Diabetic Diet: Does It Have a Place in Nursing Homes?
A diabetic diet is a type of therapeutic diet that may be prescribed to an older adult upon admission to a long-term care facility or nursing home.
While well-intentioned, diabetic diets may actually do more harm than good.
This article explains the potential consequences of a diabetic diet for older adults living in long-term care and why a liberalized approach to diet offers greater benefits.
What is diabetes?
Diabetes is a disease that occurs when your body can’t produce enough insulin or use the insulin properly.
Insulin is the hormone produced by your pancreas that lowers blood glucose, or sugar, levels.
There are two main types of diabetes:
- Type 1 diabetes: Also known as insulin-dependent diabetes, type 1 diabetes occurs when your body doesn’t produce enough insulin so you must take insulin.
- Type 2 diabetes: In type 2 diabetes, your body may produce insulin, but your cells can’t properly use it. Type 2 is the most common type of diabetes.
While more research is necessary, researchers may have identified a third type, known as Type 3 diabetes, that is associated with Alzheimer’s disease, a form of dementia that leads to the loss of memory and thinking skills (1).
Diabetes in older adults
The rates of diabetes disproportionately affect older adults.
Of the more than 30 million people living with diabetes in America, 25% are aged 65 years or older (2).
What’s more, studies estimate that between 25-34% of older adults living in long-term care have diabetes, of which 95% are type 2 (3).
The high prevalence of diabetes in older adults is due to age-related changes such as a loss of lean body mass, an increase in fat mass, and chronic low-grade inflammation.
Diabetes increases the risk of common geriatric syndromes, problems specific to aging that interfere with a person’s daily life.
These geriatric syndromes include (4):
- Falls and fractures
- Vision and hearing impairment
- Urinary incontinence
Diabetes is commonly managed through diet and with the appropriate use of insulin and other medications to control blood sugar levels.
Dietary restriction, however, is not an important part of diabetes management for older adults.
Diabetic diets in nursing homes
Despite their long tenure in nursing homes, diabetic diets are outdated and ineffective for diabetes management in older adults.
A diabetic diet generally restricts foods high in sugar such as cake, cookies, and other desserts as well as sugary beverages like pop and juice.
While these items can cause a sharp increase in blood sugar levels, and overall sugar intake should be taken into consideration, diabetic diet orders are ineffective for blood sugar management and are not recommended (3, 5, 6).
Increasing evidence suggests that diabetic and other therapeutic diets may lead to decreased food intake, unintentional weight loss, malnutrition, and a poor quality of life (3, 5).
Instead, a more liberalized diet that allows for a variety of food choices may be more beneficial for meeting the nutritional needs and blood sugar goals in residents with type 1 and type 2 diabetes on mealtime insulin.
That said, managing diabetes with medications rather than dietary changes, can enhance the joy of eating and reduce the risk of malnutrition and dehydration in older adults.
In either case, a resident’s diet should be determined with the person and in accordance with his or her informed choices, goals, and preferences, rather than exclusively by the diagnosis of diabetes or other disease.
Blood sugar goals
The risk of hypoglycemia (low-blood sugar) is the most important factor in determining blood sugar goals for older adults in long-term care according to the American Diabetes Association (ADA) (3).
Multiple factors increase the risk of hypoglycemia in older adults including:
- Impaired kidney function
- Impaired hormonal regulation and counterregulation
- Changes in appetite and nutrition intake
- Slowed intestinal absorption
At the same time, it’s also important to avoid chronic hyperglycemia (high-blood sugar), which increases the risk of dehydration, electrolyte disturbances, urinary incontinence, dizziness, and falls.
The goals for diabetes management differs depending on the care setting and clinical circumstances, and should be based on an individual’s overall health status, his or her preferences and values, life expectancy, and anticipated clinical benefit.
For example, blood glucose goals are generally more strict for younger, healthier older adults than for older adults with multiple commodities, cognitive impairment, or who are at end-of-life.
The prevalence of diabetes increases with age as more people live longer.
Although diet plays an important role in the management of diabetes, diabetic diets are not appropriate for older adults because they offer little benefit and may increase the risk of malnutrition risk and reduce quality of life.
More liberal diets have been shown to improve the nutritional status of older adults and therefore may be more appropriate for nursing home residents.