Nutritional Management for Diabetic Patients in the Home Health Care Setting

We recently discussed diabetes management of patients in the home health care environment – from educating patients and family members on treatment plans to the need for glucose monitoring, recognizing signs for hypoglycemia/ hyperglycemia, and other steps. Here our focus is on the importance of nutritional management for home health care patients with diabetes.

To recap: Diabetes is a disease that occurs when blood glucose, also called blood sugar, is too high. Blood glucose is the main source of energy and comes from the food we eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes the body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in the blood and doesn’t reach the cells. Most middle-aged and older adults with the disease have Type 2 diabetes where the body does not make or use insulin well.

Nutritional management is extremely important for diabetic and pre-diabetic patients so that adequate glycemic control can be achieved. In a home care setting, the nurse or dietician should record the diabetic’s nutrition history and review any dietary patterns to identify omitted meals, sporadic intake, and other problems that warrant further investigation (e.g., poor food choices or amounts that may exacerbate glycemic control). In addition, because of a number of factors (e.g., financial concerns, limited access to care, lack of interest in diabetes education, newly diagnosed diabetes, limited social support), home care patients may not have had previous diabetes education. A diabetes self-management education program or a nutrition education program can provide information and support for choices that promote desired glycemic control and improved health status.

It’s also important to note that nutrition counseling should be sensitive to the personal needs and cultural preferences of the patient and how much effort the patient is willing to put in to making the change to eating appropriately. The American Diabetes Association (ADA) stresses that there is no single eating pattern that is best for everyone. Additionally, in choosing an appropriate eating plan, people with diabetes should be sure to consider individual metabolic goals, such as their glucose and lipid levels and blood pressure.

Home health care providers can provide overall dietary counseling and meal planning for diabetic patients to follow. A food plan for diabetics, in general, should include healthy carbohydrates such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products, and fiber-rich foods. Eating fish as an alternative to high-fat meats is also recommended, as are foods containing monounsaturated and polyunsaturated fats that can help lower cholesterol levels. These include avocados, almonds, pecans, walnuts, olives, and canola, olive and peanut oils – but should be eaten in moderation.

Foods to avoid include saturated fats such as high-fat dairy products and animal proteins such as beef, hot dogs, sausage and bacon contain saturated fats; trans fats, which are found in processed snacks, baked goods, shortening and stick margarines; and sodium. The ADA recommends reducing sodium to less than 2300 mg per day for people with diabetes, with additional reductions individualized for those who have high blood pressure. The ADA also recommends that diabetics should limit or avoid intake of sugar-sweetened beverages (from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiovascular risk profile.

Manchester Specialty Programs specializes in providing the home health care industry with tailored insurance products, including General Liability, Professional Liability, Workers’ Compensation and other key coverages. For more information about our insurance solutions and risk management services, you or your local insurance agent can contact us today at toll free 1-802-472-1500.