Guidelines...what have you had or found??

ally5555

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sue - its very wooly again so when it comes down to what to eat how can you turn it into food.

people need an individual assessment not guidelines!
 

sugarless sue

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Rude people! Not being able to do the things I want to do.
The whole point though,Ally is this IS all most of them are getting!!Therefore this is what they follow.In a perfect world yes it would be individual attention but that is not what happens in most cases.people are handed a leaflet and have to get on with it.You only have to read members horror stories on here to see that.Better worded leaflets would at least help!!
 

ally5555

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tbh sue - when I have has a second look they are guidleines for care homes - as you know they will have very different requirements!
 

milly mole

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Just signed in for a look and found this ‘gem’ of information! Are you actually saying, Ally that old people should be fed plenty carbs, because that is what this guideline says?

“GUIDELINE 6
Diabetes and Diet
A healthy varied diet is the cornerstone of treatment for diabetes. The main dietary
principles include:
Regular Meals
❖ Residents with diabetes need to eat regularly to prevent hypoglycaemia (a low blood glucose
level) if they are taking tablets or insulin injections. This means they need to eat regular
meals including breakfast, lunch, an evening meal and a small bedtime snack daily.
Fibre
❖ Foods containing starchy carbohydrate such as bread, potatoes, cereals, rice and pasta
should be encouraged and form the main part of every meal. In particular high fibre
foods such as granary bread and wholegrain cereals help to prevent constipation. The
fibre in porridge, peas, beans, lentils, fruit and vegetables also helps to improve blood
glucose control.

❖ When taking a high fibre diet it is very important to drink plenty of fluids 8-10 cups per day.
Sugar
❖ Cut down on sugar and very sweet foods such as sugary drinks, sweets, chocolate and
cakes. However there is no reason why residents with diabetes should not eat small portions
of cake or chocolate occasionally providing it is part of a healthy diet.
❖ Artificial sweeteners such as saccharin and aspartame are useful for sweetening puddings
and cereals.
❖ Sugar free drinks and reduced sugar jam and marmalade can be included.
Fruit and Vegetables
❖ Include plenty of fruit and vegetables at each meal including fresh, frozen and tinned
fruit in fruit juice. Five portions of fruit, vegetables or pulses are recommended each day,
although it is recognised that this may not be achievable, especially in elderly residents with
reduced appetite.
❖ A glass of unsweetened fruit juice with a meal, homemade vegetable soup, and offering a
selection of fruit and vegetable is also helpful.
Diabetic Products
Avoid specialist diabetic foods as they may contain as many calories as the ordinary version of
foods and may cause stomach upset and diarrhoea if taken in large amounts.
Special Occasions
Having diabetes doesn’t stop you from joining in on special occasions eg Christmas, birthdays.
The occasional sugary food or celebration meal will do no harm providing this is part of a
balanced, healthy diet. It is best if having something sugary to have it just after a meal.”

Also came on this while reading it,

“GUIDELINE 5
Blood Glucose Monitoring Guideline for Care Homes
Blood Glucose Monitoring
❖ Enables an understanding of a patient’s glycaemic control. Can help identify trends of
hyperglycaemia and hypoglycaemia. This will allow appropriate changes to be made to
diet or medication.
The normal blood glucose is between 4-6mmols, however in the elderly targets can be relaxed
and range between 7-12mmols. Aim of treatment in the elderly is to avoid hypoglycaemia and
osmotic symptoms of hyperglycaemia (thirst and polyuria).”


Which ,of course means that by relaxing the targets ,the elderly,who already probably have compromised blood flow etc will succumb even more quickly to diabetic complications!!

