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Des dietitian presentation for torquay
- 1. Diabetes, Diet andthe Residential Home Resident Hilary Hogg BSc. RD Specialist Diabetes Dietitian Diabetes Education Services
- 2. Why is Dietimportant? • 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 dietimportant? • Insufficient/ineffective Insulin • Glucose from digesting carbohydrate unable to enter cells as an energy source • Glucose builds up in the blood Diabetes Education Services
- 4.
- 5. • Dietary Recommendationsfor the older person with diabetes can differ to the general recommendations for people with diabetes Diabetes Education Services
- 6. Basic advice forhealthy eating for residents with diabetes : Diabetes Education Services
- 7. Basic advice forhealthy eating for residents with diabetes : • Base meals on starchy foods (energy) Diabetes Education Services
- 8. Basic advice forhealthy 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 forhealthy 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 forhealthy 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 forhealthy 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 forhealthy 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
- 13. Starchy Foods/Complex Carbohydrates 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
- 20. Simple sugars • Sugar • Honey • Jam/marmalade • Sugary drinks • Sweets Diabetes Education Services
- 21. Fats Diabetes Education Services
- 22. Fats Importantin the diet for: Diabetes Education Services
- 23. Fats Importantin the diet for: • Energy Diabetes Education Services
- 24. Fats Importantin the diet for: • Energy • Essential fatty acids Diabetes Education Services
- 25. Fats Importantin the diet for: • Energy • Essential fatty acids • Fat soluble vitamins Diabetes Education Services
- 26. Fats Importantin the diet for: • Energy • Essential fatty acids • Fat soluble vitamins • Other structural/ metabolic functions Diabetes Education Services
- 27. Fats Importantin the diet for: • Energy • Essential fatty acids • Fat soluble vitamins • Other structural/ metabolic functions Sources? Diabetes Education Services
- 28. Fats Importantin 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
- 29. Protein Diabetes Education Services
- 30. Protein • Needed forall functions and metabolism within the body (all enzymes are proteins) Diabetes Education Services
- 31. Protein • Needed forall 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
- 32. Dietary Sources ofProtein Diabetes Education Services
- 33. Dietary Sources ofProtein • Meat Diabetes Education Services
- 34. Dietary Sources ofProtein • Meat • Chicken Diabetes Education Services
- 35. Dietary Sources ofProtein • Meat • Chicken • Fish Diabetes Education Services
- 36. Dietary Sources ofProtein • Meat • Chicken • Fish • Eggs Diabetes Education Services
- 37. Dietary Sources ofProtein • Meat • Chicken • Fish • Eggs • Dairy foods Diabetes Education Services
- 38. Dietary Sources ofProtein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses Diabetes Education Services
- 39. Dietary Sources ofProtein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses • Nuts Diabetes Education Services
- 40. …….and what aboutfruit ? • 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
- 41. Ideas for snacks • Plain cake • Bread sticks • Fruit • Crackers • Plain /oatmeal biscuits • Scone Diabetes 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
- 45. Disease Related Malnutrition 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 thebody as part of the Diabetes Education Services
- 52. Changes in thebody 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 ofthe ageing process affecting nutritional status Diabetes Education Services
- 54. Other aspects ofthe ageing process affecting nutritional status • Impact of acute and chronic illness – Poor appetite – Medication Diabetes Education Services
- 55. Other aspects ofthe 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 ofthe 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 ofthe 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
- 58. Medical conditions requiringDietary Manipulation Diabetes Education Services
- 59. Medical conditions requiringDietary Manipulation • Diabetes Diabetes Education Services
- 60. Medical conditions requiringDietary Manipulation • Diabetes • Dysphagia Diabetes Education Services
- 61. Medical conditions requiringDietary Manipulation • Diabetes • Dysphagia • GI conditions – diverticulitis,IBS, Coeliac disease Diabetes Education Services
- 62. Medical conditions requiringDietary Manipulation • Diabetes • Dysphagia • GI conditions – diverticulitis,IBS, Coeliac disease • Food Intolerance/allergy Diabetes Education Services
- 63. Medical conditions requiringDietary Manipulation • Diabetes • Dysphagia • GI conditions – diverticulitis,IBS, Coeliac disease • Food Intolerance/allergy • Obesity Diabetes Education Services
- 64. Medical conditions requiringDietary Manipulation • Diabetes • Dysphagia • GI conditions – diverticulitis,IBS, Coeliac disease • Food Intolerance/allergy • Obesity • Renal Failure Diabetes Education Services
- 65. Who may beat risk? Diabetes Education Services
- 66. Who may beat risk? Residents with: Diabetes Education Services
- 67. Who may beat risk? Residents with: • COPD Diabetes Education Services
- 68. Who may beat risk? Residents with: • COPD • Heart Failure Diabetes Education Services
- 69. Who may beat risk? Residents with: • COPD • Heart Failure • Neurological conditions Diabetes Education Services
- 70. Who may beat risk? Residents with: • COPD • Heart Failure • Neurological conditions • Cancer Diabetes Education Services
- 71. Who may beat risk? Residents with: • COPD • Heart Failure • Neurological conditions • Cancer • Dementia Diabetes Education Services
- 72. Who may beat risk? Residents with: • COPD • Heart Failure • Neurological conditions • Cancer • Dementia • Poor dentition Diabetes Education Services
- 73. Who may beat risk? Residents with: • COPD • Heart Failure • Neurological conditions • Cancer • Dementia • Poor dentition • Arthritis Diabetes Education Services
- 74. Screening Tools Diabetes Education Services
- 75. Screening Tools • Doyou currently use any screening tools? Diabetes Education Services
- 76. Screening Tools • Doyou currently use any screening tools? Diabetes Education Services
- 77. Screening Tools • Doyou 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 • Doyou 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 • Doyou 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 • Doyou 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
- 81. What should youdo? Diabetes Education Services
- 82. What should youdo? • Offer small frequent meals Diabetes Education Services
- 83. What should youdo? • Offer small frequent meals • Ensure all food and drinks are nutrient dense Diabetes Education Services
- 84. What should youdo? • 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 youdo? • 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
- 91. Use of Supplements 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
- 94. What to donext Diabetes Education Services
- 95. What to donext • If nutritional intake improves continue to monitor monthly Diabetes Education Services
- 96. What to donext • 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 donext • 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
- 98. Prescribable Supplements Diabetes Education Services
- 99. Prescribable Supplements • Theseinclude milk shake type drinks, juice drinks, custard style desserts, fruit based desserts, Diabetes Education Services
- 100. Prescribable Supplements • Theseinclude 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 • Theseinclude 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 residentis • 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
- 103. The Way Forward Diabetes Education Services
- 104. The Way Forward •Monitor as appropriate – weight/blood glucose Diabetes Education Services
- 105. The Way Forward •Monitor as appropriate – weight/blood glucose • Encourage a nutritionally balanced and varied diet Diabetes Education Services
- 106. Thank you! Any Questions? Diabetes Education Services
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- #48 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
- #49 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
- #50 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
- #51 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
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