Managing Diabetes in Aged Care Homes

There is a balance between control of blood sugar levels, quality of life and the risk of malnutrition if diet is restricted. In an aged care home there is usually no need for special diets, diabetic sweets or different mid meal snacks. A strict diabetes diet is usually not warranted. Managing diabetes is more relaxed for those living in aged care homes compared to when a person was younger- sometimes medical staff will prescribe a little more medication or insulin to avoid dietary restriction. 

Diabetes Explained 
Diabetes is a condition when there is too much sugar in the blood. This sugar, known as glucose is the human body’s main source of energy. When the body is functioning correctly, the hormone known as insulin helps transfer the glucose from the blood stream into the cells. However, when someone suffers from diabetes, the pancreas isn’t able to produce enough insulin to move and lower the sugar levels, meaning the glucose stays in the blood stream, which over time can damage blood vessels and nerves, leading to long-term health complications. 

 It is possible to effectively manage the two types of diabetes that are common in aged care (Type 1 and Type 2) with advice from a professional.  

Managing the Menu
The aim is to provide the same foods as everyone else. A little sugar in the diet will not have a major impact on diabetes control but will provide a far greater quality of life and satisfaction with meals. 

Many people don’t realise that food is only one of the factors that can influence blood glucose levels. Other factors include medication, exercise, alcohol, and illness. Rather than assuming food has spiked a resident’s blood glucose levels, it is important to revisit factors that might be influencing this rise.  

 Our tips to help manage diabetes include:  

1. Planning the menu around the core food groups 
Although it doesn’t guarantee that an individual will choose to eat from the core food groups, offering the variety will allow aged care residents to select them based on personal preference and needs. The menu should be the same as everyone else. 

If blood glucose levels start to rise, then restricting food choices is not the answer. Rather, consult with an Accredited Practising Dietitian for individualised advice. 

 2. Include Low Glycaemic Index options on the menu 
Low GI foods are those that are absorbed more slowly into the blood stream and that have a smaller effect on blood glucose levels after a meal. It is recommended that people with diabetes include a low GI food at every meal. 

It is likely that you already include a large number of low GI options on your menu, eg: 

• Porridge 
• Fruit loaf, raisin bread 
• Wholegrain bread or low GI white or wholemeal bread 
• Pasta 
• Milk, yoghurt, custard, ice cream 

• Fruit such as apples, pears, bananas, peaches 
• Milo 

 3. Providing regular and consistent carbohydrates 
The main (food related) factor that influences blood glucose levels is carbohydrate (starches and sugars, both natural and added). Carbohydrates should not be restricted but rather spread out over the day. It is important that the menus provided in aged care homes provide a consistent carbohydrate load from day to day.  

Most older people do not eat much at one time, and a normal balanced meal intake should not unduly affect diabetes control. We recommend frequent snacks as a source of energy and nutrients, and to ensure that there is not an excessive carbohydrate load at one time. These snacks can be the same as everyone else. There should be focus on home baked items with high fibre and low GI ingredients.  

Good choices include:

• High fibre cake/ muffins that include oats, fruit, nuts and some wholemeal flour 

• Fruit loaf or raisin bread 
• Yoghurt or dairy desserts 
• Fruits 

Supper is very important especially if the resident requires insulin and if there is a long gap between the evening meal and breakfast the next day. Suitable options include a sandwich, Milo and biscuits, or pureed fruit and custard/ yoghurt. 

4. Limiting excess sugars only if required 
Sugar in desserts, custards or served in tea/ coffee is fine when used in moderation. If a dish is particularly sweet, then it may be necessary to provide a smaller serving size to the resident - there is rarely the need to provide a separate option.  

Ordinary jam, honey, desserts, ice cream and snacks can be served. A little sugar in tea/coffee or a glass or 2 of ordinary cordial is usually managed without a problem. Some people may prefer lower sugar choice and will prefer artificial sweetener in their hot drinks- this is very individual. 

Sometimes when a person with diabetes drinks large amounts of sugary drinks, their blood glucose levels may be affected. Sugary drinks can provide a large carbohydrate load when large amounts are consumed. Diet cordial should be available when required.  

5. Managing blood glucose levels if requiring insulin 
Individuals requiring insulin sometimes need a measured amount of carbohydrate spread evenly over the day to balance the effects of insulin. They might need extra carbohydrate when exercising more than usual (this may be as simple as going out with their family for the day) or if they are experiencing low blood glucose levels for any reason. 

Sick days also need to be managed carefully. Insulin should still be given, meaning that carbohydrate also needs to be eaten. This is where higher sugar foods may come in handy e.g. ordinary cordial, jelly, desserts.  

Consult an Accredited Practising Dietitian for advice. 

To discover more about diabetes in older people, view our online training module here.