NOURISHED AGING TOOLKIT
Diabetes Care Management
A Message From Sysco's
NUTRITION SERVICES
The number of people in Canada with diabetes continues to grow – now, more than 11 million Canadians are either living with diabetes or are at risk of developing it (called prediabetes).1 Some factors that can increase the risk include ethnic background, age, and other health conditions.1 Treatment goals for diabetes can impact an individual's overall health & safety, along with quality of life.
This resource will focus on Type 2 diabetes education in senior living, including practical tips to manage blood sugar levels for residents within your communities.
This resource will focus on topics such as:
• Diabetes in Older Adults
• Management of Diabetes in Senior Living Communities
• Nutrition Care of Diabetes in Senior Living Communities
Note: This toolkit is intended for general education and awareness. Please ensure that all practices and decisions related to diabetes management are implemented in consultation with a Registered Dietitian and the medical team, and align with your organization’s internal policies, and any applicable provincial or ministry regulations.
Sysco Canada's Nutrition Services Team
WHAT IS DIABETES?
Diabetes Mellitus (DM) is a chronic condition where the body can’t properly use sugar from food, leading to high blood sugar levels. Sugar, also known as glucose, is the body’s main source of energy2,3 .
There are two main types of diabetes: Type 1 and Type 2:
Type 1 diabetes is an autoimmune disease in which the body is unable to produce insulin, the hormone responsible for managing blood sugar levels2 .
Type 2 diabetes is the most common form of diabetes, especially in older adults. It occurs when the body doesn’t use insulin properly or doesn’t produce enough. Insulin helps the body use sugar for energy2,3 .
Prediabetes means a person is at risk of developing Type 2 diabetes2,3 .
Over time, if high blood sugar isn’t managed, it can lead to other health problems and damage the body’s nerves, kidneys, eyes, feet and heart2,3 .
Diabetes for Older Adults:
• Diabetes care in older adults is different compared to the younger population, with more factors to consider3 .
• The healthcare team must consider individual residents’ needs within their diabetes management care plan and consider their cognitive and physical abilities, how frail they are, if they have dementia, and if they are receiving palliative or end of life care3 .
• Low blood sugar levels are a focus for the older population because of the use of several medications, aging, and multiple health issues3 .
DIABETES CARE IN SENIOR LIVING
Blood Sugar Levels
• The most common test used to diagnose type 2 diabetes is the HbA1c (glycated hemoglobin) test.
• This test shows a person’s average blood sugar level over the last 3 months.
• HbA1c targets for older adults are higher than the younger population because they are at a higher risk of having low blood sugar.3
• Low blood sugar, or hypoglycemia, is when blood sugar levels fall below normal.
• Symptoms could include trembling, sweating, headaches, weakness, dizziness, confusion, and fainting – which may result in falls and broken bones3 .
Stage HbA1c targets
Functionally Dependent
Frail and/or with dementia
End of Life
7.1-8.0%
7.1-8.5%
• HbA1c measurement not indicated
• Focus on preventing symptoms of high and low blood sugar levels
Diabetes Canada Clinical Practice Guidelines Expert Committee, 2018
FLUCTUATING BLOOD SUGAR LEVELS
Factors in senior living that may influence blood sugar levels include:
• Foods and beverages that are consumed by residents with friends and family4
• Foods and beverages that are consumed during programs and activities4
• High fruit juice or sweetened beverage consumption4
• Variable meal and snack intake4
• Changes in health status, such as with illness, injury, or surgery
RESIDENT-CENTERED CARE
The nursing team and physician work together to determine an individual's treatment plan and manage the type, timing, and dosage of blood sugar lowering medications. Blood sugar levels are monitored by nursing staff as needed.4
Older adults are at a higher risk of having low blood sugar and not meeting their nutrition needs. Many experts suggest adjusting an individual's medication to manage their blood sugar levels rather than restricting their diet.5
LIFESTYLE AND PHYSICAL ACTIVITY
• Physical activity is also important to support diabetes management because it helps the body to use some of that sugar that's sitting in the blood.
• For those who are regularly moving, this can help to maintain lower blood sugar levels.3
• A resident's activity plan should always be based on their current abilities and built to help with their strength, balance, walking abilities and flexibility.6
• Participating in different activities and recreation can be a great source of movement.
