Nutrition in Care Homes for People with Diabetes Kurt Maloney, Specialist Dietitian Bradford Nutrition & Dietetic Department St Lukes Hospital Objectives Identify the CQC regulation for nutrition & hydration
Discuss the dietary management of diabetes Introduction to dietary advice for overweight & malnourished patients Outline the importance of screening for malnutrition with examples
Regulation 14: Meeting nutritional & hydration needs (2014) People must have enough to eat & drink to meet their needs People must have nutritional needs assessed & food provided to meet their individual needs Must receive support with nutrition & hydration if
needed Provide a variety of nutritious & appetising food Appropriate temperature Culturally appropriate Preference & choice Prompts, encouragement, eating aids
Follow prescribing plan for supplements Regular assessment of needs Staff should know when specialist nutritional advice is needed & how to refer Regulation 14: Meeting nutritional & hydration needs (2014)
When avoidable harm or exposure to significant risk of harm is identified. CQC can prosecute for breach of regulation 14 without serving a warning notice CQC will refuse registration if providers cannot provide evidence of compliance
Dietary Advice for Diabetes Points to consider Priority of the persons diabetes management Individualised assessment & treatment No one size fits all approach
Diagnosis, prognosis & quality of life Social aspects of eating Pleasure from eating Respect individuals choices Which Nutrient Affects Blood Glucose? All affect blood glucose!
Which Nutrient Affects Blood Glucose? Food is chewed to start breaking it down Food is broken down further in the stomach Carbohydrate is broken down
into glucose Shortly after eating carbohydrate blood glucose starts to rise Body cells use the glucose for fuel or store it for later Why is Diet Important?
Major influence on diabetes management & health Blood glucose control Long & short term complications Body fat and insulin resistance Risk of other diet related diseases Vitamins, Minerals, Protein & Fats are essential for good health
Diet Myths True or False People with diabetes shouldn't have: Bananas, grapes, melon & mango Sweet foods and puddings Lots of sugary drinks People with diabetes should:
Use diabetic products Always snack between meals Follow a special or diabetic diet What is the dietary advice for diab Healthy Eating
Healthy Eating in Care Homes Regular & Balanced Meals Portion control Healthy menu planning & cooking Appetising meals & variety Healthier snack & pudding options Limit processed or junk foods Avoid sugary drinks & added sugars
Occasional treat foods are fine Healthy Eating How much is important Regular meals spreads carbs out Avoid added sugars & sugary food/drinks Fruit & fruit juices
Dont double up on starches Smaller portions of puddings The type is also important Porridge, basmati rice, new potatoes, seeded bread, whole grain starches & cereals Weight Management Simple Tips for weight management in care settings
Regular Meals Portion Control even healthy food can affect weight! Healthy, tasty menu choices and healthy snack options Healthier puddings & desserts or small portions Avoid added sugars (drinks & foods) Non restrictive approach with occasional treat foods Simple swaps and small changes Swap Chocolate pudding for chocolate Muller light
Swap Shortcake biscuits for rich tea Change drinks to diet, sugar free, no added sugar Swap sugar for sweeteners Weight Management What would you change? Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juice
Mid morning: 3 plain digestives with cup of tea Lunch: Tuna mayo sandwich, 2 slices granary bread with 5 teaspoons mayonnaise and packet of crisps Evening Meal: Beef casserole with large portion of mashed potato (made with butter) and full portion sponge pudding with custard
Supper: 3 plain digestives with cup of tea Weight Management What would you change? Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juice Mid morning: 3 plain digestives with cup of tea
Lunch: Tuna mayo sandwich, 2 slices granary bread with 5 teaspoons mayonnaise and packet of crisps Evening Meal: Beef casserole with large portion of mashed potato (made with butter) and full portion sponge pudding with custard Supper:
3 plain digestives with cup of tea Weight Management What would you change? Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juice Mid morning: 3 plain digestives with cup of tea Lunch:
Tuna mayo sandwich, 2 slices granary bread with 5 teaspoons mayonnaise and packet of crisps Evening Meal: Beef casserole with large portion of mashed potato (made with butter) and full portion sponge pudding with custard Supper: 3 plain digestives with cup of tea
Weight Management What would you change? Breakfast: Small bowl of cereal with milk, 1 Toast with butter, 1 glass of fruit juice Mid morning: 3 rich tea biscuits with cup of tea Lunch: Tuna mayo sandwich, 2 slices granary bread with 5
teaspoons light mayonnaise and packet of crisps Evening Meal: Beef casserole, extra veg with medium portion of mashed potato (made with butter) and small portion sponge pudding with custard Supper: 3 rich tea biscuits with cup of tea Weight Management
Reducing the portions with some simple swaps saves approximately 900 - 1000 calories per day! Balance the Plate Malnutrition The nutritional intake does not
meet the persons needs Malnutrition The priority is getting the patient to eat At this stage healthy eating is not a priority Aim to provide nutritious foods which are high in calories & protein
Control Blood glucose with medications during this period Consequences of malnutrition Poor wound healing and higher risk of infections Frequent hospital admissions Muscle wasting, Lack of energy/Depression
Dehydration Vitamin and mineral deficiencies Recognising Malnutrition Mobility: weakness, impaired movement Mood: apathy, lethargy, poor concentration Current intake: reduced appetite, changes in meal pattern and food choice
Physical appearance: loose clothing, rings or dentures, sunken eyes, dry mouth, emaciation, pale complexion, hair loss Screening tools: e.g. MUST Nutritional Screening Why Screen for malnutrition?
