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.”
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
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
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
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
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
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
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
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