By Mary Easaw

ACCORDING to the US Centers for Disease Control and Prevention, almost 25% of adults older than 60 years suffered from diabetes in the US in 2007 and about 68% of older adults who suffered from cardiovascular disease and diabetes died from heart disease and stroke.

Factors that affect the eating patterns of older adults with diabetes include swallowing difficulties, poor dentition, limited mobility leading to difficulty in shopping and preparing food, economic limitations, social isolation, depression, and too many medications (polypharmacy.) Poor appetite, altered taste sensation, and impaired thirst mechanism lead to increased risk of dehydration, reduced activity level, and reduced absorption of some essential nutrients (DiMaria et al, 2005.)

Nutrition plays an important role in the management of diabetes. The challenge for older diabetic adults is making appropriate food choices. Many will gain confidence and control of diabetes when they know how food affects their blood glucose levels. The following are important considerations for them.

1. Regular meal times

Blood glucose tests are a convenient way to check blood glucose levels at a particular time, helping to avoid hypoglycaemia. - Photo courtesy of Roche Diagnostics

To ensure that you have regular meals, keep a food diary in which you record all the foods, drinks, and snacks you take in a day. It should contain dates, times, blood glucose readings, medications, everything you ate, and your level of physical activity. Use a small note book, daily planner, or personal digital assistant (PDA) to record this information. Bring this record when you see your doctor and dietitian at the hospital.

The food diary will help you design a food plan that includes foods you like; know how your body responds to certain quantities of food; and review your blood glucose records and guide decisions about changes you need to make for better blood glucose control.

2. Practical cooking or eating out

Many older adults may not want to cook due to physical limitations. One good idea is to have catered food delivered to your home. The meals should consist of rice/noodles/breads with chicken/fish/lean meat, two types of vegetables and a soup. Fruits can be bought from local vendors and eaten at home. Discuss your requirements with the caterer.

If you enjoy cooking, buy small amounts of groceries, store them in the freezer or fridge. Utilise on-the-wheels vendors who sell groceries at your doorstep. Fine-tune traditional recipes by to reduce fat and/or calories. E.g. replace coconut milk with low-fat milk, bake meats instead of deep-frying them, and use fresh tomatoes instead of tomato sauce to reduce salt.

When eating out, use the Rate-Your-Plate concept. Divide your plate into two parts. One half should contain a variety of vegetables and fruits, the other half should be further divided into quarters. One should contain carbohydrates, preferably wholegrain, and the other should contain lean protein. Keep food within the borders of the plate. Finish off your meal with water or plain tea.

3. Meals and snacks

Space meals between four and five hours apart. This helps your pancreas produce adequate amounts of insulin after each meal without over-burdening. It also gives your diabetes medications time to work. The goal here is to have your blood glucose within your target range by your next meal.

Snacks are often unnecessary unless you:

-Are preparing for physical activity

-Eat the fruit that you didn't want to eat during a main meal

-Need a snack for specific time, for example during 4 pm teatime. Remember, the snack is part of your daily calorie intake.

Meal replacement products (MRPs) provide a meal or snack alternative for people with diabetes. They may help to stabilise blood glucose levels and assist with weight loss. MRPs may replace a main meal or a snack in your daily eating pattern. Meal replacements include ready-to-drink powdered shakes, soups, bars, and puddings. Listed below are guidelines when choosing meal replacements

-Should provide 190-250 calories per serving.

-Should contain 10-15g of adequate protein per serving to promote health and mealtime fullness.

-Carbohydrates can vary between 14-34g per serving. It is advisable to have carbohydrates such as maltodextrin or tapioca dextrin rather than refined sugars such as sucrose, corn syrup, or high fructose corn syrup.

-Should contain 3-6g of dietary fibre and 5-8g unsaturated fats from trans-fat free vegetables oils.

-Should contain less than 20mg cholesterol and 100-300mg sodium per serving.

4. Dealing with hypoglycemia

Blood glucose tests are a convenient way to check blood glucose levels at a particular time, helping you avoid hypoglycaemia. Hypoglycaemia occurs if you take a wrong dose of diabetes medications, delay or skip of meals, consume insufficient carbohydrate portion at a meal, exercise more than usual, or drink alcohol without food.

Setting goals for blood glucose checks will help you improve your diabetes care. Before meals, your goal should be 3.8-7.7mmol/L. Two hours after a meal, it should be less than 8.8 mmol/L. At bedtime, it should be 5.5-7.7mmol/L.

To treat hypoglycaemia, follow the Rule Of 15.

Step 1: Check your blood glucose. If the reading is below 3.8 mmol/L, eat or drink 15g of carbohydrate e,g, half a cup of fruit juice or any sweetened drink or three medium-sized sweet biscuits.

Step 2: Wait for 15 minutes (the time it will take to feel better.)

Step 3: Check your blood glucose again. If your blood sugar is still low repeat steps one through three. If you still have low blood glucose after three checks, call for immediate help.

Step 4: Check you blood glucose an hour after the treatment and top up with a snack if you had missed your meal or snack.

Finally, it is prudent to see your doctor regularly and insist that he refer you to a qualified dietitian, physiotherapist, pharmacist, and diabetes educator for other areas of care. Diabetes care is managed by a team of professionals in different areas of expertise, not just one individual! -The Star/Asia News Network

Mary Easaw is senior manager, dietetics and food services, National Heart Institute, Kuala Lumpur. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader?s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.