Diabetes in Aged Care

July, 2016

Recent research shows that up to one quarter of aged care residents have diabetes.  Diabetes is characterised by the body’s  reduced ability to control blood glucose levels (BGL) with poorly controlled diabetes having the potential to result in side effects such as poor would healing, pressure ulcers, weight loss, chronic infections, cognitive decline and increased risk of falls.  Glucose is however, an essential energy source for the body and therefore needs to be included in the diet in moderation.  Carbohydrate foods such as breads and cereals, rice, pasta, potato, dairy, fruit, cakes, biscuits, soft drinks, juices, etc all breakdown to form glucose/sugar.

Aged care residents with diabetes were previously treated with a diet that restricted energy and carbohydrate and had limited or no added sugar.  Thankfully for residents, the management of diabetes in RACF’s has become less prescriptive with evidence showing that a strict ‘diabetic diet’ provides no real long term benefits for BGL control.    It is recommended that sugar be included in the diet in moderate amounts as with all other non-diabetic residents.  Evidence suggests that the unnecessary restriction of carbohydrate foods can place residents at increased risk of malnutrition and associated consequences such as infections and pressure sores.    In terms of meals offered to residents with diabetes, it is recommended they are provided with the standard menu choices.
It has become widely recognised that it is most beneficial to promote healthy eating through regular meals and snacks.  Sugar does not need to be avoided and low fat diets are not recommended aside from situations when it is advised to do so by a medical professional.

Please consider the following points for residents with controlled diabetes:

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  1. Encourage all diabetics to have a carbohydrate containing food at each meal and snack throughout the day.    It is however preferable to discourage second servings of high carbohydrate foods, instead offering a larger serve of protein if the resident remains hungry or is at risk of malnutrition.
  2. Diet products such as diet cordials and diet jams are not necessary unless suggested by a medical professional or dietitian.  These products have the potential to result in gastrointestinal upset in some residents.
  3. Moderate amounts of sugar in the diet is unlikely to have an negative effect on blood sugar levels (eg. 1 tsp sugar in coffee, regular serve of dessert).  It is recommended to space ‘sugary’ foods throughout the day rather than having large amounts in one sitting. Foods high in sugar such as soft drinks and lollies may need to be monitored.
  4. Encourage a high fibre menu.  This is recommended for all residents, not just those with diabetes.  High fibre foods slow digestion and therefore the release of sugar in to the blood stream which will assist with blood sugar control.  Strategies for ensuring a high fibre diet could include:
    • High fibre breakfast cereal (porridge, sultana bran)
    • Add bran, oats, nuts, seeds to baked items such as cakes, muffins and biscuits
    • Encourage wholemeal breads
    • Encourage vegetables with each meal
    • Encourage fruit with desserts or as snacks
    • Add legumes to soups, casseroles

     

  5. Low fat foods are not recommended.  Encourage unsaturated fats where possible (eg. Olive oil, avocado, nuts/seeds).  Full fat foods help to maintain nutritional status.
  6. Fortify foods with additional protein and fat for those residents at risk of malnutrition.  For example utilise cream, cheese and milk powder in cooking.  Encourage boiled eggs, tinned tuna, nuts, cheese, milk, plain yoghurt for snacks.

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While the above is generalised advice for those residents with diabetes,  there will be instances where a residents BGL’s are difficult to control and the resident may require a more individualised dietary plan with a regulated amount of carbohydrate/sugars at each meal.  Please consult the resident’s dietitian and doctor in these situations.

It is also well recognised that being overweight can have a negative effect on blood sugar control.  In these situations it is recommended the options are discussed with the resident and with the resident’s permission, they are referred to a dietitian who can help create an individualised eating plan.  In most situations it is more appropriate to aim for weight maintenance rather than weight reduction.

In summary, it is recommended that residents with controlled diabetes are offered the standard diet to promote their optimal health and well-being.

Dietitians Australia

Don’t let your residents or budget experience the side effects of malnutrition or dysphagia.
Call us on 1300 850 246 or email and request a call back.

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