Des dietitian presentation for torquay

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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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  • Des dietitian presentation for torquay

    1. 1. Diabetes, Diet and theResidential Home Resident Hilary Hogg BSc. RD Specialist Diabetes Dietitian Diabetes Education Services
    2. 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. 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
    4. 4. DiabetesEducationServices
    5. 5. • Dietary Recommendations for the older person with diabetes can differ to the general recommendations for people with diabetes Diabetes Education Services
    6. 6. Basic advice for healthy eating for residents with diabetes : Diabetes Education Services
    7. 7. Basic advice for healthy eating for residents with diabetes :• Base meals on starchy foods (energy) Diabetes Education Services
    8. 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. 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. 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. 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. 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
    13. 13. Starchy Foods/Complex Carbohydrates Diabetes Education Services
    14. 14. Starchy Foods/Complex CarbohydratesImportant in the diet for: Diabetes Education Services
    15. 15. Starchy Foods/Complex CarbohydratesImportant in the diet for:• Energy Diabetes Education Services
    16. 16. Starchy Foods/Complex CarbohydratesImportant in the diet for:• Energy• Glucose – bloodstream Diabetes Education Services
    17. 17. Starchy Foods/Complex CarbohydratesImportant in the diet for:• Energy• Glucose – bloodstream• Glycogen in liver & muscles Diabetes Education Services
    18. 18. Starchy Foods/Complex CarbohydratesImportant in the diet for:• Energy• Glucose – bloodstream• Glycogen in liver & musclesSources Diabetes Education Services
    19. 19. Starchy Foods/Complex CarbohydratesImportant in the diet for:• Energy• Glucose – bloodstream• Glycogen in liver & musclesSources• Bread, cereals, rice, Diabetes Education Services
    20. 20. Simple sugars• Sugar• Honey• Jam/marmalade• Sugary drinks• Sweets Diabetes Education Services
    21. 21. Fats Diabetes Education Services
    22. 22. Fats Important in the diet for: Diabetes Education Services
    23. 23. Fats Important in the diet for: • Energy Diabetes Education Services
    24. 24. Fats Important in the diet for: • Energy • Essential fatty acids Diabetes Education Services
    25. 25. Fats Important in the diet for: • Energy • Essential fatty acids • Fat soluble vitamins Diabetes Education Services
    26. 26. Fats Important in the diet for: • Energy • Essential fatty acids • Fat soluble vitamins • Other structural/ metabolic functions Diabetes Education Services
    27. 27. Fats Important in the diet for: • Energy • Essential fatty acids • Fat soluble vitamins • Other structural/ metabolic functions Sources? Diabetes Education Services
    28. 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
    29. 29. Protein Diabetes Education Services
    30. 30. Protein• Needed for all functions and metabolism within the body (all enzymes are proteins) Diabetes Education Services
    31. 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
    32. 32. Dietary Sources of Protein Diabetes Education Services
    33. 33. Dietary Sources of Protein • Meat Diabetes Education Services
    34. 34. Dietary Sources of Protein • Meat • Chicken Diabetes Education Services
    35. 35. Dietary Sources of Protein • Meat • Chicken • Fish Diabetes Education Services
    36. 36. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs Diabetes Education Services
    37. 37. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods Diabetes Education Services
    38. 38. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses Diabetes Education Services
    39. 39. Dietary Sources of Protein • Meat • Chicken • Fish • Eggs • Dairy foods • Pulses • Nuts Diabetes Education Services
    40. 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
    41. 41. Ideas for snacks • Plain cake • Bread sticks • Fruit • Crackers• Plain /oatmeal biscuits• Scone Diabetes Education Services
    42. 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. 43. Special Occasions For example: • Small portion of Birthday cake, Christmas pud orOccasionally it is mince pie fine to enjoy a • Couple of squares treat! of chocolate (better if afterDiabetes a Education Services
    44. 44. Diabetic Products • Can be high in fat/calories • Can have a laxative effect• Not recommended! Diabetes Education Services
    45. 45. Disease Related Malnutrition Diabetes Education Services
    46. 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. 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. 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. 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. 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. 51. Changes in the body as part of the Diabetes Education Services
    52. 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. 53. Other aspects of the ageing process affecting nutritional status Diabetes Education Services
    54. 54. Other aspects of the ageing process affecting nutritional status• Impact of acute and chronic illness – Poor appetite – Medication Diabetes Education Services
