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Diabetes - Dietary and Lifestyle Recommendations
Diabetes - Dietary Recommendations

Pregnancy, Children and Older Adults

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Pregnancy

See - Diabetes in Pregnancy

Women with diabetes who are planning to become pregnant should be offered individualised dietetic consultation as part of Multidisciplinary pre-conception care.

Women with diabetes who are planning to become pregnant and who have a body mass index above 27 kg/m² should be offered lifestyle advice on how to lose weight.

All patients with type 1 or type 2 diabetes should be encouraged to attend a multi-disciplinary preconception sessions with diabetes specialist nurse/diabetes specialist dietitian to assist safe achievement of pre pregnancy glycaemic targets.

All women planning a pregnancy and while in the first 12 weeks of pregnancy should take a vitamin supplement containing 5mg of folic acid per day

All pregnant women should be encouraged to take a vitamin supplement containing 10 ΅g of vitamin D3 per day - especially women who had a BMI of 30 or more at the start of the pregnancy and those with limited sunlight exposure.
See - Vitamin D Fact Sheet
WHO reviews recommend calcium supplementation as it has a role in reducing incidence of pre eclampsia /early delivery in high risk women including those with diabetes. Particularly important if diet review identifies a low dietary calcium intake.
Recommended Weight Gain Targets in Pregnancy

Body mass index (BMI) is calculated by the midwife at the booking appointment. NICE does not set specific weight gain targets for pregnancy. Bedford Hospital uses the following targets which are based on USA Institute of Medicine Weight Gain in Pregnancy Guidelines.
 
 

BMI at booking in appointment

18.5-24.9

healthy range

25-29.9

overweight

30 and over

very overweight

Recommended total pregnancy weight gain 11.5-16kg (25-30 lbs)

2 stones

7-11.5kg (15-25lbs)

1 1/2 stones

5-7kg (11-15lbs)

1 stone

In the USA, women who gain weight within these ranges have been found to be more likely to have better maternal and infant outcomes than those who gain more or less weight.
Eating for two during pregnancy is a myth. Moderately active women with a normal BMI at booking may need an extra 200 calories daily during the last 3 months of pregnancy only. Women who are overweight/obese at booking may not need any extra calories during the third trimester.

Women diagnosed with gestational diabetes will be offered dietetic advice as part of their antenatal care that concentrates on portion control, meal pattern, low glycaemic food choices, healthy eating and encouraging post meal activity.

In order to reduce the risk of recurrence in subsequent pregnancies and of type 2 diabetes in later life, especially if overweight, evidence would suggest that women with gestational diabetes should be given 12 month post delivery weight targets. Many may benefit from postpartum advice on healthy eating, weight management and exercise.
KickStart programme available in North and Mids Beds
  KickStart is a free programme including 1:1 advice, group education & gentle exercise sessions led by dietitians and antenatal exercise specialists aimed to help women safely manage their weight during and after pregnancy. Women trying to conceive or already pregnant and concerned about their weight can be referred by any healthcare professional to prenatal KickStart. Women who have recently given birth can self-refer to postnatal KickStart.
  The KickStart team can be contacted on
  01234 792171
  dietitians@bedfordhospital.nhs.uk
  www.bedford.gov.uk/KickStart 
  https://twitter.com/bedfordks

See - Kickstart Referral Forms-Antenatal & Postnatal

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Children

See - Management of Diabetes in Children and Young People

Dietary advice for children with diabetes should come from a specialist dietitian and tailored to the individual lifestyle, activity and insulin regimen.

Dietary recommendations are based on the healthy eating guidelines for children without diabetes.

Children with Type 1 diabetes who have school dinners should be encouraged to have the ordinary desserts rather than special diabetic or low sugar options.

Carbohydrate snacks are required by some children with Type 1 diabetes in-between meals but this will depend on the type and delivery of insulin.

Depending on the timing of exercise extra carbohydrate may be required.

In children with type 2 Diabetes, advice should focus first on dietary and lifestyle changes and should come from specialist dietitian

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Older Adults and Care in Nursing and Residential Homes

There are no specific diabetes dietary guidelines for the older adult and advice is based upon the general recommendations for diabetes. Dietary advice needs to balance the clinical and quality of life aspect.

Dietary advice needs to be modified for the older adult depending on the aims of treatment. This may be the prevention of hypoglycaemia or a reduction in hyperglycaemia without striving for excellent glycaemic control. Concerns about the development of long-term diabetes complications need to be balanced against life expectancy.

People who develop diabetes in their later years have different clinical needs than a similar aged person who had diabetes for many years.

In this age group it is important that consideration be given to reduce the risks of, hypoglycaemia and malnutrition.

 
Nutrition to reduce risks of hypoglycaemia in older adults

Avoidance of hypoglycaemia is important in the older age group. Offer carbohydrate at regular intervals to those on treatments with the potential to cause hypoglycaemia. Include snacks in-between meal and a bedtime snack. A suitable bedtime snack should be given to at risk patients even if the blood glucose is high reduces the risk of late nocturnal hypoglycaemia.

Examples would be a milk based drink, 1-2 biscuits, a sandwich, breakfast cereal.

 
Achieve adequate nutritional intake in older adults

Care should be taken when advising dietary changes, as those in this age group are more at risk of malnutrition. A significant reduction in sugary and fatty foods may lead to unwanted weight loss.

To lessen the chances of an inadequate intake:

 

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Monitor nutritional intake.

 

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Weight should be closely monitored.

 

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A higher BMI of 24-29 Kg/m² is acceptable for those over 70 years of age.

 

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Identify underweight and malnourished individuals using a screening tool such as Malnutrition Universal Screening Tool (www.bapen.org.uk) Over the age of 65 the number of underweight ‘at risk’ individuals increases, particularly in institutions and in the presence of acute illness.

   

See  -  Other Conditions - Illness & Nutritional Supplements

 

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Those with small appetites require nutrient-dense foods. Overemphasis on healthy eating is therefore not appropriate. A pragmatic balance between glycaemic symptoms and intake is reasonable.

 

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Frail elderly dependant on meals on wheels or frozen meal home deliveries should select the ordinary desserts from the menu unless advised otherwise by a Dietitian.

 

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Overweight older adults who are gaining weight should reduce fatty and sugary foods. Contact or refer to a Dietitian for detailed advice.

 

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Beverages without sugar are advised as sugar in drink form causes a quick rise in blood glucose.

 

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Poor glycaemic control in the elderly may arise for many reasons. It should be addressed by reviewing possible causes and medication rather than being over restrictive with the diet.

 

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Contact your local Nutrition and Dietetic Department for further advice about individual patients.

 

Nursing and Residential Homes

Nursing and Residential homes are requested to provide people with diabetes with the same menu as those without diabetes. The vast majority can be offered ordinary desserts and cake. However sugary drinks should be discouraged.

Obese clients with diabetes may be advised otherwise by a Dietitian after individual assessment.

 

See  -  Other Conditions - Illness & Nutritional Supplements

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