To contribute to the global fight against diabetes, Mary-ann Chiam, an Accredited Practising Dietitian at Allium Care Suites who specialises in working with older elders, shares five tips on managing diabetes in the elderly as well as some coping strategies for the upcoming festive season.
by Mary-ann Chiam
This year marks 102 years since the ground-breaking discovery of insulin by Sir Frederick Banting and Charles Best, which has since gone on to save countless lives.
This act is commemorated annually on 14 November through World Diabetes Day, which aims to draw global awareness to diabetes and educate the public on taking appropriate steps to alleviate the issue.
Locally, diabetes remains a significant public health concern, with one in three individuals in Singapore at risk of developing diabetes in their lifetime. If nothing is done, by 2050, the Ministry of Health (MOH) estimates that about one million Singaporeans will be living with diabetes. Based on the 2019 Global Burden of Disease Report for Singapore, 26% of the disease burden caused by diabetes is due to dietary risk, and 50% by being overweight.
If you or your elderly loved one has been diagnosed with diabetes, it is not the end of the road. On the contrary, it can be a start to commit to a healthier and more active lifestyle.
To contribute to the global fight against diabetes, Mary-ann Chiam, an Accredited Practising Dietitian at Allium Care Suites who specialises in working with older elders, shares five tips on managing diabetes in the elderly as well as some coping strategies for the upcoming festive season.
1. Meal Planning and Eating Healthy
Many seniors have enjoyed the same favourite foods for decades, and understandably, that would be hard to break lifelong eating habits. As such, Mary-ann suggests, “Having a complete overhaul to a nutritious diet in a span of overnight would be shocking to the older adult and prove quite difficult to sustain in the long run. I advise implementing the change gradually, making a small yet significant improvement to a person’s diet”.
It is recommended to consume nutrient-dense meals and healthy well-balanced daily meals that focus on fresh ingredients with an emphasis on healthy sources of fat, good protein sources, high calcium/vitamin D food, soft vegetables, and using fresh soft fruits instead of juices.
Caregivers should consider comprehensive quality over quantity meal planning with a registered Dietitian specifically tailored to their senior’s preferences to achieve acceptable healthy glucose levels for the senior and avoid getting hypoglycaemia (low blood sugar).
Try incorporating these foods that are rich in antioxidants, fibre, minerals especially calcium, and vitamins, with emphasis on vitamin B12 and vitamins A and C:
- Dark and leafy vegetables – Kale and spinach are prime examples of high in nutrients such as vitamin (A, C and K) and magnesium that helps to lower one’s blood sugar and are high in fibre. Magnesium also helps to alleviate nerve pain in elderly diets that are deficient in magnesium. Caregivers can incorporate them in a green smoothie or soup or mix them in a salad. Senior clients who are edentulous should ensure that the dark leafy vegetables are finely chopped to aid in safe digestion and swallowing.
- Berries – They don’t call berries “nature’s candy” for nothing. From blueberries to raspberries, these small-sized fruits are amongst the healthiest foods one can snack on. Low in calories while high in fibre, they are also high in antioxidants and contain iron and vitamins (C, B2 and A).
- Fishes high in omega-3 fatty acids – Opt for fatty fishes such as salmon, sardines and mackerel, as studies have shown that omega-3 fatty acids can help people control their body weight and blood sugar. In addition, they can help to reduce the risk of heart disease and inflammation too. Try not to cook them in a fried or breaded method which introduces carbs and added calories, but opt for broiling, grilling or baking instead.
- Beans and lentils – A study has shown that eating beans, lentils, and other legumes have helped people with Type 2 diabetes gain better glycemic control and lowered their risk of heart disease. Beans contain a decent amount of vitamins (B1, B6, E and K), zinc, copper, manganese and selenium, earning the title of one of the most nutrient-dense foods.
- Nuts – If you are looking for a satisfying diabetes-friendly snack to add to your plate, look no further than opting for nuts. These super snack foods are a total package for people with diabetes as they are a good source of omega-3 fatty acids, low in carbs and high in protein and fibre. Moreover, snacking on them reduces hunger and creates a feeling of fullness. A good source of magnesium and polyunsaturated fats comes from eating creamy peanut butter spread on wholemeal bread or plain oat crackers and is easier to manage compared to nuts for seniors with diabetes.
At Allium Healthcare, the healthcare professionals recognise that dietetics is integral in supporting elders in their recovery, rehabilitation and reablement. They have rehabilitation dietitians who specialise in working with older adults and use advanced scientific information to better support and guide seniors in their nutritional needs.
Try this humble cabbage recipe that deserves more attention for being nutritious and delicious:
Healing Cabbage Soup
This dish contains 82kcal and serves 8 people.
Ingredients
- 3 tablespoons olive oil
- 1/2 onion, chopped
- 2 cloves garlic, chopped
- 2 quarts water
- 1 chicken stock cube
- 1 teaspoon salt, or to taste
- 1/2 teaspoon black pepper, or to taste
- 1/2 head cabbage, cored and coarsely chopped
- 1 (400g) can Italian-style stewed tomatoes, drained and diced
How to prepare
- In a large pot, heat olive oil over medium heat. Stir in onion and garlic; cook until onion is translucent, about 5 minutes.
- Stir in water, chicken stock cube, salt, and pepper. Bring to a boil, then stir in cabbage. Simmer until cabbage wilts, about 10 minutes.
