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Diabetes, Diet and the Residential Home Resident
- 1. Diabetes, Diet and the Residen.al Home Resident Hilary Hogg BSc. RD Specialist Diabetes Die..an
- 2. Why is Diet important? • Food and nutri.on, alongside medica.on, is central to diabetes management However: • The American Diabetes Associa.on recommenda.ons state:" the imposi.on of dietary restric.ons on elderly pa.ents with diabetes in long‐term care facili.es is not warranted.”
- 3. How is diet important? • Insufficient/ineffec.ve Insulin • Glucose from diges.ng carbohydrate unable to enter cells as an energy source • Glucose builds up in the blood
- 5. • Dietary Recommenda.ons for the older person with diabetes can differ to the general recommenda.ons for people with diabetes
- 8. Basic advice for healthy ea.ng for • Base meals on starchy foods (energy) • Provide plenty of fruit and vegetables (fibre vitamins and minerals)
- 9. Basic advice for healthy ea.ng for • Base meals on starchy foods (energy) • Provide plenty of fruit and vegetables (fibre vitamins and minerals) • Include protein sources – fish and meat
- 10. Basic advice for healthy ea.ng for • 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
- 11. Basic advice for healthy ea.ng for • 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)
- 12. Basic advice for healthy ea.ng for • 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 different to the rest of the popula.on
- 17. Starchy Foods/Complex Carbohydrates Important in the diet for: • Energy • Glucose – bloodstream • Glycogen in liver & muscles
- 18. Starchy Foods/Complex Carbohydrates Important in the diet for: • Energy • Glucose – bloodstream • Glycogen in liver & muscles Sources
- 19. Starchy Foods/Complex Carbohydrates Important in the diet for: • Energy • Glucose – bloodstream • Glycogen in liver & muscles Sources • Bread, cereals, rice, pasta, potato
- 20. Simple sugars • Sugar • Honey • Jam/marmalade • Sugary drinks • Sweets
- 21. Fats
- 23. Fats Important in the diet for: • Energy
- 24. Fats Important in the diet for: • Energy • Essen.al fa]y acids
- 25. Fats Important in the diet for: • Energy • Essen.al fa]y acids • Fat soluble vitamins
- 26. Fats Important in the diet for: • Energy • Essen.al fa]y acids • Fat soluble vitamins • Other structural/metabolic func.ons
- 27. Fats Important in the diet for: • Energy • Essen.al fa]y acids • Fat soluble vitamins • Other structural/metabolic func.ons Sources?
- 28. Fats Important in the diet for: • Energy • Essen.al fa]y acids • Fat soluble vitamins • Other structural/metabolic func.ons Sources? • Oils, bu]er, margarine, fat on meat, oily fish
- 29. Protein
- 30. Protein • Needed for all func.ons and metabolism within the body (all enzymes are proteins)
- 31. Protein • Needed for all func.ons and metabolism within the body (all enzymes are proteins) • Require adequate energy & other nutrients such as Zinc and B vitamins for effec.ve u.lisa.on of protein
- 33. Dietary Sources of Protein • Meat
- 34. Dietary Sources of Protein • Meat • Chicken
- 35. Dietary Sources of Protein • Meat • Chicken • Fish
- 36. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs
- 37. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods
- 38. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses
- 39. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses • Nuts
- 40. …….and what about fruit ? • ALL fruit can be included – variety is good • Up to 4 por.ons/day – spread out over the day • 1 por.on = approx a handful eg 1 apple, banana, 8‐10 grapes, 2‐3 rings of .nned pineapple in juice • 1 por.on of dried fruit is half to one tablespoon • Fruit juice: 1‐2 small glasses per day with a meal
- 41. Ideas for snacks • Plain cake • Bread s.cks • Fruit • Crackers • Plain /oatmeal biscuits • Scone • Tea cake
- 42. Ideas for Desserts • Sugar free jelly • Ice cream (occasionally) • Stewed fruit and • Milky puddings custard (reduced sugar) • Yogurt • Sugar free instant whip • Fruit crumble (low sugar)
- 43. Special Occasions For example: • Small por.on of Birthday cake, Christmas pud or Occasionally it is fine to mince pie enjoy a treat! • Couple of squares of chocolate (be]er if aner a meal)
- 44. Diabe.c Products • Can be high in fat/ calories • Can have a laxa.ve effect • Not recommended!
