Download Cake OR pudding

Dietary Guidance for Diabetes
Introduction
Nutritional guidelines for the older population recommend the majority of people aged over 65
years or more should follow similar patterns in eating and lifestyle to those advised for maintaining
health in younger adults. However consideration does need to be given to the fact that a number of
elderly residents in care homes are undernourished, underweight and have a low intake of some
nutrients (calcium, iron and vitamin C). In some cases dietary recommendations for the older
person with diabetes can differ to the general recommendations for people with diabetes. For
example where an individual with diabetes is underweight and/ or malnourished it may not be
appropriate to reduce the fat and sugar in their diet.
The guidance below provides general guidance for managing diabetes in the majority of people.
This includes for those people with diabetes who are underweight/ malnourished. Some people
may have an individualised careplan provided by a Dietitian which should be followed.
Carbohydrate or starchy foods
The group of foods which directly increases blood sugar or blood glucose levels are carbohydrates
or starchy foods. Overall it is the total amount of carbohydrate in meals or snacks which has the
greater influence on blood glucose rather than the source or type. There are 2 types of
carbohydrate:
1. Sugars or simple carbohydrates
2. Starches or complex carbohydrates
Sugars:
 Sugar can be absorbed quickly into the bloodstream and cause undesirable peaks in blood
glucose
 Sugar is found naturally in some foods e.g. fruit (fructose) and milk (lactose). This is less readily
absorbable and these foods provide many nutritional benefits. These foods do not generally
need limiting
 Sugar is added to some foods e.g. cakes, confectionary. This sugar is absorbed quicker and is
contained in foods with little nutritional benefit. These foods are generally reduced
 Sugar is absorbed quicker when foods and drinks containing sugar are taken on their own rather
than as part of a meal e.g. a sugary drink or sweets taken as a snack between meals
 Sugar should therefore generally be reduced for people with diabetes but does not need to be
completely avoided. Healthy eating guidance should generally be followed by people with
diabetes
 However where people have a particularly poor dietary intake and/ or are at risk of malnutrition
healthy eating guidance is not recommended and sugar may need to be included
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 1
Sources of sugar:
 All types of sugar including granulated, brown, Demerara etc.
 Honey, syrup
 Jam, marmalade
 Sweets, chocolate
 Sugary cakes and biscuits
 Desserts
 Fruit
 Milky drinks such as hot chocolate and milkshakes
Advice for diabetes:
 Sugar can be used in foods and in baking as part of a healthy diet; higher fibre, lower sugar
choices are best e.g. Digestive biscuits, teabread, fruit cake, English muffins
 Sugar free, no added sugar or diet drinks, instead of sugary versions can be an easy way to
reduce sugar
 Desserts should have no more than 15g added sugar per portion (including accompaniment).
See below for suitable desserts
Starches:
 Broken down to make sugars in the gut
 Provide energy and nutrients
 Should be eaten regularly at meals
Sources of starch:
 Bread and bread products e.g. teacakes, scones and crumpets
 Rice and couscous
 Pasta and noodles
 Potatoes and potato products
 Breakfast cereals including oats
 Flour products including crackers, biscuits, pastry batters, dumplings
Glycaemic Index (GI):
 This is a way of grading foods according to their effect on blood glucose levels
 A low GI food has less effect and a high GI food more effect
 Foods with a low GI include All Bran, muesli, porridge, many fruits, milk, pasta and yoghurt
 Some foods with a low GI have a high fat content e.g. chocolate and cake and may need to be
limited because of healthy eating
 See accompanying information “Understanding the Glycaemic Index” for more information
Advice for diabetes:
 Residents should be encouraged to choose a starchy food option for each meal. Starchy foods
available from the menus include:
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 2
Breakfast: breakfast cereal, porridge, bread/ toast, crumpets, English muffins
Lunch: potatoes, pasta, rice, Yorkshire pudding, dumplings, pastry, crackers
Supper: bread, teacakes, crumpets, scones
 Current portion sizes should be followed to ensure a similar amount of starchy foods are eaten
each day
General Guidance








