Dietary recommendations for the older person with diabetes can differ to the general recommendations for people with diabetes. 

Older people are more likely to be underweight, rather than overweight, and prevalence of malnutrition is high. It may therefore not be appropriate to reduce the fat, sugar and salt in the diet for every older person with diabetes.

Older people with diabetes should have their individual dietary requirements established by a registered dietitian.

• Plan for three regular meals a day. Try to help residents avoid skipping meals and spread breakfast, lunch and evening meal over the day. This will not only help control appetite, but also help in controlling blood glucose levels.
• At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate eaten is important to control blood glucose levels (a registered dietitian can provide more information on quantities specific to individual needs). All varieties are fine, but try to include those that are more slowly absorbed (have a lower glycaemic index/GI) as these won’t affect blood glucose levels as much.
  Better choices include: pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potato and yam, porridge oats, All Bran and natural muesli.

The high fibre varieties of starchy foods (wholegrain) will also help to maintain the health of the digestive system and prevent problems such as constipation.

• Cutting down on fat can help with weight management for those people who are overweight.  All fats contain calories. Fat is the greatest source of calories so eating less fat and fatty foods will help with weight management. Here are some tips to cutting the fat:

1. Use less saturated fat by having less butter, margarine and cheese.
2. Choose lean meat and fish as low fat alternatives to fatty meats.
3. Choose lower fat dairy foods such as skimmed or semi-skimmed milk, low fat or diet yogurts, reduced fat cheese and lower fat spreads.
4. Grill steam or oven bake instead of frying or cooking with oil or other fats.
5. Watch out for creamy sauces and dressings and swap for tomato based sauces instead.

• Include more fruit and vegetables. Aim for at least five portions a day to provide your residents with vitamins, minerals and fibre, as well as to help the balance of the overall diet. One portion is, for example, a banana or apple, a handful of grapes, a tablespoon of dried fruit, a small glass of fruit juice or fruit smoothie, three heaped tablespoons of vegetables or a cereal bowl of salad.

Fresh fruit is not always easy for the older person to manage so remember that dried, tinned or frozen fruits, fruit desserts and fruit juice all count towards the potions.

• Include more beans and lentils, such as kidney beans, butter beans, chickpeas, red and green lentils, as these can help to control blood glucose levels and blood fats. Try adding them to stews, casseroles and soups, or to a salad.
• Aim to provide at least two portions of oily fish a week. Examples include mackerel, sardines, salmon and pilchards. Oily fish contains a type of polyunsaturated fat called omega 3 which helps protect against heart disease.
• Limit sugar and sugary foods. This does not mean that your residents need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. Using sugar-free, no added sugar or diet fizzy drinks/squashes instead of sugary versions can be an easy way to reduce sugar in the diet.
• Limit the amount of processed foods you provide since these foods contain high levels of salt. Try flavouring foods with herbs and spices instead of salt.
• Alcohol should be taken in moderation only – that’s a maximum of two units of alcohol per day for a woman and three units per day for a man.  For example, a single pub measure (25ml) of spirit is about 1 unit or half a pint of lager, ale, bitter or cider has 1 – 1½ units. 
  
  Over the years the alcohol content of most drinks has gone up. A drink can now contain more units than you think – a small glass of wine (175mls) could contain as much as 2 units.  Remember alcohol contains empty calories so cutting back is helpful if a person with diabetes is trying to lose weight. 
  
  Alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication. For this reason people with diabetes are advised to never drink on an empty stomach.  Check with your resident’s healthcare team about whether they are at risk of hypoglycaemia.
• Don’t use diabetic foods or drinks. They offer no benefit to people with diabetes. They will still affect blood glucose levels, contain just as much fat and calories as the ordinary versions, can have a laxative effect and are expensive.

Reviewed March 2010
Next review September 2011