Professional Comment

Navigating The Complexities Of Diabetes In Social Care Settings

By Leni Wood, Head of Nutrition and Wellness at Nellsar Care Homes (

Across Great Britain, a growing diabetes crisis looms large, impacting more than five million individuals living with this condition, according to the latest figures released by Diabetes UK. What’s more, an additional 850,000 individuals remain undiagnosed, painting a stark picture of the pressing need for comprehensive diabetes care that tackles the diverse challenges faced by these individuals head-on

Unravelling the unique impact of diabetes on older adults
The British Dietetics Association champions steering clear of processed foods and refined sugars while emphasising hydration and embracing a whole-food diet brimming with protein, healthy fats, complex carbohydrates, and a healthy dose of vegetables. However, adhering to these overarching dietary guidelines for diabetes proves to be a complex puzzle, particularly for older adults. Many seniors living with diabetes may suffer from undernutrition or being underweight, rendering the blanket reduction of calories, fats, salt, and sugar inappropriate for their individual needs.

The need for nutritional expertise
An array of factors can dampen the appetite of older individuals, including the side effects of medications, oral health complications, dehydration, social isolation, as well as a range of illnesses. To ensure that older individuals with diabetes receive the most robust support possible, it is important that they undergo a comprehensive nutritional assessment conducted by a registered dietitian.

As is the case within the 13 care communities within Nellsar Care Homes, an in-house nutritionist emerges as an indispensable resource in supporting residents living with diabetes. These professionals collaborate closely with care home kitchens to meticulously craft personalised menu plans, dispense culinary recommendations, and conduct educational sessions for both staff and residents. The guiding principle here is the promotion of a “food-first” approach, fine-tuned to individual preferences — ensuring that residents have access to delectable and nutritionally enriching meal choices.

Further strides can be made to elevate the dining experience for residents living with diabetes. Simple yet impactful strategies, such as coaching nutrition and catering teams to prominently feature balanced and healthful options on menus and tea trolleys, have proven effective. In a conscious effort to foster inclusivity, at Nellsar, we opt for the term “healthy choices” instead of constricting them as “diabetic options”.

Another important consideration is the residents’ food preferences and their previous approaches to self-managing diabetes in their own homes. While some individuals may have adhered to diabetes-specific diets, it’s important to recognise that sugar-free alternatives do not universally appease everyone’s palate or dietary requirements. For those dependent on insulin, meticulous blood sugar level management is essential, yet the task assumes added complexity for individuals living with conditions such as dementia, who often have a penchant for sweeter foods.

Embracing the principle of moderation
Moderation rises as the guiding beacon for diabetes management in care homes. Striking a delicate balance is challenging and although it is important to acknowledge reduced sugar alternatives, we now have access to a variety of recipes which offer nutritional balance and taste combined.

Diabetes care should not be restricted to merely controlling the condition; rather, it should look beyond this and consider enhancing the quality of life for those living with this condition. As a sector we must abandon the outdated notion that “sugar is forbidden” for individuals living with diabetes, urging instead to embrace a person-centred approach that recognises the profound impact of dietary choices on overall well-being.

Leni Wood is Head of Nutrition and Wellness at Nellsar, a family-run group of 13 care homes throughout Kent, Surrey, and Essex. Built on strong foundations, Nellsar has worked hard to build the trusted reputation of its homes and prides itself on being approachable, accountable, and empathic in its relationships with the families it supports.