Regular meals: residents should be encouraged to eat breakfast, lunch and tea. See guidance
below for where meals are refused
Fat: cutting down on fat is advised in general healthy eating advice to help with weight
management. Reducing intake of saturated fat and replacing with unsaturated fat is advised to
help protect against heart disease. Where residents are underweight fat will provide
concentrated sources of calories to help with weight gain
Fruit: aim for at least 5 portions of fruit and vegetables a day to provide vitamins, minerals and
fibre. Fruit contains natural sugar (fructose) and people with diabetes are advised to spread
fruit portions over the day, eating only one portion at a time. Fruit juice is high in fructose and
should only be taken with a meal and then only a small glass (120ml)
Diabetic products: these are not generally recommended as they tend to be expensive and
offer little benefit compared with ordinary, low or reduced sugar alternatives e.g. Digestive or
Hobnob biscuits rather than diabetic alternatives, scones or teacakes rather than cakes. They
may have a laxative effect
Sweeteners: these can be used instead if sugar in drinks, on cereal and in baking. They are
virtually free from calories, do not affect blood glucose levels and do not contribute to dental
caries. Examples include Canderel, Sweetex, Hermesetas and Splenda. Non sucrose bulk
sweeteners e.g. fructose, sorbitol and xylitol have little benefit over sugar. They still have a
significant calorie content, can raise blood glucose levels to some degree and may have a
laxative effect
Snacks: the need for snacks should be considered on an individual basis and is not routine
guidance for all individuals with diabetes. For people taking insulin regular snacking can help to
stabilise blood glucose levels and help prevent hypoglycaemia. Individuals who are underweight
or at risk of malnutrition may benefit from regular snacks to help improve calorie and protein
intake. However for individuals who are overweight or within desirable weight range not
snacking regularly can help with weight management and blood glucose levels. Where there is
uncertainty advice should be obtained from an appropriately qualified professional e.g.
Dietitian or Diabetes Specialist Nurse.
Pickles, sauces and salad dressings: People with diabetes can eat these items in small
quantities at meal times, despite the fact they contain sugar. Low fat sauces and salad dressings
should be used sparingly if an individual is trying to lose weight
Products labelled ‘low fat’ e.g. biscuits, cakes, desserts: the fat in these products is often
replaced with sugar making the sugar content high and therefore unsuitable for people with
diabetes. Lower sugar versions of normal products should be used; see table below
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 3
Individual Guidance




Underweight and malnutrition: for individuals with diabetes and a high risk malnutrition score
a high energy- high protein diet may be appropriate. This may involve higher intakes of fat and
sugar than generally advised in order to increase calories. It can also involve the use of
nutritional supplements. Where high blood glucose levels are noted it may be necessary to
adjust diabetes medication to manage these rather than changing diet. This should be discussed
with the residents healthcare team
Weight management: weight is a significant factor in the development and management of
type 2 diabetes. Reducing fat and sugar intake for residents who are overweight and obese may
be necessary but may not be appropriate for all residents
Residents treated with insulin: ‘carbohydrate counting’ may be used to help control blood
glucose levels in people treated with insulin. This will involve calculating the carbohydrate
provided by starches and sugars for meals and snacks and ensuring the correct amount is
provided. This guidance is outside the scope of this information and would be provide on an
individual basis by a Dietitian
Hypoglycaemia: this can occur when blood glucose levels fall rapidly. It is more common in
people treated with insulin but can also occur in people taking sulphonylurea drugs e.g.
Gliclazide, Glipizide, Glibenclamide. Consideration may need to be given to the quantity and
timings of carbohydrate containing foods and drinks, the potential need for snacks and timings
of meals in relation to medication timing
Alison Clark (Registered Dietitian)
December 2014
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 4
Foods to Avoid and Suitable Alternatives


The guidance below is general guidance
Where an individual has received specific dietary advice from a Dietitian this should be
followed
Foods to avoid
Sugar
Large servings jam,
marmalade, honey,
syrup
Sugar coated breakfast
cereals
Suitable alternatives
Artificial sweetener e.g. Canderel, Hermesetas,
Sweetex, Splenda, Truvia
Small serving (1 teaspoon per bread slice) jam Spread butter or
or marmalade or reduced sugar varieties
margarine thickly
Squash and fizzy drinks
Plain breakfast cereal e.g. Weetabix, Shredded
Wheat, Rice Krispies, Cornflakes, All-bran,
muesli
Diet or sugar free versions
Fruit juice
Small glass (120ml) taken with meal
Sugary biscuits
Plain biscuits e.g. Digestive, Rich Tea and
crackers
Sugary cakes e.g. cakes
with cream filling, icing
Plain cakes e.g. madeira, Angel Cake and high
fibre cakes e.g. fruit cake, teabread
Scones, teacakes, crumpets, English muffins
Sugar free sweets
Small amount chocolate eaten with meal is
suitable
Fruit tinned in natural juice, stewed fruit with
sweetener
Sweets and chocolates
Fruit tinned in syrup,
fruit stewed in sugar
Underweight/
risk malnutrition
Custard made with
sugar
Full cream milk
Serve with butter
and cheese as
appropriate
Serve with butter,
cream, cheese as
appropriate
Serve with cream,
custard or ice cream
Custard made with a sweetener- this can be
made up without sweetening and then sugar
or sweetener added as appropriate prior to
serving
Ice cream or cream can be used as alternatives
Puddings e.g. sponges,
Suitable puddings are those with 15g or less
tarts, flans, slices, pies, added sugar per portion. This includes sugar
crumbles, puddings
from jam, syrup or honey etc. but not sugar
found in fruit. See below for suitable desserts
Yoghurts and fromage
Yoghurts and fromage frais with less than 10g
frais with more than
carbohydrate per 100g e.g. Muller Light,
10g carbohydrate/ 100g Activia 0%
Mousses and jelly
No added sugar Angel Delight, sugar free jelly
Make with fortified
full cream milk
Drinking chocolate,
malted drinks
Make with fortified
full cream milk
Dietary Guidance for Diabetes
Low sugar hot chocolate and malted drinks
e.g. Options, Highlights
Alison Clark RD December 2014
May be included on
individual basis
Page 5
Desserts