- Stir in tomatoes. Return to a boil, then simmer for 15 to 30 minutes, stirring often.
2. Stay Active
Staying active plays a huge part in diabetes management. If a person has diabetes, being active makes their body more sensitive to insulin, which in turn helps to manage their diabetes. Engaging in aerobic exercises such as walking, swimming, and bicycling can help to control your glucose level and manage your weight.
It is recommended that a healthy person engages in 150 minutes of moderate-intensity aerobic activity a week or 20 minutes of vigorous-intensity aerobic activity three or more days a week. In addition, do strength training, such as free weights, resistance bands, or yoga, at least two times per week. Strength training builds muscle and helps control glucose levels.
It may be challenging to incorporate exercise initially; however, we’d recommend finding something you’d like to do. It’s best to start small and schedule the activity within one’s daily routine. The more regularly the training is accomplished, the faster this will become a habit. It’s also imperative to aim for a specific goal, such as being active for 30 minutes from Monday to Friday. However, always discuss with your doctor for recommendations on the right exercises.
Here are a few questions you can ask your healthcare provider:
- What physical activities are recommended and safe for me?
- Is there any extra precaution I need to take to protect my feet?
- Must I take precautions and consume a snack / light meal before exercising?
- Am I required to make any changes to my medication before I raise the intensity/level of my physical activity?
3. Replacing Sweetened Drinks with Water
One study1 of 2,800 people found that those who drank more than two servings of sugary beverages per day had a 99% and 20% increased risk of LADA and Type 2 diabetes, respectively. Aim to replace sweet drinks with high calcium sources like milk or soya milk or with water in your daily intake.
It is also recommended that you drink a glass of water before meals. A high sugar intake can contribute to an increased risk of Type 2 diabetes because of the links between obesity and high sugar intake.
Speak to your Dietitian for tips to ensure proper hydration while balancing your carbohydrate load and minimising wide swings in your blood sugar levels.
4. Taking Care of Your Mental Well-Being
Stress can raise blood pressure and blood glucose levels. It can also affect how well you manage medical conditions. Insufficient sleep has been associated with many health problems, such as high blood pressure, stroke, and diabetes.
Additionally, stress (especially chronic stress) can negatively affect blood glucose levels, with stress being a driving factor in excessive drinking, eating, less exercise, and less sleep.
Unsurprisingly, one might feel discouraged and fatigued from dealing with around-the-clock diabetes care. The overwhelming feeling of the relentlessness of diabetes is coined as ‘diabetes distress’ and may lead to diabetes burnout. According to a CDC report,2 in any 18-month period, 33% to 50% of people with diabetes would experience diabetes distress. Diabetes distress is widespread, and it’s an entirely natural reaction.
Example of the signs and symptoms that you or your loved ones are experiencing diabetes distress is:
- Refusing to check your blood sugar levels;
- Feeling frustrated and angry about diabetes and the demands of keeping up with diabetes care;
- Feeling worried about the repercussions of not keeping up with diabetes care but unmotivated to make the change;
- Opting to make unhealthy food/drink choices on the regular; and/or
- Skipping your doctor’s appointments.
When you or your loved ones are faced with diabetes distress, it is essential to be kind and not put the blame on anyone’s shoulders, as nobody has a perfect relationship with diabetes. It helps to talk with family and friends about how you are feeling and how they can support you. Another option is to participate in support groups or join online forums to speak to others willing to listen to your experience and ready to communicate. Alternatively, you can talk with a healthcare professional who can professionally support and guide you through the emotional and physical aspects of managing your diabetes.
5. Go for Regular Checkups
Early detection of the warning signs could be pivotal towards preventing serious harm from diabetes. Nipping the issue in the bud early gives an opportunity for a lifestyle change to better improve the odds of beating back diabetes. When caring for someone with diabetes, Math plays a significant role in their daily routine.
For example, someone who is caring for a person with diabetes would have to measure the sugar levels to check if they fall within the normal range. Secondly, they will have to measure the number of grams of carbohydrates that the person eats to keep their blood sugar in check. Lastly, they’ll have to calculate the amount of time the diabetic person moves in a day.
As such, a person needs to get regular checkups with their healthcare provider to understand their health position better and ensure they’d avoid severe complications of this disease. [APBN]
This article was first published in the March 2023 print version of Asia-Pacific Biotech News.
References
- Löfvenborg, J. E., Andersson, T., Carlsson, P. O., Dorkhan, M., Groop, L., Martinell, M., … & Carlsson, S. (2016). Sweetened beverage intake and risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes. European journal of endocrinology, 175(6), 605-614. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27926472/
- Centers for Disease Control and Prevention. (2022). Diabetes and Mental Health. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/diabetes/managing/mental-health.html
About the Author
Mary-ann Chiam, Senior Principal Dietitian, Food Service for Older Adults Specialist, Allium Healthcare.
Mary-ann has 20 years of clinical knowledge of specialised dietetic products. She manages the Dietetics and Food Service Department and leads the team in promoting nutritious eating habits, and appropriate dietary modifications for residents at Intermediate and Long-Term Care (ILTC) institutions. Mary-ann has a Master’s Degree in Nutrition and Dietetics and a BSc (Hons) in Biochemistry. Notably, she is a member of the Enterprise Spring Technical Committee on Nutrition for Older Adults.