To continue CHAMP’s celebration of National Nutrition Month, I’ve chosen to write about the special consideration it takes to provide care for seniors who have diabetes. Chronic illnesses can increase the risk of malnutrition in all age groups, but seniors are often the population most at risk. A combination of factors such as impaired dentition, changes in taste, high rates of depression and financial limitations all impact an individual’s nutritional state and when diabetes is in the mix, there are additional concerns.

Decreased thirst sensation combined with hyperglycemia, can lead to severe dehydration, coma and death among patients with diabetes. Gastroparesis, an autonomic neuropathy, causes early satiety often accompanied by alternating episodes of constipation and diarrhea. This may lead to limiting dietary intake and to social isolation, both of which are barriers to satisfactory nutrition. Perhaps the most significant complication from poor nutrition is the increased risk of hypoglycemia.  As intake changes, diabetes medications need to be adjusted. The combination of seniors’ decreased awareness of low blood glucose and reduced dietary intake can lead to low blood glucose unless medications are titrated to the appropriate level.

Let’s consider the following diabetic patients:

Mrs. S., a 76 year old retired school teacher, has been having recurrent episodes of nocturnal hypoglycemia, including one that led to a fall and subsequent hospitalization. These episodes are very frightening to Mrs. S. and she doesn’t understand what is happening. Her insulin regimen, 20 units of 70/30 insulin before breakfast and dinner, has been the same for a number of years without any significant problems. So why the sudden change? With a little prompting, the visiting nurse discovers that her husband died a few months ago and she has lost interest in cooking for herself. “I don’t have the heart for it. I just open a can of soup.” Her emotional state and decrease in dietary intake have compromised her nutritional status. Without a medication adjustment, she will continue to be at risk for hypoglycemia.

John J., an active senior, received new dentures. They were ill-fitting and John had difficulty chewing but he didn’t want to be a bother to his dentist. Instead, he opted to eat soft foods such as potatoes, pasta, ice cream and puddings leading to a compromised nutritional status. There were a combination of issues that included muscle wasting, increased adipose tissue and persistent hyperglycemia.  John began to feel tired, was less active and was unable to fully enjoy his life. Additional antiglycemic medications were ordered to control his blood glucose levels, but the real issue was overlooked.

These two cases illustrate the need to increase hydration, pay attention to protein and carbohydrate intake and adjust medications to reflect emerging changes in weight and health status for seniors with diabetes. Clinically, underlying causes of nutritional deficiency can be just as important. Identifying and addressing nutrition barriers – physical, functional and / or psychosocial can return the senior to optimum health.

So, how can you identify the barriers to good nutrition? Validated tools such as the Mini Nutritional Assessment, MiniCog, and Geriatric Depression Scale can provide valuable insight.

Visit CHAMP’s tools page to view these and other helpful nutrition resources!

Caryl Ann O’Reilly is a Clinical Nurse Specialist, Certified Diabetes Educator at the Centers of Excellence at the Visiting Nurse Service of New York. She authored the Home Care chapter in the American Diabetes Association’s Complete Nurses Guide to Diabetes, 2009.