    55. 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. 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. 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
    58. 58. Medical conditions requiring Dietary Manipulation Diabetes Education Services
    59. 59. Medical conditions requiring Dietary Manipulation• Diabetes Diabetes Education Services
    60. 60. Medical conditions requiring Dietary Manipulation• Diabetes• Dysphagia Diabetes Education Services
    61. 61. Medical conditions requiring Dietary Manipulation• Diabetes• Dysphagia• GI conditions – diverticulitis,IBS, Coeliac disease Diabetes Education Services
    62. 62. Medical conditions requiring Dietary Manipulation• Diabetes• Dysphagia• GI conditions – diverticulitis,IBS, Coeliac disease• Food Intolerance/allergy Diabetes Education Services
    63. 63. Medical conditions requiring Dietary Manipulation• Diabetes• Dysphagia• GI conditions – diverticulitis,IBS, Coeliac disease• Food Intolerance/allergy• Obesity Diabetes Education Services
    64. 64. Medical conditions requiring Dietary Manipulation• Diabetes• Dysphagia• GI conditions – diverticulitis,IBS, Coeliac disease• Food Intolerance/allergy• Obesity• Renal Failure Diabetes Education Services
    65. 65. Who may be at risk? Diabetes Education Services
    66. 66. Who may be at risk?Residents with: Diabetes Education Services
    67. 67. Who may be at risk?Residents with:• COPD Diabetes Education Services
    68. 68. Who may be at risk?Residents with:• COPD• Heart Failure Diabetes Education Services
    69. 69. Who may be at risk?Residents with:• COPD• Heart Failure• Neurological conditions Diabetes Education Services
    70. 70. Who may be at risk?Residents with:• COPD• Heart Failure• Neurological conditions• Cancer Diabetes Education Services
    71. 71. Who may be at risk?Residents with:• COPD• Heart Failure• Neurological conditions• Cancer• Dementia Diabetes Education Services
    72. 72. Who may be at risk?Residents with:• COPD• Heart Failure• Neurological conditions• Cancer• Dementia• Poor dentition Diabetes Education Services
    73. 73. Who may be at risk?Residents with:• COPD• Heart Failure• Neurological conditions• Cancer• Dementia• Poor dentition• Arthritis Diabetes Education Services
    74. 74. Screening Tools Diabetes Education Services
    75. 75. Screening Tools• Do you currently use any screening tools? Diabetes Education Services
    76. 76. Screening Tools• Do you currently use any screening tools? Diabetes Education Services
    77. 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. 78. Screening Tools• Do you currently use any screening tools? A rapid, general, simple, often initial evaluation to detect presence or risk of malnutritione.g. MUST Diabetes Education Services
    79. 79. Screening Tools• Do you currently use any screening tools? A rapid, general, simple, often initial evaluation to detect presence or risk of malnutritione.g. MUSThttp://www.bapen.org.uk/ must_tool.html Diabetes Education Services
    80. 80. Screening Tools• Do you currently use any screening tools? A rapid, general, simple, often initial evaluation to detect presence or risk of malnutritione.g. MUSThttp://www.bapen.org.uk/ must_tool.html Diabetes Education Services
    81. 81. What should you do? Diabetes Education Services
    82. 82. What should you do?• Offer small frequent meals Diabetes Education Services
    83. 83. What should you do?• Offer small frequent meals• Ensure all food and drinks are nutrient dense Diabetes Education Services
    84. 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. 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. 86. Food Fortification – if malnutrition identified – first line advice: Diabetes Education Services
    87. 87. Food Fortification – if malnutrition identified – first line advice: - full cream milk +/- sk milk powder Diabetes Education Services
    88. 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. 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. 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. 91. Use of Supplements Diabetes Education Services
    92. 92. Use of Supplements• Introducing 1-2 nourishing drinks/ soup per day may improve nutritional status Diabetes Education Services
    93. 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. 94. What to do next Diabetes Education Services
    95. 95. What to do next• If nutritional intake improves continue to monitor monthly Diabetes Education Services
    96. 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. 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
    98. 98. Prescribable Supplements Diabetes Education Services
    99. 99. Prescribable Supplements• These include milk shake type drinks, juice drinks, custard style desserts, fruit based desserts, Diabetes Education Services
    100. 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. 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. 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
    103. 103. The Way Forward Diabetes Education Services
    104. 104. The Way Forward• Monitor as appropriate – weight/blood glucose Diabetes Education Services
    105. 105. The Way Forward• Monitor as appropriate – weight/blood glucose• Encourage a nutritionally balanced and varied diet Diabetes Education Services
    106. 106. Thank you! AnyQuestions? Diabetes Education Services

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