1. Diabetes, Diet and the
Residential Home Resident
Hilary Hogg
BSc. RD
Specialist Diabetes Dietitian
Diabetes
Education
Services
2. Why is Diet important?
• Food and nutrition, alongside
medication, is central to diabetes
management
However:
• The American Diabetes Association
recommendations state:" the
imposition of dietary restrictions on
elderly patients with diabetes in long-
Diabetes
Education
Services
3. How is diet important?
• Insufficient/ineffective Insulin
• Glucose from digesting carbohydrate
unable to enter cells as an energy
source
• Glucose builds up in the blood
Diabetes
Education
Services
5. • Dietary Recommendations for the older
person with diabetes can differ to the
general recommendations for people
with diabetes
Diabetes
Education
Services
6. Basic advice for healthy eating
for residents with diabetes :
Diabetes
Education
Services
7. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
Diabetes
Education
Services
8. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
• Provide plenty of fruit and vegetables
(fibre vitamins and minerals)
Diabetes
Education
Services
9. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
• Provide plenty of fruit and vegetables
(fibre vitamins and minerals)
• Include protein sources – fish and meat
Diabetes
Education
Services
10. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
• Provide plenty of fruit and vegetables
(fibre vitamins and minerals)
• Include protein sources – fish and meat
• Ensure there are dairy products in the
diet
Diabetes
Education
Services
11. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
• Provide plenty of fruit and vegetables
(fibre vitamins and minerals)
• Include protein sources – fish and meat
• Ensure there are dairy products in the
diet
• Allow plenty of fluids (1500mls/day)
Diabetes
Education
Services
12. Basic advice for healthy eating
for residents with diabetes :
• Base meals on starchy foods (energy)
• Provide plenty of fruit and vegetables
(fibre vitamins and minerals)
• Include protein sources – fish and meat
• Ensure there are dairy products in the
diet
• Allow plenty of fluids (1500mls/day)
• Moderate fat/low sugar – slightly Diabetes
Education
Services
14. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
Diabetes
Education
Services
15. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
• Energy
Diabetes
Education
Services
16. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
• Energy
• Glucose –
bloodstream
Diabetes
Education
Services
17. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
• Energy
• Glucose –
bloodstream
• Glycogen in liver &
muscles
Diabetes
Education
Services
18. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
• Energy
• Glucose –
bloodstream
• Glycogen in liver &
muscles
Sources
Diabetes
Education
Services
19. Starchy Foods/Complex
Carbohydrates
Important in the diet
for:
• Energy
• Glucose –
bloodstream
• Glycogen in liver &
muscles
Sources
• Bread, cereals, rice, Diabetes
Education
Services
22. Fats
Important in the diet for:
Diabetes
Education
Services
23. Fats
Important in the diet for:
• Energy
Diabetes
Education
Services
24. Fats
Important in the diet for:
• Energy
• Essential fatty acids
Diabetes
Education
Services
25. Fats
Important in the diet for:
• Energy
• Essential fatty acids
• Fat soluble vitamins
Diabetes
Education
Services
26. Fats
Important in the diet for:
• Energy
• Essential fatty acids
• Fat soluble vitamins
• Other structural/
metabolic functions
Diabetes
Education
Services
27. Fats
Important in the diet for:
• Energy
• Essential fatty acids
• Fat soluble vitamins
• Other structural/
metabolic functions
Sources?
Diabetes
Education
Services
28. Fats
Important in the diet for:
• Energy
• Essential fatty acids
• Fat soluble vitamins
• Other structural/
metabolic functions
Sources?
• Oils, butter, margarine,
fat on meat, oily fish
Diabetes
Education
Services
30. Protein
• Needed for all functions and
metabolism within the body (all
enzymes are proteins)
Diabetes
Education
Services
31. Protein
• Needed for all functions and
metabolism within the body (all
enzymes are proteins)
• Require adequate energy & other
nutrients such as Zinc and B vitamins
for effective utilisation of protein
Diabetes
Education
Services
35. Dietary Sources of Protein
• Meat
• Chicken
• Fish
Diabetes
Education
Services
36. Dietary Sources of Protein
• Meat
• Chicken
• Fish
• Eggs
Diabetes
Education
Services
37. Dietary Sources of Protein
• Meat
• Chicken
• Fish
• Eggs
• Dairy foods
Diabetes
Education
Services
38. Dietary Sources of Protein
• Meat
• Chicken
• Fish
• Eggs
• Dairy foods
• Pulses
Diabetes
Education
Services
39. Dietary Sources of Protein
• Meat
• Chicken
• Fish
• Eggs
• Dairy foods
• Pulses
• Nuts
Diabetes
Education
Services
40. …….and what about fruit ?
