WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers

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1 WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Managing Nutrition with Diabetes in Older Age This dietary information fact sheet is intended for informational purposes only. It is not a substitute for proper medical diagnosis or dietary advice given by health professionals. The information was correct at time of publication in Nutritional Content by Aisling Snedkar RD Editing and design by Emma Murtagh Proofreading by Amanda Ramirez and Rose Snyder On behalf of ProActivate Ireland Project number: DE02-KA This project has been funded with support from the European Union. This publication reflects the views only of the author, and neither the Commission nor the National Agency can be held responsible for any use which may be made of the information contained therein.

2 WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Managing Nutrition with Diabetes in Older Age INTRODUCTION We all experience changes to our bodies due to aging that are largely out of our control. However, we can make a variety of positive lifestyle changes, including changing diet, which will help to control mature onset of Type 2 Diabetes. This info sheet will look exclusively at Type 2 Diabetes as it is more common in older people, who are the target group of this fact sheet. TYPE 2 DIABETES Type 2 Diabetes is usually diagnosed in people who are older than the age of 40, and accounts for up to 90% of all diagnosed diabetes. It occurs when the insulin-producing cells of the pancreas are no longer able to make enough insulin to completely facilitate transport of glucose from the bloodstream into the cells. This is known as insulin insufficiency and is often combined with insulin resistance, which is a condition where the body may still be making enough insulin, but it is unable to get it into the cells to carry out its actions. 1

3 Type 1 Diabetes generally develops in people under the age of 40 and occurs when the insulin producing cells in the pancreas have been destroyed completely and the body is no longer able to make any insulin. The following are some key points for diabetes control and that will be covered in this fact sheet. Maintaining a Healthy Weight Healthy Eating for Diabetics MAINTAINING A HEALTHY WEIGHT Blood Presure Control Being overweight is strongly associated with diabetes; excess weight stops insulin from working as well as it should. If your body is making less insulin, you may not be making enough to meet the demands of a larger body. Maintaining a healthy weight is one of the best ways to prevent diabetes while also reducing associated problems such as high cholesterol and high blood pressure and the risk of heart disease and strokes. LOSING WEIGHT TO PREVENT OR CONTROL DIABETES Losing weight can be daunting, especially if you feel you have a lot to lose. Start with a target of reducing current body weight by only 5 10%. For example, if you weigh 80 kg, 10% of this would be 8 kg, or, 5% of this would be 4 kg. Cholestrol Management 2

4 In people who are older, rapid weight loss is not recommended, as this is most often associated with muscle wastage. It is important to lose weight slowly, ideally through a combination of good diet and physical activity. The next section, Healthy Eating for Diabetics, and our fact sheet on Healthy Eating & Portions contain some useful tips and suggestions for changing your diet. THE POSITIVE EFFECT OF PHYSICAL ACTIVITY ON BLOOD GLUCOSE CONTROL Physical activity is a fun way of changing your lifestyle to manage diabetes. It is recommended that you do 30 minutes of moderate activity, for example, brisk walking, on most days of the week. Being active helps to control weight, exercises the heart muscle, and improves blood circulation. When walking, for example, blood glucose gets used up and insulin starts to work more effectively. This happens when muscles are warmed up by exercising making it easier for insulin to carry blood glucose into the cells. Exercise has a positive impact on so many aspects of life including mood, mental health, strength, bone health, flexibility, balance and ability to sleep and eat well. The WHOLE project offers a comprehensive physical activity course designed specifically for frail older people. Consult our website to find out more: 3

5 TOP TIPS FOR A HEALTHY WEIGHT Eat regularly; Take care with portions (Try using a smaller plate at main meals to help control portion size); Reduce fat intake (Try to avoid spreading fat on food or adding fat to food by frying it); Increase intake of fruit and vegetables; Make sure to fill half the plate with vegetables; Be physically active regularly. HEALTHY EATING FOR DIABETICS The same healthy diet that is advised for people without diabetes is also appropriate for those with diabetes. For suggestions on a healthy diet, please see our Healthy Eating & Portions fact sheet. It can be helpful to focus on a few specific areas of diet to improve health and reduce the risk associated with diabetes. Making one change at a time can have a very positive effect on overall health. 4