Are our elders not worth more than this to us?? Why should we not strive for good control in the elderly as well as younger people?
 

hanadr

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Hi Milly mole
they don't strive for good control in young people either.
HbA1c of up to 7% is acceptable, that's going on double a non-diabetic Hba1c of 4.2%
Somehow, I think it suits the medics if diabetics are ILL. Fits the scare mongering publicity better.
And why are they more worried about hypos in elderly residents. Most will undoubtedly be T2s and not on insulin. Thus hypos are rare. If they feed these people high carb and sulphonylurea tablets, and NOT TEST daily, the will kill them faster.
One of my walking group members with learning difficulties, lives in sheltered accomodation. No-one knows his last HbA1c or when it was last taken. I did ask his carer. She just thinks someone else is in charge of that. Herman knows himself that he's not allowed sugar or biscuits when we have coffee together. I always bring sweeteners for him. He's an absolute darling. Memory span of a flea and very limited undersanding, but delightful. I'd love to be sure he's being properly cared for, but I'm not in any position to help( except with those sweeteners.
 

phoenix

Expert
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5,671
Type of diabetes
Type 1
Treatment type
Pump
Foods containing starchy carbohydrate such as bread, potatoes, cereals, rice and pasta
should be encouraged and form the main part of every meal. In particular high fibre
foods such as granary bread and wholegrain cereals help to prevent constipation. The
fibre in porridge, peas, beans, lentils, fruit and vegetables also helps to improve blood
glucose control.
From my point of view,I think that the statement is back to front.

1)The fibre in porridge etc helps to improve blood glucose control
2) Higher fibre foods such as granary bread etc help to prevent constipation
3) Some foods containing carbohydrates, with a large proportion from the lower part of the glycaemic index should be served at every meal.

Which ,of course means that by relaxing the targets ,the elderly,who already probably have compromised blood flow etc will succumb even more quickly to diabetic complications!!

Are our elders not worth more than this to us?? Why should we not strive for good control in the elderly as well as younger people?
the elderly are a different population with different needs and responses to medication etc It may not necessarily be a good idea to atempt to impose tight control.
This paper on the clinical management of diabetes in the elderly describes some of the differences and diffculties . http://clinical.diabetesjournals.org/cgi/content/full/19/4/172 Steve Edelman is well known for being an advocate of self empowerment for people with diabetes.

Some of the problems:
The elderly are more likely to have hypos. Elderly patients also often have hypo unawareness , they also may not be able to respond quickly to a hypo.

'ideal HbA1c target of <7% may be difficult to achieve in the elderly... research lacking on benefit of tight control (>80 years of age).

' Restricting caloric intake in long-term care patients should be done with much caution. Many already have insufficient caloric intake because of confusion, dysphagia, and diminished appetite.

Medications have differing effects on the elderly and some may be contraindicated because of other co existing problems. For example metformin should not be given if the kidney function is diminished(as it often is in the elderly) and can also cause anorexia and weight loss. There are pros and cons with all the options.

Coexisting health problems, such as dementia or psychiatric illnesses, may require a simplified approach to diabetes care

The paper also says that complications occur at higher rates in the elderly.


It concludes that a multidiscipinary approach ( doctor, pharmacist, social worker dietitian,) is necessary. I '

I agree with that, unfortunately, guidelines often seem to miss out the individual. the elderly person must if posssible have some say in the matter and there answer may not always be the one that we think is best for them. Recently my 80 year old father (who's sometimes a bit of a hypochondriac) wondered if he might have diabetes, would I test him? I asked him would he change his diet if he was. No, he would carry on just the same. (actually I asked the GP to do a fasting test and it came back fine, in spite of the fact that my father eats lots of white bread, cakes, potatoes , meat, the odd banana and almost no veg )
 

Katharine

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The dietary guideline echoes the same rubbish that is forced on younger diabetics. Apart from emphasising constipation there is almost no difference to the the Diabetes UK muck.

This diet is not healthy for anyone particularly diabetics. The thing is that it is cheap and is the sort of stuff served up in nursing homes, hospitals, schools and prisons every day.
 

sugarless sue

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Rude people! Not being able to do the things I want to do.
Thanks for that Katharine.There is no reason elderly people cannot be kept below a 7% in care Homes.The meals are organised to cater for the individual resident and ,especially with residents with Dementia the choice is advocated by the staff.Even with A&O x3 residents the choice can be guided by the staff as there is not a huge choice on a daily menu.It is all down to individual care planning.