Recommended Salt Intake for Diabetics
People with diabetes should limit their daily sodium intake to less than 2,300 mg per day (approximately 5 grams of salt), which is the same recommendation as for the general population. 1, 2
Primary Recommendation
- The American Diabetes Association consistently recommends <2,300 mg/day of sodium for all individuals with diabetes, regardless of blood pressure status 1, 2
- This recommendation carries a "B" level of evidence (moderate-quality evidence based on systematic reviews and meta-analyses) 1, 2
- This target has remained stable across multiple guideline updates from 2014 through 2025 1, 2
Special Considerations for Hypertension
For diabetics with concurrent hypertension, further sodium restriction may be considered on an individualized basis, but restriction below 1,500 mg/day is generally NOT recommended. 1, 3
- Earlier guidelines (2015) suggested considering 1,500 mg/day for those with both diabetes and hypertension, but cautioned against universal application of this stricter target 1
- More recent guidelines (2021) explicitly state that restriction below 1,500 mg/day is "generally not recommended" even for hypertensive diabetics 1
- The shift away from aggressive sodium restriction reflects concerns about palatability, nutritional adequacy, cost of specialty low-sodium products, and practical feasibility 1
Evidence Supporting Blood Pressure Benefits
The blood pressure reductions achieved with sodium restriction in diabetics are clinically significant:
- Long-term studies (4-12 weeks) show sodium restriction reduces systolic BP by approximately 6-7 mm Hg and diastolic BP by 3 mm Hg 4
- Short-term studies (5-7 days) demonstrate even larger reductions: systolic BP by 8.4 mm Hg and diastolic BP by 3.0 mm Hg 4
- These BP reductions are comparable to single-drug antihypertensive therapy 5, 4
- Meta-analysis shows that achieving lower BP through salt restriction reduces stroke risk without increasing myocardial infarction risk 2
Type 1 vs Type 2 Diabetes
The sodium recommendation of <2,300 mg/day applies equally to both type 1 and type 2 diabetes. 1, 4
- In type 1 diabetes, salt restriction reduces BP by approximately 7.1/3.1 mm Hg (systolic/diastolic) 5
- In type 2 diabetes, salt restriction reduces BP by approximately 6.9/2.9 mm Hg 5
- No significant difference in BP response exists between the two diabetes types 4
Diabetic Kidney Disease Considerations
- The <2,300 mg/day recommendation applies to diabetics with early kidney disease (microalbuminuria with normal GFR) 1, 4
- Some studies suggest sodium restriction may reduce urinary albumin excretion, though evidence is mixed 4
- Sodium restriction does not appear to adversely affect GFR in diabetics 4
Practical Implementation Challenges
Common pitfall: The vast majority of diabetics (98.6%) who should limit sodium to 1,500 mg/day actually consume more than this amount, and 88.2% of the general diabetic population exceeds even the 2,300 mg/day target 6
Key barriers to address with patients:
- Palatability of low-sodium foods 1
- Higher cost of specialty low-sodium products 1
- Difficulty achieving nutritionally adequate diet while restricting sodium 1
- Limited availability of low-sodium options 1
Cardiovascular and Mortality Benefits
- Population modeling suggests reducing salt intake from 12 g/day to 3 g/day could reduce strokes by approximately 33% and ischemic heart disease by 25% 7
- Even the more modest reduction to 5-6 g/day (2,300 mg sodium) provides substantial cardiovascular protection 7
- Tight BP control through sodium restriction in diabetics lowers risk of strokes, heart attacks, heart failure, and slows diabetic kidney disease progression 5, 4