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Diabetes, Diet and the Residential Home Resident

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Diabetes, Diet and the Residential Home Resident

  1. 1. Diabetes,
Diet
and
the
Residen.al
 Home
Resident Hilary
Hogg BSc.
RD Specialist
Diabetes
Die..an
  2. 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. 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
  4. 4. • Dietary
Recommenda.ons
for
the
older
person
 with
diabetes
can
differ
to
the
general
 recommenda.ons
for
people
with
diabetes
  5. 5. Basic
advice
for
healthy
ea.ng
for

  6. 6. Basic
advice
for
healthy
ea.ng
for
• Base
meals
on
starchy
foods
(energy)
  7. 7. Basic
advice
for
healthy
ea.ng
for
• Base
meals
on
starchy
foods
(energy)• Provide
plenty
of
fruit
and
vegetables
(fibre
 vitamins
and
minerals)
  8. 8. 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
  9. 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• Ensure
there
are
dairy
products
in
the
diet
  10. 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• Allow
plenty
of
fluids
(1500mls/day)
  11. 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)• Moderate
fat/low
sugar
–
slightly
different
to
 the
rest
of
the
popula.on
  12. 12. Starchy
Foods/Complex
Carbohydrates
  13. 13. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:
  14. 14. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:• Energy
  15. 15. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:• Energy• Glucose
–
bloodstream
  16. 16. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:• Energy• Glucose
–
bloodstream• Glycogen
in
liver
&
 muscles
  17. 17. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:• Energy• Glucose
–
bloodstream• Glycogen
in
liver
&
 musclesSources
  18. 18. Starchy
Foods/Complex
CarbohydratesImportant
in
the
diet
for:• Energy• Glucose
–
bloodstream• Glycogen
in
liver
&
 musclesSources• Bread,
cereals,
rice,
 pasta,
potato
  19. 19. Simple
sugars• Sugar• Honey• Jam/marmalade• Sugary
drinks• Sweets
  20. 20. Fats
  21. 21. Fats Important
in
the
diet
for:
  22. 22. Fats Important
in
the
diet
for: • Energy
  23. 23. Fats Important
in
the
diet
for: • Energy • Essen.al
fa]y
acids
  24. 24. Fats Important
in
the
diet
for: • Energy • Essen.al
fa]y
acids • Fat
soluble
vitamins
  25. 25. Fats Important
in
the
diet
for: • Energy • Essen.al
fa]y
acids • Fat
soluble
vitamins • Other
structural/metabolic
 func.ons
  26. 26. Fats Important
in
the
diet
for: • Energy • Essen.al
fa]y
acids • Fat
soluble
vitamins • Other
structural/metabolic
 func.ons Sources?
  27. 27. 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
  28. 28. Protein
  29. 29. Protein• Needed
for
all
func.ons
and
metabolism
 within
the
body
(all
enzymes
are
proteins)
  30. 30. 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
  31. 31. Dietary
Sources
of
Protein
  32. 32. Dietary
Sources
of
Protein • Meat
  33. 33. Dietary
Sources
of
Protein • Meat • Chicken
  34. 34. Dietary
Sources
of
Protein • Meat • Chicken • Fish
  35. 35. Dietary
Sources
of
Protein • Meat • Chicken • Fish • Eggs
  36. 36. Dietary
Sources
of
Protein • Meat • Chicken • Fish • Eggs • Dairy
foods
  37. 37. Dietary
Sources
of
Protein • Meat • Chicken • Fish • Eggs • Dairy
foods • Pulses
  38. 38. Dietary
Sources
of
Protein • Meat • Chicken • Fish • Eggs • Dairy
foods • Pulses • Nuts
  39. 39. …….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
  40. 40. Ideas
for
snacks • Plain
cake • Bread
s.cks • Fruit • Crackers• Plain
/oatmeal
biscuits• Scone• Tea
cake
  41. 41. 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)
  42. 42. 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)
  43. 43. Diabe.c
Products • Can
be
high
in
fat/ calories • Can
have
a
laxa.ve
 effect• Not
recommended!
  44. 44. Disease
Related
Malnutri.on
  45. 45. 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
  46. 46. 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
  47. 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

 
 ‐
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
  48. 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

 
 ‐
44
%
of
pa.ents
 structure,
func.on
and
 
 in
nursing
homes clinical
outcome
  49. 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
 
 
 
 
 
 (Stra]on
RJ,
2005) 
 clinical
outcome
  50. 50. Changes
in
the
body
as
part
of
the
normal

