People living with diabetes — especially those who also have chronic kidney disease (CKD) — may develop hyperkalemia (high potassium levels). The signs of high potassium can be hard to notice at first, but over time, too much potassium in the blood can cause serious complications, including heart rhythm changes, muscle weakness, and even temporary paralysis.

It’s important to understand how diabetes can lead to high potassium and then find safe ways to lower those levels before you experience complications.

How Diabetes and High Potassium Are Connected

Up to 40 percent of people living with type 2 diabetes develop diabetic kidney disease. This happens because high blood sugar levels can damage the blood vessels in the kidneys. The damage means that it’s harder for the kidneys to filter substances, like potassium, out of the blood. Damaged blood vessels in the body can also lead to high blood pressure, which can cause more kidney damage because it raises the pressure in the kidney system that filters the blood. In addition, insulin problems linked with diabetes can block potassium from entering cells. This means that it stays in the bloodstream, raising levels of potassium throughout the body.

Some medications that may be prescribed for people living with diabetes can lead to high potassium, too. A group of medications called renin-angiotensin-aldosterone blockers, like ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), is often used to treat high blood pressure, prevent further kidney damage, and lower your risk of having a heart attack or a stroke. However, these medicines can sometimes cause high potassium as a side effect.

If your kidneys aren’t working well, your doctor may prescribe a diuretic to help you urinate more and get rid of extra fluid in your body. One type of diuretic, called a potassium-sparing diuretic, will help you lose fluid without losing potassium. However, when these are used alongside the medications mentioned above, you can end up with too much potassium.

If you’re living with kidney damage due to diabetes, a healthcare professional should be monitoring your potassium levels, among other metrics. That way, you’ll know if these levels are too high. Then, you can decide if you need to change medications or if you want to try to lower your potassium in a different way.

Safe Ways To Lower Potassium Levels

There are a few approaches you can try if you want to safely lower your potassium levels. Note that you should always talk to your doctor before you try any of these strategies.

Adopt a Low-Potassium Diet

Since you get potassium every day in the foods you eat, it makes sense that changing your diet could help change your potassium levels. This may also be part of a kidney-friendly diet if your doctor has asked you to follow that kind of plan. Make sure your doctor or a registered dietitian tells you how much potassium you need each day, because you don’t want to eat too little, either. In some cases, it may not be healthy or necessary to eliminate foods that contain potassium. Instead, you can eat smaller portions or eat these foods less often.

In general, you’ll want to avoid salt substitutes that use potassium. This could include:

• Many fresh and dried fruits and vegetables
• Dried beans and peas
• Most meats
• Many juices
• Any product that has a tomato base

In some cases, it may be enough to substitute lower-potassium foods, like grapes, for higher-potassium ones, like bananas.

Figuring this out on your own can be a challenge, particularly when you’re also trying to eat in a way that helps you stay in control of your diabetes. In order to eat well for both goals, you may want to meet with a registered dietitian who can help you find recipes that work not only for your dietary needs but also for your tastes and your lifestyle.

The DASH (Dietary Approaches to Stop Hypertension) eating plan may be recommended for people with high blood pressure. This diet plan recommends eating foods that are high in potassium. If you have hypertension, your healthcare provider can give you individualized recommendations.

Drink Plenty of Water

Making sure you stay hydrated can help your kidneys function better and may help with blood pressure, too. This may not directly lower your potassium levels, but it will help your kidneys work as well as they possibly can, which may mean that they can remove more potassium from your blood.

If you’re already living with chronic kidney disease, whether it’s related to diabetes or not, you may not need to drink as much water as some people do. This may be because your kidneys aren’t working as well and your body may not be making as much urine. If this describes you, it’s very important to talk to your nephrology (kidney care) team before you try drinking more water. They’ll tell you how much water you can safely drink in a day. You should always follow their instructions.

Keep Your Bowels Healthy

Regular bowel movements help your body get rid of some extra potassium, because if you’re constipated, potassium can build up more easily. Addressing that constipation could help you eliminate more potassium from your bloodstream. If you’re not having bowel movements as regularly as your doctor says you should, getting more fiber may be the key. However, the list of foods that contain fiber has a lot of overlap with the list of foods that have a high amount of potassium. You may need to get guidance from a dietitian or your nephrologist (kidney specialist) before you try to figure out what to eat on your own.

There are also fiber supplements and medications that you can use to help you have more regular bowel movements. Once again, your doctor can tell you if these are safe for you and give you instructions on how much and how often to take them.

Avoid Herbs and Supplements

If you’re struggling with your potassium levels, you shouldn’t add any herbs or supplements to your regimen before you speak with your doctor about them. These can have ingredients or additives that may raise your potassium levels, even if they don’t list this as a side effect. If there’s something that you’re really interested in or have decided you want to try, work with your doctor to make sure that using it is safe for your body.

Working With Your Doctor To Manage Potassium Levels

Managing your potassium levels isn’t something that you can do on your own. You’ll need to see your healthcare team regularly to get blood tests that will determine how much potassium is in your system. These tests can help you find out if you have high potassium, if the approach you’re taking to lower your potassium is helping, and if you need to consider doing more to get your levels within the safe range. At the same time, your doctor can monitor your diabetes to make sure that’s under control, too.

If your potassium is very high or stays high, your doctor may adjust some of your medications to keep your potassium in a safe range. Your doctor can help you make informed decisions about any medications you decide to start or stop taking.

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What safe steps have you taken to lower your potassium while living with diabetes? Let others know in the comments below.