- 46. Disease Related Malnutri.on • A state of nutri.on in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on .ssue/body structure, func.on and clinical outcome
- 47. Disease Related Malnutri.on • Under nutri.on is • A state of nutri.on in common in pa.ents in which a deficiency, the community excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on .ssue/body structure, func.on and clinical outcome
- 48. Disease Related Malnutri.on • Under nutri.on is • A state of nutri.on in common in pa.ents in which a deficiency, the community excess or imbalance of ‐ 26% of pa.ents energy, protein and seen by district other nutrients causes nurses (King CL et al 2004) measurable adverse effects on .ssue/body structure, func.on and clinical outcome
- 49. Disease Related Malnutri.on • Under nutri.on is • A state of nutri.on in common in pa.ents in which a deficiency, the community excess or imbalance of ‐ 26% of pa.ents energy, protein and seen by district other nutrients causes nurses (King CL et al 2004) measurable adverse effects on .ssue/body ‐ 44 % of pa.ents structure, func.on and in nursing homes clinical outcome
- 50. Disease Related Malnutri.on • Under nutri.on is • A state of nutri.on in common in pa.ents in which a deficiency, the community excess or imbalance of ‐ 26% of pa.ents energy, protein and seen by district other nutrients causes nurses (King CL et al 2004) measurable adverse effects on .ssue/body ‐ 44 % of pa.ents structure, func.on and in nursing homes (Stra]on RJ, 2005) clinical outcome
- 52. Changes in the body as part of the normal – Reduced sense of taste and smell – Poor den..on and less saliva produced – Impaired vision – Slower diges.ve func.on – Reduced capacity to absorb nutrients – Impaired kidney func.on – Reduc.on in lean body .ssue – Reduced immune func.on
- 53. Other aspects of the ageing process affec.ng nutri.onal status
- 54. Other aspects of the ageing process affec.ng nutri.onal status • Impact of acute and chronic illness – Poor appe.te – Medica.on
- 55. Other aspects of the ageing process affec.ng nutri.onal status • Impact of acute and chronic illness – Poor appe.te – Medica.on • Food quality, availability and choice. – Cooking methods
- 56. Other aspects of the ageing process affec.ng nutri.onal status • Impact of acute and chronic illness – Poor appe.te – Medica.on • Food quality, availability and choice. – Cooking methods • Psychological status
- 57. Other aspects of the ageing process affec.ng nutri.onal status • Impact of acute and chronic illness – Poor appe.te – Medica.on • Food quality, availability and choice. – Cooking methods • Psychological status • Dehydra.on
- 58. Medical condi.ons requiring Dietary Manipula.on
- 59. Medical condi.ons requiring Dietary Manipula.on • Diabetes
- 60. Medical condi.ons requiring Dietary Manipula.on • Diabetes • Dysphagia
- 61. Medical condi.ons requiring Dietary Manipula.on • Diabetes • Dysphagia • GI condi.ons – diver.culi.s,IBS, Coeliac disease
- 62. Medical condi.ons requiring Dietary Manipula.on • Diabetes • Dysphagia • GI condi.ons – diver.culi.s,IBS, Coeliac disease • Food Intolerance/allergy
- 63. Medical condi.ons requiring Dietary Manipula.on • Diabetes • Dysphagia • GI condi.ons – diver.culi.s,IBS, Coeliac disease • Food Intolerance/allergy • Obesity
- 64. Medical condi.ons requiring Dietary Manipula.on • Diabetes • Dysphagia • GI condi.ons – diver.culi.s,IBS, Coeliac disease • Food Intolerance/allergy • Obesity • Renal Failure
- 69. Who may be at risk? Residents with: • COPD • Heart Failure • Neurological condi.ons
- 70. Who may be at risk? Residents with: • COPD • Heart Failure • Neurological condi.ons • Cancer
- 71. Who may be at risk? Residents with: • COPD • Heart Failure • Neurological condi.ons • Cancer • Demen.a
- 72. Who may be at risk? Residents with: • COPD • Heart Failure • Neurological condi.ons • Cancer • Demen.a • Poor den..on
- 73. Who may be at risk? Residents with: • COPD • Heart Failure • Neurological condi.ons • Cancer • Demen.a • Poor den..on • Arthri.s
- 74. Screening Tools
- 75. Screening Tools • Do you currently use any screening tools?