• ALL fruit can be included – variety is good
• Up to 4 portions/day – spread out over
the day
• 1 portion = approx a handful eg 1 apple,
banana, 8-10 grapes, 2-3 rings of tinned
pineapple in juice
• 1 portion of dried fruit is half to one
tablespoon
• Fruit juice: 1-2 small glasses per day Diabetes
with
Education
Services
42. Ideas for Desserts
• Sugar free jelly
• Ice cream
(occasionally)
• Stewed fruit and
custard
• Milky puddings
(reduced sugar) • Yogurt
• Sugar free instant • Fruit crumble (low
whip sugar) Diabetes
Education
Services
43. Special Occasions
For example:
• Small portion of
Birthday cake,
Christmas pud or
Occasionally it is mince pie
fine to enjoy a • Couple of squares
treat! of chocolate
(better if afterDiabetes
a
Education
Services
44. Diabetic Products
• Can be high in
fat/calories
• Can have a
laxative effect
• Not
recommended!
Diabetes
Education
Services
46. Disease Related Malnutrition
• A state of nutrition
in which a
deficiency, excess or
imbalance of energy,
protein and other
nutrients causes
measurable adverse
effects on tissue/
body structure,
function and clinical
Diabetes
Education
Services
47. Disease Related Malnutrition
• Under nutrition is • A state of nutrition
common in patients in which a
in the community deficiency, excess or
imbalance of energy,
protein and other
nutrients causes
measurable adverse
effects on tissue/
body structure,
function and clinical
Diabetes
Education
Services
48. Disease Related Malnutrition
• Under nutrition is • A state of nutrition
common in patients in which a
in the community deficiency, excess or
- 26% of patients imbalance of energy,
seen by district protein and other
nurses nutrients causes
(King CL et al
2004)
measurable adverse
effects on tissue/
body structure,
function and clinical
Diabetes
Education
Services
49. Disease Related Malnutrition
• Under nutrition is • A state of nutrition
common in patients in which a
in the community deficiency, excess or
- 26% of patients imbalance of energy,
seen by district protein and other
nurses nutrients causes
(King CL et al
2004)
measurable adverse
- 44 % of effects on tissue/
patients
in body structure,
nursing homes function and clinical
Diabetes
Education
Services
50. Disease Related Malnutrition
• Under nutrition is • A state of nutrition
common in patients in which a
in the community deficiency, excess or
- 26% of patients imbalance of energy,
seen by district protein and other
nurses nutrients causes
(King CL et al
2004)
measurable adverse
- 44 % of effects on tissue/
patients
in body structure,
nursing homes function and clinical
Diabetes
(Stratton RJ, 2005) Education
Services
51. Changes in the body as part of the
Diabetes
Education
Services
52. Changes in the body as part of the
– Reduced sense of taste and smell
– Poor dentition and less saliva produced
– Impaired vision
– Slower digestive function
– Reduced capacity to absorb nutrients
– Impaired kidney function
– Reduction in lean body tissue
– Reduced immune function
Diabetes
Education
Services
53. Other aspects of the ageing process
affecting nutritional status
Diabetes
Education
Services
54. Other aspects of the ageing process
affecting nutritional status
• Impact of acute and chronic illness
– Poor appetite
– Medication
Diabetes
Education
Services
55. Other aspects of the ageing process
affecting nutritional status
• Impact of acute and chronic illness
– Poor appetite
– Medication
• Food quality, availability and choice.
– Cooking methods
Diabetes
Education
Services
56. Other aspects of the ageing process
affecting nutritional status
• Impact of acute and chronic illness
– Poor appetite
– Medication
• Food quality, availability and choice.
– Cooking methods
• Psychological status
Diabetes
Education
Services
57. Other aspects of the ageing process
affecting nutritional status
• Impact of acute and chronic illness
– Poor appetite
– Medication
• Food quality, availability and choice.
– Cooking methods
• Psychological status
• Dehydration
Diabetes
Education
Services
75. Screening Tools
• Do you currently use
any screening tools?
Diabetes
Education
Services
76. Screening Tools
• Do you currently use
any screening tools?
Diabetes
Education
Services
77. Screening Tools
• Do you currently use
any screening tools?
A rapid, general,
simple, often initial
evaluation to detect
presence or risk of
malnutrition
Diabetes
Education
Services
78. Screening Tools
• Do you currently use
any screening tools?
A rapid, general,
simple, often initial
evaluation to detect
presence or risk of
malnutrition
e.g. MUST
Diabetes
Education
Services
79. Screening Tools
• Do you currently use
any screening tools?
A rapid, general,
simple, often initial
evaluation to detect
presence or risk of
malnutrition
e.g. MUST
http://www.bapen.org.uk/
must_tool.html Diabetes
Education
Services
80. Screening Tools
• Do you currently use
any screening tools?
A rapid, general,
simple, often initial
evaluation to detect
presence or risk of
malnutrition
e.g. MUST
http://www.bapen.org.uk/
must_tool.html Diabetes
Education
Services
82. What should you do?
• Offer small frequent meals
Diabetes
Education
Services
83. What should you do?
• Offer small frequent meals
• Ensure all food and drinks are nutrient dense
Diabetes
Education
Services
84. What should you do?
• Offer small frequent meals
• Ensure all food and drinks are nutrient dense
• Provide a balanced intake of protein,
vitamins and minerals – tinned/frozen fruits
or fruit desserts may be easier to manage
than fresh fruit.
