostly changed my future's path.
I used to take three meds for high blood pressure, but now I'm off all of them. I was on a high dose of cholesterol medication, and now it's a super low dose. I was on both quick and long-acting insulin, but now I'm off the long-acting and only take a small dose of quick-acting in the afternoon and evening. It's pretty amazing (and a bit of a relief!).
I watch my sugar and carb intake. Sometimes I need to watch that I don't eat too many carbs because they turn to sugar when they hit your bloodstream. I have to focus on protein because dialysis removes a good amount, and I'm trying to rebuild my muscle mass. It's one of the side effects of using GLP-1's. But to be fair, I never exercised while I was losing the weight. I lost a lot of it with that big weight loss. 
When I eat my meals, I focus on lean meats and fresh veggies. And I eat them in that order to get the most benefit. For snacks, I mostly eat fresh fruits and veggies with a little bit of "empty calories" (Haribo gummy frogs and Starburst) and an occasional single serving of junk food (original 1-ounce bag Doritos or original 1.5-ounce bag Cheez-Its).


I've found that if I stick to single-serve snacks, I'm less likely to overeat. It costs a bit more, but it keeps me honest. I also try to keep an eye on my portions because they tend to get bigger if I don't. For fruit, I wash and pre-package them into single-serve bags and store them in the fridge. I do the same for savory and sweet snacks when needed. That way, I can just grab and go without worrying about portion sizes.

If you're thinking about losing weight to help with comorbidity issues, go for it. You owe it to yourself to be your best self. But do it mindfully, safely and slowly. In reality "slow and steady wins the race!" Plus, I'm living proof it works.

Okay, that's enough for now. I don't want to overwhelm you! I hope you have a super serene and peaceful weekend! Below are a variety of links to resources, links to my personal sites and of course my quote for the day. Talk to you soon!


Tina


Useful Resources:

Core Medical & Patient Education
Diet & Nutrition Support
Clinical & Research Resources


My Links:

National Kidney Registry (main)

My Personal Microsite

My Personal Blog(all posts)

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Thank you for reading my posts.

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