  51. 51. 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
  52. 52. Other
aspects
of
the
ageing
process
 affec.ng
nutri.onal
status
  53. 53. Other
aspects
of
the
ageing
process
 affec.ng
nutri.onal
status• Impact
of
acute
and
chronic
illness – Poor
appe.te – Medica.on
  54. 54. 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
  55. 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• Psychological
status
  56. 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• Dehydra.on
  57. 57. Medical
condi.ons
requiring
Dietary
 Manipula.on

  58. 58. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes
  59. 59. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes• Dysphagia
  60. 60. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes• Dysphagia• GI
condi.ons – diver.culi.s,IBS,
Coeliac
disease
  61. 61. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes• Dysphagia• GI
condi.ons – diver.culi.s,IBS,
Coeliac
disease• Food
Intolerance/allergy
  62. 62. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes• Dysphagia• GI
condi.ons – diver.culi.s,IBS,
Coeliac
disease• Food
Intolerance/allergy• Obesity
  63. 63. Medical
condi.ons
requiring
Dietary
 Manipula.on
• Diabetes• Dysphagia• GI
condi.ons – diver.culi.s,IBS,
Coeliac
disease• Food
Intolerance/allergy• Obesity• Renal
Failure
  64. 64. Who
may
be
at
risk?
  65. 65. Who
may
be
at
risk?Residents
with:
  66. 66. Who
may
be
at
risk?Residents
with:• COPD

  67. 67. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure
  68. 68. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure• Neurological
condi.ons
  69. 69. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure• Neurological
condi.ons• Cancer
  70. 70. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure• Neurological
condi.ons• Cancer• Demen.a
  71. 71. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure• Neurological
condi.ons• Cancer• Demen.a• Poor
den..on
  72. 72. Who
may
be
at
risk?Residents
with:• COPD
• Heart
Failure• Neurological
condi.ons• Cancer• Demen.a• Poor
den..on• Arthri.s
  73. 73. Screening
Tools
  74. 74. Screening
Tools• Do
you
currently
use
any
 screening
tools?
  75. 75. Screening
Tools• Do
you
currently
use
any
 screening
tools?
  76. 76. 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
  77. 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.one.g.
MUST
  78. 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.one.g.
MUSTh]p://www.bapen.org.uk/ must_tool.html
  79. 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.one.g.
MUSTh]p://www.bapen.org.uk/ must_tool.html
  80. 80. What
should
you
do?
  81. 81. What
should
you
do?• Offer
small
frequent
meals
  82. 82. What
should
you
do?• Offer
small
frequent
meals• Ensure
all
food
and
drinks
are
nutrient
dense
  83. 83. 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.
  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
–

.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
  85. 85. Food
For.fica.on
–
if
malnutri.on
 iden.fied
–
first
line
advice:
  86. 86. Food
For.fica.on
–
if
malnutri.on
 iden.fied
–
first
line
advice:
 ‐
 full
cream
milk
+/‐
sk
milk
powder
  87. 87. 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
  88. 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

 ‐

 nutri.ous
snacks
eg
scone,
malt
loaf,
dried
 
 fruit
(up
to
1tbsp)
  89. 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)
 ‐

 encourage
milky
puddings/creamy
 
 
 yogurts
  90. 90. Use
of
Supplements
  91. 91. Use
of
Supplements• Introducing
1‐2
 nourishing
drinks/soup
 per
day
may
improve
 nutri.onal
status
  92. 92. Use
of
Supplements• Introducing
1‐2
 nourishing
drinks/soup
 per
day
may
improve
 nutri.onal
status• Try
recipes
or
non
 prescribable
 supplements
ini.ally
  93. 93. What
to
do
next
  94. 94. What
to
do
next• If
nutri.onal
intake
improves
con.nue
to
 monitor
monthly
  95. 95. 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
  96. 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• Con.nue
to
monitor
and
record
food
and
drink
 intake
in
par.cular
for
‘at
risk’
residents
  97. 97. Prescribable
Supplements
  98. 98. Prescribable
Supplements• These
include
milk
shake
type
drinks,
juice
drinks,
custard
style
 desserts,
fruit
based
desserts,
  99. 99. Prescribable
Supplements• These
include
milk
shake
type
drinks,
juice
drinks,
custard
style
 desserts,
fruit
based
desserts,
 fat/protein
emulsions
to
take
as
small
‘shots’,

  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’,

 –
a
die..an
can
assess
which
would
be
more
suitable
for
each
 pa.ent
–
ask
the
GP
to
refer
  101. 101. ….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
  102. 102. The
Way
Forward
  103. 103. The
Way
Forward• Monitor
as
appropriate
–
 weight/blood
glucose
  104. 104. The
Way
Forward• Monitor
as
appropriate
–
 weight/blood
glucose• Encourage
a
nutri.onally
 balanced
and
varied
diet
  105. 105. 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

  106. 106. Thank
you!




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