Early identification of patients at risk Early intervention When repeated weekly allows monitoring where nutritional care plans in place Audit practice
MUST Benefits of using MUST Easy to use, rapid and reproducible Any care worker can be trained to use MUST Can be used with patients who cant be weighed and measured
Available on line from www.bapen.org, as well as paper format in a variety of sizes MUST Toolkit is freely available to use for non-commercial purposes and available for download from the BAPEN website: http
://www.bapen.org.uk/screening-for-malnutrition/must/must-t oolkit/the-must-itself Acute Disease is unlikely to apply outside hospital Case Study: Jane 75 years old Type 2 diabetes: Diet controlled
5 4 or 1.62m 7st 12lb or 50kg Resident for 2 weeks Not eating well, managing small amounts of meals, no snacks but says Ive always had a small appetite No previous weights available despite checking with family and available medical documentation
Case Study: Steve 80 years old Type 2 diabetes: Gliclazide & Metformin 5 9 or 1.76m 13st 5lb or 85kg Long term resident, normally has a good appetite but slowly lost his appetite, staff are concerned Eating one small meal per day and struggling with snacks
despite being encouraged Gliclazide was stopped by the DSN due to hypos Concerned staff check his weight history and discover he weight 98kg only 2 months ago = 13kg weight loss Treating Malnutrition What to do If you feel a resident is at risk of malnutrition:
Food Fortification Adds calories & protein without increasing volume Little & often, high calorie Ideas for Food fortification
Sprinkle 2-3 tablespoons of dried milk powder into a pint of full fat milk Full fat yoghurts, full fat milk, milky drinks, ice creams, milkshakes Add margarine or butter to vegetables, potatoes, bread and chapattis. Dont use a low fat spread! Sprinkle grated cheese onto savoury dishes such as soup & potatoes Add sugar, honey or syrup to puddings, cereals, drinks and milkshakes
Double cream can be added to a variety of savoury and sweet foods such as casseroles, curries, soup, mashed potato, sauces, custard, milky puddings and drinks. Fortified menu Menu 1 Breakfast Porridge (made with water), bread + butter,
cup of tea Lunch Cup a soup, banana Evening meal Poached cod, jacket potato, yoghurt Extras Tea between meals, Horlicks at supper
Menu 2 Fortified menu Breakfast Porridge (whole milk, syrup) bread + butter (+ jam), cup of tea (+ orange juice) Lunch Soup (creamy + bread), banana (+ custard)
Evening meal Poached cod (+cheese sauce) jacket potato (+ butter), yoghurt (trifle) Extras Tea between meals, Horlicks at supper (made with milk (+ 2 biscuits, cake) Comparison
Menu 1 Menu 2 Energy 980 kcals
2070 kcals Protein 48g 75 g
Hydration Good hydration can help with Mental performance Headaches Urinary tract infections Falls Pressure sores and
wounds Constipation Concentration Kidney stones Gall stones Tiredness Lethargy Oral health Oral Nutritional Supplements Prescribed supplements Ensure Plus, Pro Cal Shot
High energy, high protein in small volume Expensive to use & compliance is poor Quick & Easy to use Follow prescribing information Timing Flavours Referring to the Dietitian
Community Matron ( Nursing Homes) District Nurses (Residential Homes) GP
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