6 THE EFFECTS OF CARBOHYDRATES ON BLOOD GLUCOSE LEVELS Carbohydrate foods are often broken into two categories, starchy carbohydrates and sugars. All carbohydrates are broken down through digestion into glucose and absorbed into your bloodstream. Glucose is an essential fuel that all cells use for energy and is necessary to keep them alive. Starchy carbohydrates are recommended rather than sugars because they generally turn into glucose more slowly. Also, if they are wholegrain, they bring additional health benefits to your diet. Starchy carbohydrates include: Sugars include: Bread Sugar Grains Syrup Pasta Honey Rice Sweets Potatoes Biscuits Breakfast cereals Cakes Oats Chocolate Bulgur Doughnuts Polenta Jams, jellies, and marmalades 5

7 WHAT COUNTS AS A PORTION? *Consult your country s recommendations for carbohydrate portions as they differ from country to country Food Raw Weight Cooked Weight Pasta or Rice 30 g 75 g Noodles 30 g 160 g Couscous, bulgur wheat, quinoa and polenta Examples of One Portion 1 slice of bread or toast or wholemeal bread 4 plain crisp breads (30 g) Cereals or raw porridge oats (30 g), preferably wholegrain 3 plain crackers (30 g), preferably wholegrain 1 crumpet (50 g) 2 oatcakes (25 g) 1 Scotch pancake (30 g) 3 cups plain popcorn (20 g) Raw or cooked plantain and yam (90 g) Raw or cooked potatoes (150 g), 2 3 small scoops of mashed potato or two small potatoes the size of an egg or one medium baked potato Raw or cooked sweet potatoes (120 g) ½ cup or 3 dessertspoons of cooked rice, pasta or noodles 30 g 90 g Examples of Two Portions 1 bagel (70 g) 1 bread roll (110 g) 1 chapatti made without fat (100 g) ½ chapatti made with fat (60 g) 1 oval pitta bread (80 g) 1 plain or fruit scone (30 g) 3 wheat biscuits 2 thick cut slices of bread 6

8 TOP TIPS TO HELP MANAGE BLOOD GLUCOSE LEVELS: Eat three main meals each day at regular times, this can help control blood glucose and also appetite; Eat some starchy carbohydrate foods at each meal, preferably high fibre wholegrain varieties; Pay attention to the portion of carbohydrates you eat at each meal to ensure the portions are not too large, and to keep blood glucose levels stable throughout the day; Limit intake of sugary carbohydrates. WHAT ABOUT THE SUGAR THAT IS CONTAINED IN FRUIT? It is safe for people with Type 2 Diabetes to eat fruit. Fruit is healthy; it is low in fat, high in fibre, and contains essential vitamins and minerals that are good for you. Fruit also contains some carbohydrates. It is recommended that you have 2 3 portions of fruit each day, as they count towards the recommended 5 7 combined portions of fruit and vegetables each day. 7

9 WHAT IS A PORTION? 1 medium apple, orange, banana, pear or similar size fruit 2 small fruits - plums, kiwis or similar size fruit ½ a grapefruit berries, grapes or cherries 4 dessertspoons of cooked fresh fruit, fruit tinned in own juice or cooked frozen fruit 1 small glass (150ml) of unsweetened fruit juice or smoothie made only from fruit or vegetables 2 slices of pineapple ½ mango 1 medium banana 1 slice of melon WHAT ABOUT THE SUGAR THAT IS CONTAINED IN MILK? It is safe for people with Type 2 Diabetes to eat and drink milk products. Milk contains a natural sugar known as lactose. When you have milk or milk products like yoghurts and puddings, it is recommended to choose low fat options as full fat options can be high in calories. Aim to have 2 3 portions of the dairy-containing food each day. 8

10 Size What to choose 1 matchbox size of cheese Choose reduced fat or half fat cheeses A 125 g pot of dairy or soya yoghurt Diet or natural flavoured yoghurts 300 ml of milk Try 1% fat milk or reduced fat + fortified milks 300 ml of soymilk or other plant milk TOP TIPS: Choose milks that are fortified with calcium and B12 If blood glucose is well controlled, it is appropriate to have 1 2 small treats per week; If blood glucose control is not optimal, it is best to limit the portion size of sugary foods and how often you have them. They should only be consumed in very small amounts and rarely; Use sweeteners instead of sugar in drinks; All drinks should be sugar-free or diet; Choose biscuits that are plain or wholemeal, or have oat crackers or crisp breads instead; Sugar-free jelly, fresh or tinned fruit in its own juice, or low fat/low sugar yoghurts can be a good alternative to having sweet desserts. A NOTE ABOUT DIABETIC FOODS Foods that are labelled diabetic or suitable for diabetics often contain sweeteners, such as sorbitol, xylitol, or mannitol. These do not increase blood glucose levels, but they can cause a laxative effect if excessive amounts are consumed. These foods also tend to have the same or similar calorie content to regular foods as often more fat has been added to increase the taste. It is, therefore, not recommended to consume more of these diabetic-friendly products than you would the regular versions, i.e. do not eat more diabetic chocolate than you would normal chocolate. 9

