Kurt Maloney Specialist Dietitian Bradford Nutrition amp Dietetic Department St Lukes Hospital Objectives Identify the CQC regulation for nutrition amp hydration Discuss the dietary management of diabetes ID: 919455
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Slide1
Nutrition in Care Homes for People with Diabetes
Kurt Maloney, Specialist Dietitian Bradford Nutrition & Dietetic Department St Luke’s Hospital
Slide2Objectives Identify the CQC regulation for nutrition & hydration
Discuss the dietary management of diabetes Introduction to dietary advice for overweight & malnourished patientsOutline the importance of screening for malnutrition with examples
Slide3Regulation 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 needsMust receive support with nutrition & hydration if needed
Slide4Provide a variety of nutritious & appetising foodAppropriate temperature Culturally appropriate Preference & choice Prompts, encouragement, eating aidsFollow prescribing plan for supplements
Regular assessment of needsStaff should know when specialist nutritional advice is needed & how to refer
Slide5Regulation 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
Slide6Dietary Advice for Diabetes
Slide7Points to consider…Priority of the person’s diabetes management Individualised assessment & treatment
No ‘one size fits all’ approach Diagnosis, prognosis & quality of life Social aspects of eatingPleasure from eating Respect individuals’ choices
Slide8Which Nutrient Affects Blood G
lucose?
All affect blood glucose!
Slide9Food 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
Which Nutrient
A
ffects
B
lood
G
lucose?
Slide10Why is Diet Important? Major influence on diabetes management & health
Blood glucose control Long & short term complications Body fat and insulin resistanceRisk of other diet related diseasesVitamins, Minerals, Protein & Fats are essential for good health
Slide11Diet Myths – True or False People with diabetes shouldn't have:
Bananas, grapes, melon & mangoSweet foods and puddingsLots of sugary drinksPeople with diabetes should: Use diabetic products Always snack between meals Follow a ‘special’ or ‘diabetic’ diet
What is the dietary advice for diabetes?
Slide12Healthy Eating
Slide13Healthy Eating in Care HomesRegular & Balanced MealsPortion control
Healthy menu planning & cookingAppetising meals & variety Healthier snack & pudding optionsLimit processed or ‘junk’ foodsAvoid sugary drinks & added sugars Occasional ‘treat’ foods are fine
Slide14Healthy Eating
Slide15How much is important Regular meals spreads carbs outAvoid added sugars & sugary food/drinks Fruit & fruit juices Don’t double up on starches
Smaller portions of puddings The type is also importantPorridge, basmati rice, new potatoes, seeded bread, whole grain starches & cereals
Slide16Weight 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’ foodsSimple swaps and small changesSwap Chocolate pudding for chocolate Muller light Swap Shortcake biscuits for rich teaChange drinks to diet, sugar free, no added sugarSwap sugar for sweeteners
Slide17Weight Management What would you change?
Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juiceMid morning: 3 plain digestives with cup of teaLunch: 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
Slide18Weight Management What would you change?
Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juiceMid morning: 3 plain digestives with cup of teaLunch: 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
Slide19Weight Management What would you change?
Breakfast: Large bowl of cereal with milk, 2 Toast with butter, 1 glass of fruit juiceMid morning: 3 plain digestives with cup of teaLunch: 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
Slide20Weight Management What would you change?
Breakfast: Small bowl of cereal with milk, 1 Toast with butter, 1 glass of fruit juiceMid 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
Slide21Weight Management
Reducing the portions with some simple swaps saves approximately 900 - 1000 calories per day!
Slide22Balance the Plate
Slide23Malnutrition
‘The nutritional intake does not meet the person’s needs’
Slide24MalnutritionThe priority is getting the patient to eatAt this stage healthy eating is not
a priorityAim to provide nutritious foods which are high in calories & protein Control Blood glucose with medications during this period
Slide25Consequences of malnutrition
Poor wound healing and higher risk of infectionsFrequent hospital admissions Muscle wasting, Lack of energy/DepressionDehydration
Vitamin and mineral
deficiencies
Slide26Recognising Malnutrition
Mobility: weakness, impaired movement Mood: apathy, lethargy, poor concentrationCurrent 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
Slide27Nutritional Screening
Slide28Why Screen for malnutrition?
Early identification of patients at risk
Early intervention
When repeated weekly allows monitoring where nutritional care plans in place
Audit practice
Slide29‘MUST’
Slide30Slide31Benefits of using MUSTEasy to use, rapid and reproducible
Any care worker can be trained to use ‘MUST’Can be used with patients who can’t be weighed and measuredAvailable on line from www.bapen.org, as well as paper format in a variety of sizes
Slide32MUST 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-toolkit/the-must-itself
Slide33Slide34Slide35Slide36‘Acute Disease is unlikely to apply outside hospital’
Slide37Slide38Slide39Case Study: Jane 75 years oldType 2 diabetes: Diet controlled5’ 4” or 1.62m 7st 12lb or 50kg
Resident for 2 weeksNot eating well, managing small amounts of meals, no snacks but says ‘I’ve always had a small appetite’ No previous weights available despite checking with family and available medical documentation
Slide40Case Study: Steve80 years oldType 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 concernedEating one small meal per day and struggling with snacks despite being encouragedGliclazide was stopped by the DSN due to hyposConcerned staff check his weight history and discover he weight 98kg only 2 months ago = 13kg weight loss
Slide41Treating Malnutrition
Slide42What to do If
you feel a resident is at risk of malnutrition:
Slide43Food Fortification
Adds calories & protein without increasing volume
Little & often, high calorie
Slide44Ideas 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. Don’t 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.
Slide45Fortified menu
Menu 1BreakfastPorridge (made with water), bread + butter, cup of teaLunch
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
)
Slide46Comparison
Menu 1 Energy 980 kcals
Protein
48g
Menu 2
2070 kcals
75 g
Slide47Hydration
Good hydration can help withMental performance Headaches Urinary tract infections Falls Pressure sores and woundsConstipation Concentration Kidney stones
Gall stones
Tiredness
Lethargy
Oral health
Slide48Oral Nutritional SupplementsPrescribed supplements – Ensure Plus, Pro Cal ShotHigh energy, high protein in small volume
Expensive to use & compliance is poor Quick & Easy to use Follow prescribing information TimingFlavours
Slide49Referring to the Dietitian Community Matron ( Nursing Homes)
District Nurses (Residential Homes)GP
Slide50