- 76. Screening Tools • Do you currently use any screening tools?
- 77. Screening Tools • Do you currently use any screening tools? A rapid, general, simple, onen ini.al evalua.on to detect presence or risk of malnutri.on
- 78. Screening Tools • Do you currently use any screening tools? A rapid, general, simple, onen ini.al evalua.on to detect presence or risk of malnutri.on e.g. MUST
- 79. Screening Tools • Do you currently use any screening tools? A rapid, general, simple, onen ini.al evalua.on to detect presence or risk of malnutri.on e.g. MUST h]p://www.bapen.org.uk/ must_tool.html
- 80. Screening Tools • Do you currently use any screening tools? A rapid, general, simple, onen ini.al evalua.on to detect presence or risk of malnutri.on e.g. MUST h]p://www.bapen.org.uk/ must_tool.html
- 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 – .nned/frozen fruits or fruit desserts may be easier to manage than fresh fruit.
- 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 – .nned/frozen fruits or fruit desserts may be easier to manage than fresh fruit. • Low sugar NOT no sugar – can be in foods and baking
- 86. Food For.fica.on – if malnutri.on iden.fied – first line advice:
- 87. Food For.fica.on – if malnutri.on iden.fied – first line advice: ‐ full cream milk +/‐ sk milk powder
- 88. Food For.fica.on – if malnutri.on iden.fied – first line advice: ‐ full cream milk +/‐ sk milk powder ‐ add extra bu]er/cream/oil/cheese
- 89. Food For.fica.on – if malnutri.on iden.fied – first line advice: ‐ full cream milk +/‐ sk milk powder ‐ add extra bu]er/cream/oil/cheese ‐ nutri.ous snacks eg scone, malt loaf, dried fruit (up to 1tbsp)
- 90. Food For.fica.on – if malnutri.on iden.fied – first line advice: ‐ full cream milk +/‐ sk milk powder ‐ add extra bu]er/cream/oil/cheese ‐ nutri.ous snacks eg scone, malt loaf, dried fruit (up to 1tbsp) ‐ encourage milky puddings/creamy yogurts
- 92. Use of Supplements • Introducing 1‐2 nourishing drinks/soup per day may improve nutri.onal status
- 93. Use of Supplements • Introducing 1‐2 nourishing drinks/soup per day may improve nutri.onal status • Try recipes or non prescribable supplements ini.ally
- 94. What to do next
- 95. What to do next • If nutri.onal intake improves con.nue to monitor monthly
- 96. What to do next • If nutri.onal intake improves con.nue to monitor monthly • If no improvement ask the GP to refer to the die..an
- 97. What to do next • If nutri.onal intake improves con.nue to monitor monthly • If no improvement ask the GP to refer to the die..an • Con.nue to monitor and record food and drink intake in par.cular for ‘at risk’ residents
- 99. Prescribable Supplements • These include milk shake type drinks, juice drinks, custard style desserts, fruit based desserts,
- 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’,
- 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 die..an can assess which would be more suitable for each pa.ent – ask the GP to refer
- 102. ….and if resident is overweight? • Nutri.onally balanced diet s.ll 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 por.ons of higher energy food • Low fat/sugar desserts
- 103. The Way Forward
- 104. The Way Forward • Monitor as appropriate – weight/blood glucose
- 105. The Way Forward • Monitor as appropriate – weight/blood glucose • Encourage a nutri.onally balanced and varied diet
- 106. The Way Forward • Monitor as appropriate – weight/blood glucose • Encourage a nutri.onally balanced and varied diet • Ask GP to refer to a die..an if more specialist input required
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- 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
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