11 BLOOD PRESSURE CONTROL High blood pressure, also known as hypertension, can increase the risk of heart attacks and strokes for everyone, but particularly for those with diabetes. It can also increase the risk of kidney and eye damage. The diet recommended for people with diabetes includes foods that will naturally help to lower blood pressure. This diet includes: Plenty of fruit and vegetables; Low fat dairy products; Whole grains; Fish (aim for twice a week, try to have at least one portion of oily fish but preferably two); Reduced alcohol intake. National recommended units of alcohol consumption per week should not be exceeded. It is not recommended to drink all of the allowed units in one day. They should be spaced out throughout the week with some alcohol free days too; Reduce salt intake. REDUCING SALT INTAKE It is recommended that adults should not have more than 6 g of salt per day (i.e. one teaspoon). Sodium is a constituent of sea salt and flavoured salt flakes and crystals, and it is the sodium in salt that causes high blood pressure. 10

12 Tips: Stop adding salt to food at the table; take the salt cellar off the table; Gradually reduce the amount of salt added during cooking and increase the amounts of herbs and spices used instead; Buy stock cubes that are reduced salt and do not add extra salt if stock is part of the meal; Reduce the intake of processed foods as they can contain a lot of hidden salt. CHOLESTEROL MANAGEMENT People with diabetes should strictly control their cholesterol levels in order to reduce the risk of heart attacks and strokes. There are different types of fat found in foods, some of which increase cholesterol levels and are unhealthy for you. Others are a very important part of a healthy diet. Remember, all fats are high in calories and so it is very important to reduce fat intake if trying to lose weight. UNSATURATED FATS Unsaturated fats are usually found in fish, vegetables and grains. There are two types of these fats: Polyunsaturated fats: found in sunflower oil, oily fish, corn oil, soya oil and margarines that are labelled polyunsaturated ; Monounsaturated fats: found in rapeseed oil, olive oil and margarines made from these oils. 11

13 The fats that are found in oily fish are also known as Omega-3 fats. Aim to eat up to two portions of oily fish each week; examples of oily fish are fresh tuna, sardines, salmon, kippers, mackerel, herring, trout, and pilchards. Do not have more than four portions of oily fish per week. They can contain low level of pollutants, which can build up in the body if eaten too frequently. Fish oil supplements are not recommended. If you dislike fish, talk to your dietician about alternatives. SATURATED FATS Saturated fats are found in animal-based foods such as fatty meat, meat products, full fat dairy foods like butter and cheese, lard, and dripping. Choose lean cuts of meat, less processed meat, and low fat dairy products in order to reduce intake of saturated fats. Trans fats are found in highly processed foods such as store bought biscuits, cakes and, pastries. Homemade baked good, made with basic ingredients generally do not have trans fats. Trans fats are often labeled as hydrogenated fats. An easy way to avoid them is to reduce consumption of processed foods. 12

14 READING FOOD LABELS It can be helpful to learn how to read food labels in order to choose foods that are lower in sugar, fat, saturates, or salt. The following is a simple guide to reading food labels. Per 100g Sugar Fat Saturates Salt High Eat occasionally Over 15 g Over 20 g Over 5 g Over 1.5 g Medium In moderation 5 15 g 3 20 g g g Low Healthy choice 5 g or less 3 g or less 1.5 g or less 0.3 g or less IMPORTANT POINTS Move more and move more often; Eat regularly and sensibly; Include wholegrain starchy carbohydrates; Have 5 7 portions of fruit and vegetables each day; Watch fat intake and eat oily fish at least once a week; Reduce salt intake; Reduce intake of sugary foods and drinks; Work on reducing weight by 5 10%. 13