An older adult with diabetes who is living in a residential home setting (or that person's loved one) may have concerns about whether they’re getting access to the best food choices. 

To ensure that nutritional needs are being met, primary care providers can make recommendations and directives to achieve wellness goals. Here is some guidance that primary care providers can suggest to patients with diabetes who live in residential facilities. 

What to Expect in a Residential Facility  

In most residential facilities, there’s a menu that is designed and created by a registered dietitian that meets the recommended dietary allowances, said Jennifer Beery, a registered dietitian and licensed nutritionist with Orlando Health in Orlando, Florida. Typically, menus are seasonal and follow a 4-week rotating cycle, she said. Additionally, the facility's budget is considered when selecting menu choices. 

The Importance of a Well-Rounded Diet 

It’s crucial for older adults living with diabetes to eat balanced meals, to ensure they are meeting their unique nutritional needs. 

“A balanced diet provides carbohydrates for energy, protein for maintaining muscle mass and skin integrity, and fat as another source of energy, as well as the help with nutrient absorption,” said Beery. 

“It’s also important for maintaining bone and blood health, along with other needs of the body. Regular, balanced diets that include nutrient-dense foods can help people living with diabetes to better control blood sugar throughout the day.” 

It’s essential for anyone with diabetes to maintain a nutritious diet, but this directive is even more important for older adults. 

“Diabetes increases your risk of cardiovascular disease, heart attack, and stroke, and can lead to damage of the kidneys, eyes, and nerves,” said Tara Schmidt, a registered dietitian and instructor of nutrition at Mayo Clinic in Rochester, Minnesota. “I remind my patients that diet is a modifiable risk factor; it’s one big aspect of our health that we have control over.” 

How to Self-Advocate 

If patients tell a primary care provider that they are frustrated with nutrition choices at their residential facility, a smart course of action is to refer them to the resources at the place they reside. 

“Patients should be encouraged to bring up their concerns with residential facility staff,” said Schmidt, who is also lead dietitian for the Mayo Clinic Diet. “It is likely there may be more options or solutions they are simply not yet aware of.” 

For patients who want to eat with more focus on nutrition, Schmidt has provided some directives to self-advocate: 

• Ask staff for a smaller portion of items being served.
• Make simple, polite requests, such as a swapped side dish, sauces on the side, or an item cut in half ahead of time.
• Focus carbohydrate choices on those that provide the highest nutrition, like grains, fruits, and dairy.
• Limit sweets and sugary beverages.
• Take time to learn what substitute selections may be available, or even suggested purchases for the future, like lower-sugar alternatives.
• Advise staff on preferences. If a resident prefers fruit instead of cake for dessert, make sure this is part of their care plan and that it is honored. Residents can also ask for unsweetened beverages and low- or no-added-sugar options, if available, Beery at Orlando Health said.
• Stay hydrated. Choose water or other unsweetened beverages throughout the day.

Tapping Available Resources 

Schmidt said there is probably an onsite or contracted registered dietitian residents can meet with. “Simply ask a staff member to help put you in touch with them, such as a food service worker or manager,” she said. If there’s no registered dietitian available, other food service or nursing staff may be able to help identify appropriate food choices, answer questions, or go through the menu ahead of time, Schmidt said. 

The Benefits of Communal Dining  

Sharing meals with others keeps individuals more connected to their community, increases one’s social interactions with others, and helps to build supportive relationships, according to Beery. 

One study shows that people tend to have improved nutrient intakes when enjoying meals with others. “This can be helpful for reducing malnutrition and helping to maintain an individual’s independence and mental health,” she said. 

Healthy Living Tips for Patients With Diabetes 

For patients with diabetes, it’s particularly important to make healthy eating a priority. Here are some guidelines Schmidt has provided, which you can share with your patients. 

• Aim for three meals per day, about 4-5 hours apart. Do not skip meals, and as much as possible, avoid snacking.
• Adhere to a medical provider’s directions on how and when to take diabetes medication. Taking the right amount of medication at the right time is very important to effectively control your blood glucose.
• Prioritize exercise and physical activity, which should be incorporated into one’s daily routine, whether it’s formal exercise or simply walking the property. Exercise helps mood, strength, heart health, brain health, and blood sugar control.
• Take advantage of community dining, which has many benefits, including improved nutrition, decreased feelings of loneliness and depression, and enhanced social connectiveness. On the flip side, social isolation is associated with accelerated biological aging and all-cause mortality, Schmidt said.
• Convey that balanced eating doesn’t have to be complicated. Suggest that patients picture a plate like a pie graph: Aim for 50% vegetables, 25% lean protein, and 25% whole grains or starch. Fruit and milk or yogurt may be added as well.
• Keep some healthy options in your room. If refrigeration is available, some on-hand options may include fruit, crackers with a pouch of tuna, ready-to-eat soup, Greek yogurt, protein shakes, or nuts to supplement meals.