NUTRITIONAL CARE OF DIABETES
Liberalized & Resident-Centered Diets
In senior living settings, residents were traditionally prescribed therapeutic diets based on their health conditions (i.e. diabetic or diabetic renal diets). This approach can be restrictive. Many healthcare professionals now support a more liberalized approach as best practice, to improve residents’ nutritional intake and overall quality of life.5,7
Resident-centered care focuses on resident choice, meeting their personal and cultural preferences and individualizing their diet to their unique needs. Some individuals may still wish to follow a therapeutic diet, and this should be respected.5,7
Assessment by a Registered Dietitian ensures that dietary goals are designed for residents who have unstable blood sugar levels or require special diets to accommodate other chronic illnesses (i.e. kidney disease, dialysis etc.).8
Purpose
Food Choices
Desserts & Sweets
Blood Sugar Control
Risk of Malnutrition
Best For
Restrictive Diet Liberalized Diet
Focuses on strict blood sugar control
Limited variety; may exclude preferred or cultural foods
Often limited or sugar-free
May improve targets, but not always sustainable
Higher, especially if unappealing or unfamiliar
Short-term situations, residents with very unstable blood sugars
Support quality of life and food preferences
Includes familiar and culturally appropriate foods to encourage intake
Allowed in moderation
Balances moderate control with resident safety and satisfaction
Lower, as residents are more likely to eat foods they enjoy
Most senior living residents, especially those who are frail, have dementia or are palliative
Table: Restrictive vs Liberalized Diets4,5,8
NUTRITIONAL CARE OF DIABETES
Menu Planning to Support Optimal Blood Sugar
A well-planned senior living menu using Canada’s Food Guide, including snacks and desserts, is suitable for those with diabetes. An emphasis should be placed on providing adequate calories, protein and vitamins and minerals, rather than having a separate menu for those with diabetes.9
Ensure residents are regularly assessed by a registered dietitian and medical team to confirm they receive appropriate dietary interventions based on their needs.
Some considerations:
Providing regular timing of balanced meals and snacks:
▪ This provides residents with consistent carbohydrate intake which helps to regulate blood sugar levels.
▪ This is particularly important for older adults who are at a higher risk of experiencing low blood sugar.4,9
SNACKS FOR DIABETES MANAGEMENT
Residents may or may not require individualized snack options between meals to manage their blood sugar levels. This may depend on the type of diabetes, which medications they are taking, their activity level and their overall intake.9
Snacks higher in fibre and protein can help to regulate blood sugar levels.
Some healthy options include6,9:
• Sandwich (meat and/or cheese filling)
• Yogurt or cottage cheese & fresh fruit
• Milk & plain cookies (digestive, arrowroot)
• Peanut butter on whole grain toast
• Crackers and cheese
• Vegetable sticks and hummus
NUTRITIONAL CARE OF DIABETES
Menu Planning to Support Optimal Blood Sugar
Including low Glycemic Index (GI) foods:
▪ The GI is a way of ranking carbohydrate foods based on how they effect a person’s blood sugar levels. A low GI food is processed by the body more slowly and has a smaller effect on blood sugar levels. High GI foods will raise blood sugar levels much quicker but can still have their place in a balanced diet.10,11
▪ This is helpful in regulating blood sugar levels for all individuals.
▪ When you make a meal with a high GI food, it is best to pair it with other foods that are high in fibre or protein. This will help to manage any spikes in blood sugar.
Glycemic Index Guide
Fruits & Vegetables
Apple, Honeydew Melon, Pear, Prunes, Carrots, Green Peas
Grains & Starches
Quinoa, Brown Rice, Egg Noodles, Whole Wheat English Muffin, Multigrain Bread, Pumpernickel Bread
Protein Sources
Black Beans, Lentils, Hummus, Edamame, Tempeh, Greek Yogurt, Cottage Cheese, Kefir
Fruits & Vegetables
Banana (Ripe), Grapes, Pineapple, Parsnip, Watermelon
Grains & Starches
Couscous, Egg Noodles, Rye Bread
Fruits & Vegetables
Banana (Overripe)
Grains & Starches
White or Whole Wheat Bread, Naan, Instant Oats, Instant Rice, Potato, Sweet Potato
NUTRITIONAL CARE OF DIABETES
Menu Planning to Support Optimal Blood Sugar
Sugar does not need to be avoided
▪ It is acceptable for older adults with diabetes to eat or drink foods on the menu that have sugar in them, including desserts, juices and jams.7,12
▪ However, if a resident is consistently choosing to consume foods that have large amounts of added sugars whether from the menu or from foods consumed outside of the menu, this can contribute to uncontrolled blood sugar levels. An individual assessment is important.9,12
▪ In some cases, reducing intake of added sugars (i.e. sugar substitutes, ½ portions of dessert, low calorie juice and condiments etc.) may be appropriate.9
Including more whole grains and foods with fibre
▪ The recommended daily menu target for fibre is 30g/day. Foods with fibre can help with both diabetes and bowel function.12
▪ Looking at the nutrition facts table and ingredient list can help to confirm whether an item is made from whole grains or has fibre.
You can find both fibre and sugar under the carbohydrate section of a nutrition facts table. Use the % Daily Value (DV) to determine if something is high in sugar or fibre. Nutrients that are 5% or less of a person's daily requirements is a little and nutrients that are 15% or more of a person's daily requirements is a lot. For example, % DV of 22% for sugar would make that a higher sugar item.
