Residents and family members often raise the question, ‘Is there a diabetic menu?’ ‘Are diabetic desserts available?’ The short answer is that Aurrum’s main menu is suitable for residents with diabetes, as are the desserts.
The long answer is that diabetes management in aged care is a delicate balance between the greater risk of malnutrition and quality of life in the elderly and the need for good blood glucose control.
Over-zealous dietary restriction could well result in malnutrition in the older individual with detrimental effects on a resident’s functionality, well-being and health outcomes.
It is now widely recognised that the burden of dietary restrictions on elderly residents is not warranted and that the risk of long-term complications of diabetes is small compared to the risks of nutritional problems.
The management of diabetes has changed significantly in the last decade. Previously recommendations were very prescriptive with a strong emphasis on limiting sugar. We now know however that sugar can be consumed in moderate amounts in the diets of people with diabetes and the emphasis has shifted to a healthy eating diet (as recommended to the general population), consuming more slowly digested (low Glycaemic Index) foods, and appropriate amounts of carbohydrates to manage blood glucose control.
Some of the dietary restrictions that our elderly residents may have had imposed on them in the past no longer apply, particularly now that they are older and are at a far greater risk of poor nutritional status and malnutrition.
In aged care, it is preferable to make medication changes rather than impose dietary restrictions to control blood glucose levels.
Some residents may wish to continue with previous practices to manage their diabetes, for example, use artificial sweeteners in hot drinks, or diet cordial, and these requests will be catered for.
Aurrum’s menu is suitable for diabetic residents because:
1. The menu provides regular meals and snacks, which contain consistent amounts of starch or carbohydrate foods with each meal.
Aurrum provides three meals and three snacks each day to achieve this, including supper to assist with preventing hypoglycaemia in residents in the mornings who may be susceptible. Snacks available include plain biscuits, cheese and crackers and fruit along with suitable baked goods. Appropriated texture modified diet items are also provided as required e.g. pureed fruit, custard, yoghurt.
2. Sugar does not need to be avoided.
It is acceptable for residents with diabetes in long term care facilities to consume desserts without limiting foods which contain sugar.
Ordinary jams, honey, ice-cream, jelly, juice, cakes and biscuits and ordinary desserts are all suitable items to offer to residents with diabetes. If a resident consumes a lot of sugary drinks or a lot of jelly, then they will be encouraged to consume the diet cordial between meals to reduce the carbohydrate load.
As a general rule, ‘diet’ items such as diabetic jams, diet ice-cream and diet jelly are not recommended.
3. Low Glycaemic Index (GI) carbohydrates/starchy foods are incorporated into the menu on a daily basis, with the aim being to include one low GI choice at every meal time.
GI refers to the rate at which a starchy food is digested and absorbed and its subsequent effect on blood sugar levels. Slowly absorbed carbohydrates (low GI) are slowly released into the blood stream and this reduces the increase in blood sugar level. If you then combine a low GI food with a high GI food then the total GI load will be a medium GI. In this way we include a low GI food with each meal to reduce the total GI of that meal. E.g. pasta, raisin bread, oats, corn, beans and pulses, dairy, most fruits including prunes and 100% juices.
4. Low fat diets are not recommended.
Low fat products are not used as standard in aged care facilities. Full cream dairy products are provided to all residents with or without diabetes.
5. High fibre products
High fibre items are included on the menu daily including:
Wholemeal, white hi fibre and raisin bread.
High fibre cereals items including biscuits, muffins and cakes.
Fruit is an option at all meals and mid-meals.
Vegetables and salads.
Legumes and pulses, which are generally best accepted in soups and casseroles.
6. Three dairy serves per day
Aurrum’s menus contains 3-4 serves of dairy per day, available from milk at breakfast on cereals, milk as a beverage, dairy options such as cheese and biscuits or yoghurt at mid-meals, one diary based desert per day and custard or cheese sauces served with menu items. Dairy is essential for bone health and a source of calories and protein in a menu.
7. Two fruit serves per day
Aurrum menus have fruit available at all meals and mid-meals. Fruit is a good source of fibre and nutrients and should not be restricted for individuals with diabetes. Fruit juice also counts as one serve of fruit /day and is a valuable nutrient for some residents.
8. Encourage fluids
All residents require adequate fluids ~1.8L/d. Suitable choices for residents with diabetes include water, tea, coffee, milk, Milo, cordial, soft drink and fruit juices.
All our staff will be receiving training to update their knowledge about managing diabetes in aged care so they can better support our residents and their families.
We will also be holding Aged Care Nutrition evenings at our homes over the coming months to discuss any nutritional queries or questions that you may have.
Please stay tuned for more information about these events.