The desserts listed below are from the current menus. The added sugar content has been
calculated using the recipes provided
Desserts should have NO MORE THAN 15g ADDED SUGAR PER PORTION including
accompaniment
Added sugar includes sugar from honey, syrup and jam BUT NOT sugar found in foods such as
fruit or milk
Reducing sugar in accompaniments e.g. custard or using cream allows more desserts to be
suitable
Desserts based on fruit or milk provide additional nutritional benefit
Dessert
Chocolate and orange
pudding
Chocolate sauce
Suitable
 or X

X
Fruit crumble
Coconut tart
Rice pudding



Fruit flan
Fruit filled meringue

X
Gooseberry fool

Jam and coconut
sponge
X
Fruit jelly
Blancmange
Apple crumble slice
Lemon meringue pie
Fresh fruit salad
Egg custard tart
Date slice
Jam crumble slice
Strawberry
cheesecake
Pineapple pudding
Eton Mess
Custard



X



X
X
Dietary Guidance for Diabetes
Comments



Alternative
Cream or custard made
with sweetener
Sweeten with sweetener
Make with fortified full cream
milk for fortified diets
Fruit with cream or ice
cream
Use sweetener to sweeten
custard and fruit
Jam and syrup both added
which increase added sugar
content
Use sugar free jelly
Eves pudding (Jam and
syrup not added)
Lemon pie (no meringue)
Use fruit tinned in natural juice
Fruit crumble slice
Serve with sugar free custard
Drain syrup from strawberries
Sweeten with sweetener
Alison Clark RD December 2014
Page 6
Make with fortified full cream
milk for fortified diets
Suggested Meal Plan: Desirable/ overweight
Meal
Suggested foods
Bowl of cereal with semi skimmed milk and sweetener
Breakfast
AND/ OR
Toast with butter or margarine and 1 teaspoon per slice jam or
marmalade or marmite
Mid morning
Plain biscuit OR fruit if wanted
Cooked meal:
Meat, poultry or fish
Vegetables or salad
Potatoes or rice or pasta
Pudding:
See above for suitable pudding
Lunch
Mid afternoon
Plain biscuit OR fruit if wanted
Snack meal:
Main course option
Serve with salad and bread
Cake OR pudding:
See above for suitable options
Evening Meal
Supper
Fruit OR plain biscuit if wanted
Drinks
Coffee and tea without sugar (sweetener if wanted), no added sugar or
diet squash and fizzy drinks, water
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 7
Suggested Meal Plan: Fortified Diet
Meal
Suggested foods
Bowl of cereal with fortified milk and sweetener
Breakfast
AND/ OR
Toast with thickly spread butter or margarine and 1 teaspoon per slice
jam or marmalade or marmite
Mid morning
Plain biscuits OR crackers with butter and cheese OR suitable yoghurt
Cooked meal:
Meat, poultry or fish
Vegetables or salad with butter/ mayonnaise
Potatoes or rice or pasta with butter
Pudding:
See above for suitable puddings- fortify when
possible
Lunch
Mid afternoon
Plain biscuits OR crackers with butter and cheese OR suitable yoghurt
Snack meal:
Evening Meal
Cake OR pudding:
Supper
Main course option
Serve with bread thickly spread with butter or
margarine
See above for suitable puddings- fortify when
possible
Small bowl of cereal with fortified milk OR toast with thickly spread
butter and jam
Suitable milky drink
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 8
Drinks
PRIORITISE coffee and tea without sugar (sweetener if wanted),
fortified milk, milky drinks OVER no added sugar or diet squash and
fizzy drinks, water
Dietary Guidance for Diabetes
Alison Clark RD December 2014
Page 9