Diabetes
Education
Services
85. What should you do?
• Offer small frequent meals
• Ensure all food and drinks are nutrient dense
• Provide a balanced intake of protein,
vitamins and minerals – tinned/frozen fruits
or fruit desserts may be easier to manage
than fresh fruit.
• Low sugar NOT no sugar – can be in foods
and baking
Diabetes
Education
Services
86. Food Fortification – if malnutrition
identified – first line advice:
Diabetes
Education
Services
87. Food Fortification – if malnutrition
identified – first line advice:
-
full cream milk +/- sk milk powder
Diabetes
Education
Services
88. Food Fortification – if malnutrition
identified – first line advice:
-
full cream milk +/- sk milk powder
-
add extra butter/cream/oil/cheese
Diabetes
Education
Services
89. Food Fortification – if malnutrition
identified – first line advice:
-
full cream milk +/- sk milk powder
-
add extra butter/cream/oil/cheese
-
nutritious snacks eg scone, malt
loaf, dried
fruit (up to 1tbsp)
Diabetes
Education
Services
90. Food Fortification – if malnutrition
identified – first line advice:
-
full cream milk +/- sk milk powder
-
add extra butter/cream/oil/cheese
-
nutritious snacks eg scone, malt
loaf, dried
fruit (up to 1tbsp)
-
encourage milky puddings/creamy
yogurts
Diabetes
Education
Services
92. Use of Supplements
• Introducing 1-2
nourishing drinks/
soup per day may
improve nutritional
status
Diabetes
Education
Services
93. Use of Supplements
• Introducing 1-2
nourishing drinks/
soup per day may
improve nutritional
status
• Try recipes or non
prescribable
supplements initially
Diabetes
Education
Services
95. What to do next
• If nutritional intake improves continue
to monitor monthly
Diabetes
Education
Services
96. What to do next
• If nutritional intake improves continue
to monitor monthly
• If no improvement ask the GP to refer
to the dietitian
Diabetes
Education
Services
97. What to do next
• If nutritional intake improves continue
to monitor monthly
• If no improvement ask the GP to refer
to the dietitian
• Continue to monitor and record food
and drink intake in particular for ‘at
risk’ residents
Diabetes
Education
Services
99. Prescribable Supplements
• These include milk shake type drinks, juice drinks,
custard style desserts, fruit based desserts,
Diabetes
Education
Services
100. Prescribable Supplements
• These include milk shake type drinks, juice drinks,
custard style desserts, fruit based desserts,
fat/protein emulsions to take as small ‘shots’,
Diabetes
Education
Services
101. Prescribable Supplements
• These include milk shake type drinks, juice drinks,
custard style desserts, fruit based desserts,
fat/protein emulsions to take as small ‘shots’,
– a dietitian can assess which would be more suitable for
each patient – ask the GP to refer Diabetes
Education
Services
102. ….and if resident is
• Nutritionally balanced diet still
important
• Starchy carbohydrate with all meals
• Offer healthier/low sugar between
meal snacks if hungry- (family /regular
visitors) eg
sugar free jelly/fruit/plain biscuit
• Consider giving smaller portions of Diabetes
Education
Services
Increased risk of degenerative diseases – heart disease, arthritis cancers 50% more likely to be malnourished with dementias\n\n\nRisk of dehydration is much higher – \nskin is thinner and therefore more water is lost via this route\nThe kidneys are not able to concentrate urine as well\nThirst mechanism is not sensitive\n\nImplications are immense\nIncrease drowsy, confusion, unpleasant taste in mouth loss of skin elasticity, increased risk of pressure sore development, Constipation UTIs Electrolyte imbalance and altered cardiac function.\n
Increased risk of degenerative diseases – heart disease, arthritis cancers 50% more likely to be malnourished with dementias\n\n\nRisk of dehydration is much higher – \nskin is thinner and therefore more water is lost via this route\nThe kidneys are not able to concentrate urine as well\nThirst mechanism is not sensitive\n\nImplications are immense\nIncrease drowsy, confusion, unpleasant taste in mouth loss of skin elasticity, increased risk of pressure sore development, Constipation UTIs Electrolyte imbalance and altered cardiac function.\n
Increased risk of degenerative diseases – heart disease, arthritis cancers 50% more likely to be malnourished with dementias\n\n\nRisk of dehydration is much higher – \nskin is thinner and therefore more water is lost via this route\nThe kidneys are not able to concentrate urine as well\nThirst mechanism is not sensitive\n\nImplications are immense\nIncrease drowsy, confusion, unpleasant taste in mouth loss of skin elasticity, increased risk of pressure sore development, Constipation UTIs Electrolyte imbalance and altered cardiac function.\n
Increased risk of degenerative diseases – heart disease, arthritis cancers 50% more likely to be malnourished with dementias\n\n\nRisk of dehydration is much higher – \nskin is thinner and therefore more water is lost via this route\nThe kidneys are not able to concentrate urine as well\nThirst mechanism is not sensitive\n\nImplications are immense\nIncrease drowsy, confusion, unpleasant taste in mouth loss of skin elasticity, increased risk of pressure sore development, Constipation UTIs Electrolyte imbalance and altered cardiac function.\n
