Recommended Daily Sodium Intake for Individuals with Diabetes
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
Primary Recommendation
- The American Diabetes Association consistently recommends <2,300 mg/day of sodium for all individuals with diabetes, based on moderate-quality evidence (Grade B recommendation). 2, 1
- This recommendation has remained stable across multiple guideline updates from 2015 through 2025, reflecting consensus in the diabetes care community. 2, 1
Special Considerations for Hypertension
- For individuals with both diabetes and hypertension, you might consider further sodium restriction, but restriction below 1,500 mg/day is generally NOT recommended. 2, 1
- The 2015 guidelines noted that while the American Heart Association recommends 1,500 mg/day for people with diabetes and hypertension, other studies have warranted caution for universal sodium restriction to this level. 2
- The most recent 2021 and 2025 guidelines explicitly state that restriction below 1,500 mg/day should generally be avoided, even in those with hypertension. 2, 1
Evidence Supporting This Recommendation
The recommendation to avoid very low sodium intake (<1,500 mg/day) is supported by:
- Research showing a J-shaped relationship between sodium intake and cardiovascular outcomes in diabetes, where both very low and very high sodium intakes are associated with increased mortality and cardiovascular events. 3
- Studies in Type 1 diabetes demonstrating that low sodium intake may paradoxically activate the renin-angiotensin-aldosterone system (RAAS), potentially increasing atherosclerosis despite blood pressure lowering. 3
Practical Implementation Guidance
When counseling patients about sodium restriction, consider these factors:
- Palatability of food - overly restrictive diets may reduce adherence 2, 1
- Availability and affordability of low-sodium products 2, 1
- Difficulty achieving nutritionally adequate diets when sodium is severely restricted 2, 1
Common Pitfalls to Avoid
- Do not routinely recommend sodium intake below 1,500 mg/day, even for patients with both diabetes and hypertension, as this may cause harm through RAAS activation. 2, 3
- Avoid using the general population recommendation of 1,500 mg/day from the American Heart Association for routine diabetes management - the diabetes-specific guideline of <2,300 mg/day with caution below 1,500 mg/day takes precedence. 2, 1
- Be aware that most patients consume far more than recommended levels (average 3,266-3,436 mg/day), so achieving even the 2,300 mg/day target requires significant dietary modification. 4, 5