Increase Dietary Fibre on the Menu
12
▪ Whole grain hot or cold cereals
▪ Baked goods made with whole grains
▪ Add wheat germ or ground flax to hot cereals
▪ Soups with whole grains like brown rice
▪ Whole grain crackers, pastas, breads
▪ Fruits & vegetables
ARTIFICIAL SWEETENERS
Diabetes Canada guidelines recommend that 10% of daily energy intake (12 teaspoons) can come from sucrose (i.e. table sugar).13
MYTH: IT IS NOT SAFE TO CONSUME ARTIFICIAL SWEETENERS
Artificial sweeteners have been approved to be used in Canada and are considered generally safe for people to consume within the acceptable daily intake (ADI) recommended by Health Canada.14
These sweeteners have fewer calories and have little to no impact on blood sugar levels. They may not be required for residents; however, it may help provide more variety without exceeding the recommended intake of added sugars. 13,14
The name of each artificial sweetener or sugar substitute can be found on the ingredient list on packaged foods and drinks.14
Use Diabetes Canada (2018) Sugars and Sweeteners resource to see which sweeteners have been approved in Canada and their acceptable daily intake levels.
Ensure residents are regularly assessed by a registered dietitian and medical team to confirm they receive appropriate dietary interventions based on their needs.
Common Sweeteners in Canada
DIABETES AND COGNITIVE IMPAIRMENT
Cognitive impairments can make it challenging to manage diabetes in senior living settings due to forgetfulness, food refusals, a change in taste and inconsistent food intake.15
These residents may require menu flexibility and food and drinks readily available as needed. It is possible for appetite to vary depending on the time of day. Residents may respond more to stronger flavours, more colourful foods and attractive presentation. 15
CULTURAL CONSIDERATIONS IN DIABETES CARE
Many traditional cultural foods incorporate carbohydrates and should not be removed from a person’s diet. "All Foods Fit", including for people living with diabetes and can be incorporated into a well-balanced menu.16
Diverse cultural foods can also be incorporated as special menus on specific holidays or celebration days. This is dependent on the resident population, therefore resident feedback is very important.16
Religious Fasting
Although older adults and people with chronic disease may be exempt from fasting, some individuals may wish to continue this practice. Ensure that residents are assessed by their healthcare team if this is something they wish to do.17
This would require modifications and flexibility in the times that residents receive their meals. Eating a balanced meal before and after fasting is very important to help maintain blood sugar levels. If a resident experiences negative health effects, a discussion should be had with the resident and their family to consider the benefits and risks of fasting.17
Sysco’s Nutrition Services Team offers insight on trends, research and best practices for nutrition in food service. Here are some of the resources available to help drive your business
Standardized Menus
A 4-week standard and snack menu pre-built to meet the DRIs and industry best practices for seniors living. Use the Sysco Menu as your base menu or as a source for inspiration for building your own.
Also Available & Liquid Menus
A 1-Day Also Available menu, including 3 meals, providing additional mealoptions to enhance variety. A 3-Day full liquid menu for residentsrequiring a liquid diet order or as a reference/education onfluid diet orders.
Seasonally inspired one-day menus, created to celebrate life’s special moments - including, social, religious and cultural events. Toolkits include celebration ideas and resources.
Nourishing News is a digital magazine that provides educational content, vendor product features, recipes andother resources available to our healthcare & senior living customers.
Nourishing Kitchen
Sysco Synergy Tech Suite Menu Guide
This menu guide has been designed as a resource for healthcare and senior living communities to provide guidance onthe nutrition information, diets and standards used within Synergy Tech Suite.
A recipe flipbook designed in partnershipwith our vendor community and Sysco’s Culinary Consultants to provide delicious & healthcare friendly recipe ideas.
Nourished Aging Toolkits
A series of toolkits that provide educational and practical information on topics relevant to healthcare andsenior living customers.
Sysco Canada’s exclusive all-in-onefoodservice management software and hardware solution for healthcare andsenior living industries.
Menus and supporting toolkits designed to assist with foodsafety, emergency preparedness, outbreak management, audit & staff training tools.
https://www.youtube.com/@SyscoCanadaChannel
https://www.facebook.com/Syscocanada/live_videos/ https://www.linkedin.com/showcase/healthcare-senior-living/posts/https://www.instagram.com/syscocanada/
SYNERGY TECH SUITE
Your key ingredient to bring personalized care to mealtime
What is Synergy Tech Suite?
Synergy Tech Suite is Sysco Canada's exclusive foodservice management software and hardware, which can support you and your communities by providing residents with personalized dietary interventions to help manage diabetes.
Personalize Diet Interventions
Synergy Tech Suite provides the option to add a customized dietary intervention for a resident’s personal menu. Interventions may include personal items, meal/snack substitutions (e.g. lowcalorie syrup/jam/jelly/juice), adjustments to serving sizes (e.g. 1/2 portion of baked desserts), likes and dislikes, and items that should not be served, if applicable.
Customize Diet Types
Synergy Tech Suite provides the option to customize diets that are specific to your home. You can easily add or maintain a diabetic diet.
Touch Software
Synergy Tech Suite provides the ability to track macronutrients (like carbohydrates) on the Touch display screens and nutritional information can be printed from an individual's personal menu. Any prescribed dietary interventions are automatically to an individual's order at point of service to ensure nothing is missed.
If you are interested in learning more about our software solution, please reach out to your Sysco rep, or email sysco@mealsuite.com You can also visit the Sysco Canada website. www.sysco.ca/healthcare where you can sign up for a demo to learn more about Synergy Tech Suite.
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