Does anyone else see a problem with this policy?

[Spritenurse1210]

The facility i work at for the agency, just did away with diabetic diets. now all they have are pureed, regular and mechanical soft diets. I know some of you almost fell out of your chair after reading this post. Any thoughts/suggestions

[Spritenurse1210, BSN, RN]

If anyone is familiar with military chow halls (cafeterias) they have sort of a buffet set up and everyone can take what they want. Well, in this facility, since it is military affiliated (all the residents were at one time an enlisted member of any of the military branches) they use this method of serving food to the residents who are able to go to the line and get the food themselves. for the ones that are unable to do this, they prepair trays in 3 seperate diets ground meat, diabetic, and regular. now that they are doing away with diabetic diets as of september first, i am not sure how this is going to work. since i am not regular staff, i didnt attend the meeting, and this was told to me by the regular employees.

[leslie :-D]

we had a dietitian one time, who recommended taking all diabetics off their ada diets.

and no more sweet n'low, just reg sugar packets.

when our eyes popped out, she said this was the new line of thinking (she was young).

i had asked an md about it, and he had heard the same.

ss insulin would cover any dramatic peaks.

hard concept to swallow.

leslie

[CRNI-ICU20]

how does this teach diabetics to follow good glucose control if they are always peaking and valleying (is valleying a word??? i dunnow) Anyway....if we are just going to throw nutrition out the window, why don't we just open a McDonald's kiosk within the hospital...

"ya'all want fries with that ma'am?" ugh.

[EmmaG, RN]

Some interesting links on this subject.

http://spectrum.diabetesjournals.org/cgi/content/full/18/1/34

Traditionally, providers have ordered diets for hospitalized individuals with diabetes by writing a specified calorie count followed by "ADA diet" (e.g., "1800-calorie ADA diet"). For more than a decade, however, the American Diabetes Association (ADA) has not endorsed any single meal plan or set macronutrient pattern.

Yet the practice of ordering an "ADA diet" remains.5,9,10 The consistent carbohydrate meal plan is beginning to gain acceptance in hospitals. This meal plan is defined as offering comparable carbohydrate content from day to day at breakfast, lunch, and dinner, as well as in snacks.9 The plan is not based on a set number of calories and is designed to contain appropriate fat content for patients with diabetes.9 Its intent is to meet individuals' nutritional needs and facilitate improved metabolic control.3

To maximize effectiveness of the consistent carbohydrate meal plan for individuals who take insulin, providers need to recognize the functions of insulin. For patients who are eating, insulin should be prescribed for basal, prandial, and correction or supplemental needs.3,11 To provide more flexibility and to accommodate individual food preferences, some facilities allow individuals with diabetes to select from menus with a specified number of carbohydrate choices per meal. Generally, foods that contain sucrose are included in the total daily carbohydrate count, although the majority of carbohydrate food choices are whole grains, fruits, vegetables, and low-fat milk.5

Although the consistent carbohydrate meal plan is gaining acceptance, provider-ordered diets with set calorie counts based on the exchange system are still the standard. Use of meal plans that stipulate no concentrated sweets, no added sugar, or low sugar are no longer appropriate. These diets unnecessarily restrict sucrose and do not reflect current evidence-based nutrition recommendations.5,9

Facilities have implemented the consistent carbohydrate meal plan in various ways. In some hospitals, providers can still write orders for an "ADA diet," and a consistent carbohydrate meal plan will be sent by default. To gain acceptance and understanding for transitioning to a consistent carbohydrate system, extensive education is required for staff and health care providers, as well as for patients.

Differing philosophies exist about including snacks in the consistent carbohydrate meal plan.

In an informal survey of members (n = 15) of the Diabetes Care and Education (DCE) Practice Group of the American Dietetic Association, 73% of respondents indicated that hospitals where they are employed include at least one snack as part of a "diabetic diet." With appropriate insulin or oral diabetes medication therapy, snacks should not be a requirement but instead should be given as an option to meet patient preferences or additional caloric needs.

No evidence exists to support the use of diets based on "no concentrated sweets" and "no added sugar."

[ktwlpn, LPN]

we have a "no concentrated sweets" diet.The majority of the population is so non-compliant when on a tightly controlled diet that they were actually experiencing more hypo/hyper reactions then they are now. In LTC we are looking closer then ever before at quality of life and resident's rights.Tightly controlled blood sugar levels is almost an impossible goal-the goal now is stable weight and few to no symptomatic episodes.This population has already sustained the damage from years oif non-compliance-we can't change that at this point.The benefits of a tightly controlled diet at this late stage of life does not outweigh the importance of emotional well being .Over all our dietary department has really changed-the emphasis is on whole grain,low salt,low sugar,more fiber.lower carbs...However we do have a few oriented residents that prefer to control their intake the same way they always have and they are allowed that control....The goal of a 23 yr old diabetic is vastly different from that of an 82 yr old....

[woody62, RN]

There is no longer an ADA diet. The ADA stopped publishing a recommended diet back in the early 1990's. What they advised and what most Type 2 diabetics do, is depending on their daily activities, as well as what type of medication they are on, they advise a maximum and minimum number of grams of carbohydrates a day. Most of us Type 2's know just how many carbohydrates we can eat with each meal. I eat an average of 70 to 76 gms of carbohydrates a day, while taking 35u of NPH and 500 mg of metformin twice a day. I also exercise by walking twice a day. My last A1c was 5.2, indicating I am in good control. When I am in the hospital for more then a day, I ask to meet with the dietitian right away, so we can go over my diet and I can be certain I receive what I ask for.

Woody:balloons:

[jetscreamer101]

In my previous LTC facility, the dietary dept (I'm not sure who spearheaded this program) eliminated all special diets. No cardiac diets, diabetic diets, none, nada, zilch. Who in their right mind would give regular syrup to diabetics? They did. And whose fault was it when we would get blood sugars over 350? Nursing of course.

So we wheedled a smaller portion diet, which really didn't solve the problem.

What diet did we have for ESRD and on dialysis residents? Regular diet. No kidding. We ended up having to go through their food preference list and mark those they shouldn't have as dislikes so they wouldn't be served those things. (Dialysis got really irritated when we sent someone with a banana for a snack (dietary did it). I guess No potassium rich foods didn't apply to the banana?

Save me from this craziness!

(I have since moved on to another facility.