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Diabetes Management in Long-term Care Facilities


Diabetes Management in Long-term Care Facilities

My mother has had diabetes her whole life. Should she follow a special diet for her diabetes while she is in a nursing home?
Maybe not! Experts agree that a regular diet is appropriate for most long-term care residents who have diabetes. New diabetes guidelines say that sweets, such as cakes, cookies, and sweetened drinks, can have a place in the diet of a person with diabetes with a little advance planning.

For elderly nursing-home residents, planning for carbohydrate substitutions becomes less critical, and it is possible to manage changes in blood sugar with medications. The staff at your mother’s facility will weigh the risks vs the benefits of a diet for your mother and make recommendations accordingly.

What are the risks vs the benefits?
A risk of a special diet for diabetes is that it may cause your mother to eat less if she does not like the diet. Poor food intake may cause weight loss and result in malnutrition or other complications. For this reason, a special diet for diabetes can prove risky if your mother refuses to eat it.

Most studies are unable to show any benefit to giving therapeutic diets to long-term care residents with diabetes. Unless your mother is focused on eating correctly to maintain her blood sugar and gets upset with a regular diet, it is probably in her best interests to follow a regular diet.

Is that why nursing homes recommend a more liberal diet for persons with diabetes?
Yes. For many patients in long-term care, poor food intake is a big problem. If a patient is provided a regular diet that includes favorite foods, they may enjoy their meals more and therefore eat more than if they are given a special diet for diabetes.

Experts suggest that elderly persons with diabetes receive a diet that is consistent in carbohydrates, receiving the same amount of carbohydrates from meal to meal and day to day. Menus in most long-term care facilities usually meet those guidelines.

Does that mean I can give my mom whatever she wants to eat, whenever she wants it?
Yes and no. It is critical that your mom enjoy her favorite foods, if that makes her happy. If that means snacking on foods brought from home now and then, that is fine. However, eating whatever she wants, whenever she wants might result in unwanted weight gain and problems with blood sugar, especially if she is on insulin.

It is still important for her to eat regular meals that contain a mix of protein (meats, dairy, and dried beans/peas), carbohydrates (breads, cereals, fruits, and vegetables), and fats. She also needs to limit between-meal snacks, if possible. If she is eating a significant amount of carbohydrates, such as Christmas cookies or Easter candy, it is a good idea to inform the staff that is taking care of her that her blood sugar level might rise and fall.

On the other hand, if your mom truly enjoys eating and prefers to snack frequently, it is her right to do so. As long as she understands the risks (if she is able to understand them), then you should allow her to enjoy her meals and snacks, because they add to her quality of life.

My mother does not eat much. Should I worry about this?
It is common for older adults to lose interest in food. Sometimes this is a natural part of the aging process. Other times it is a result of minor illnesses, medication changes, or situational factors, such as the death or a friend or loved one. At any rate, you cannot force your mother to eat. This is one reason that a liberalized diet is important. If your mom is not eating much of anything, some food is better than none, even if that food is loaded with sugar.

What affects my mother’s blood sugar besides the foods she eats?
High blood sugar can result from many things other than a person’s diet. As the body ages, the organs that are involved with blood sugar regulation, such as the pancreas, may function less efficiently, sometimes resulting in high blood sugar. Some medications, such as steroids, or minor illnesses, such as urinary tract infections, can raise blood sugar. Blood sugar also may become elevated with chronic diseases, such as diabetes and chronic liver disease, or with other sources of stress. 


References and recommended readings
Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes—2006: a position statement of the American Diabetes Association. Diabetes Care. 2006;29:2140-2157.

Dorner B, Friedrich EK, Posthauer ME; American Dietetic Association. Position of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. J Am Diet Assoc [serial online]. 2010;110:1549-1553. Available at: Accessed July 28, 2012.


Review Date 7/12


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