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Managing diabetes in aged care

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Older diabetes sufferers are at risk of many problems, including malnutrition, but best practice is to balance blood glucose levels and quality of life. 

Diabetes is a growing health problem, characterised by the body’s reduced capacity or inability to control blood glucose (sugar) levels.

Poorly-controlled diabetes can result in:

• Chronic infections

• Poor wound healing

• Weight loss

• Fatigue.

Diabetes can also lead to long-term health problems, such as:

• Heart disease

• Nerve damage

• Vision impairment

• Kidney failure.

The increasing prevalence of diabetes has meant that residential aged care facilities are facing the growing burden of caring for, and managing clients with diabetes. With the high risk of malnutrition in this population group, managing residents with diabetes can be challenging for many nurses and aged care kitchens.

Best practice diabetes management in the elderly population has evolved immensely. There is now a better understanding of the disease and its implications for the frail elderly. And there have been many improvements in diabetes medications and insulin therapies.

This progression has led to a movement away from a restrictive ‘diabetic diet’ to a more relaxed approach. The priority for diabetes management in aged care is to achieve a balance between controlling blood glucose levels and promoting quality of life for residents.

For the dietary management of residents with diabetes, residential aged care facilities should consider the following:

1. Menu planning

A separate diabetic menu is not required. If the standard menu is well balanced, there is no need to provide alternative diabetic options. An even distribution of carbohydrate-containing foods at each meal and snack ensures the regular menu can be applied for all residents. Input from an Accredited Practising Dietitian (APD) will assist in this aspect of menu planning.

2. Artificial sweeteners

Diet products such as diet cordial, diet jams and artificial sweeteners are not necessary for residents with diabetes. These products can be expensive, and when consumed regularly, may result in gastrointestinal upset in some residents.

Residents who have been using these products at home may choose to continue to use these upon entering the facility. Kitchens should be able to provide these at the resident’s request, however a review by an APD to explain the decreased need for these to the resident or their family, may be useful.

3. Sugar

Sugar added to tea or coffee, or a thin spread of jam on toast can be included as part of a healthy diet for residents with diabetes. A spoonful of sugar in a drink between meals is unlikely to impact greatly on blood glucose levels. Likewise, regular desserts such as fruit crumble and custard, milk-based mousses and ice-cream are acceptable to include as part of the menu for residents with diabetes. Foods with large amounts of added sugar such as soft drinks and lollies are of low nutritional value so should be kept to a minimum.

4. Suggested servings

Standard serve sizes are important for residents with diabetes. Although the standard menu can be offered, second servings of high-carbohydrate foods such as potato, rice, pasta, bread, desserts, fruit and cakes, should be discouraged. This decision should, however, be made by the resident.

5. Fibre

A higher-fibre menu is a benefit to all residents, not just those with diabetes. Higher-fibre foods slow the release of glucose into the blood, assisting in balancing blood glucose levels. Ways to ensure enough fibre in the diet include:

• Offering porridge, bran-based cereals or muesli at breakfast.

• Providing wholemeal bread as a standard item on the menu.

• Ensuring two serves of fruit and five serves of vegetables are offered each day.

• Offering higher-fibre snack options, such as cakes and biscuits with added dried fruit, bran or wholemeal flour.

• Offering fresh cut-up fruit.

• Adding legumes to soups.

6. Meal frequency

Regular meals and snacks are important for all elderly residents to ensure enough food and fluids are consumed. Although this is also important for residents with diabetes, these residents are often unnecessarily provided with extra snacks, often plates of sandwiches, to avoid low blood glucose levels.

Not all residents with diabetes are at risk of low blood glucose. Only those receiving insulin, and some on oral hypoglycaemic medications, are at risk.

For these residents, a substantial supper snack should be given to avoid blood glucose levels dropping overnight. Appropriate snacks may include a milk-based drink, yoghurt, a sandwich or dry biscuits with cheese.

Those residents with diabetes who are ‘diet-controlled’ are not normally at risk of low blood glucose levels and are likely not to require anything additional to what is provided to other residents.

7. Dietary advice

Residents with consistently high blood glucose levels need individual dietary advice and support by an APD in combination with a review of medications and/ or insulin by their doctor.

8. Weight control

Being overweight can have a negative effect on blood sugar control. However, overweight residents need to be managed with caution and a referral to an APD for individual advice is encouraged.

In many cases, the aim should be for weight maintenance rather than weight reduction, as the risk of malnutrition poses a much greater threat to the health and wellbeing of the resident.

All residents with diabetes should be referred to an APD on admission to a residential aged care facility. APDs play an important role in ensuring these residents receive a healthy, individualised diet for optimal health and wellbeing.

Philippa Cahill is an Accredited Practising Dietitian (APD) and Accredited Nutritionist (AN).

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