Karen Chapman Novakovski - Associate Professor of Nutrition

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December 2013/January 2014

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In This Issue

Diabetes - The Medical Perspective

Two types of patients use nursing homes: those with short-term needs for rehabilitation and those with long-term needs for self-care. In both cases, managing diabetes may be more problematic than either at-home self-care or inpatient care.

Nursing homes may be constrained by regulations or staffing in providing the intensity of care often found in the hospital or at home. For instance, some nursing homes will only provide insulin injections twice per day. For those who have been used to one basal dose plus pre-meal doses of rapid acting insulin, this may be problematic. In selecting a nursing home for either short-term or long-term care, getting information about the nursing home’s policy on insulin administration could be worthwhile.

Some nursing homes also require that those with diabetes receive three snacks in addition to 3 meals per day. Once again, this may represent a change from one’s usual dietary pattern. Any change from the usual pattern may also require a recalibration of medication and blood glucose goals. This type of change in medication and diet is best handled by doctors, nurses and dietitians trained in diabetes care. Ask if the nursing home has training for these professionals in diabetes, or access to consultation with a diabetes team.

Other areas of concern for the nursing home resident include plans for blood glucose monitoring. Low blood glucose can cause acute changes in mentality, such as delusions or lower responsiveness. Being able to recognize these symptoms and change blood glucose levels can optimize the care for the nursing home resident.


Diabetes and Food

If you or a family member are residents of a nursing home, you still have the right to choose what you diet or meal plan looks like, according to the Diabetes Management in Long-term Care Facilities manual, published by the Minnesota State Diabetes Educators (2011). In fact, they state that the resident has the right to refuse dietary treatment.

Current recommendations for meals for residents with diabetes include having the same amount of carbohydrates at each meal, or having the meals individualized to the resident’s goals and treatment plan. Food intake should be monitored. Poor intake should be reported to the nurse or dietitian, and a carbohydrate replacement may be offered. Because nighttime low blood sugar can be a concern, if a resident goes to bed very soon after the dinner meal.

Poor nutrition and inadequate food intake in the nursing home can lead to additional problems, such as weight loss, dehydration, and slower healing of infections. Sugar does not need to be removed from the diet of a person with diabetes in the nursing home. Even desserts can be incorporated into a controlled carbohydrate meal plan.

Diabetes and Medications

Type 2 diabetes is more usual for nursing home residents to have than type 1 diabetes. Type 2 diabetes may be managed with diet and exercise alone, with oral medications, or with insulin.

If the nursing home resident is 80 years old or older and taking Metformin, kidney function tests can be ordered to be sure the drug is safe. If the nursing home resident is receiving a tube feeding, any medication should be tailored to the amount of carbohydrate in the tube feeding, as well as the timing of the tube feeding. Tube feedings that are given for 12-24 continuous hours are a different carbohydrate load than when a person is eating three meals a day.

If the nursing home resident is to have diagnostic tests and needs to fast, the clinician needs to plan for this period and adjust the medications around this period of fasting.

Talk to your nurse, clinician, dietitian or pharmacist if you have questions or concerns about medications and your nursing home stay.


Recipes to Try

Low Fat Cake Mix Cookies


Non-stick cooking spray
8 oz lite cool whip
1 low fat cake mix
1 egg
1/3 cup powdered sugar

  1. Spray cooking spray on cookie sheet.
  2. Combine cool whip, cake mix, and egg in a medium mixing bowl.
  3. Chill for 30 minutes.
  4. Preheat oven to 350 degrees.
  5. Put powdered sugar in plastic container large enough to also fit 2 or 3 cookies.
  6. Scoop 1 rounded spoonful of cookie dough and place 2 or 3 in plastic container. After putting lid on container, gently shake to coat with powdered sugar.
  7. Place on cookie sheet and bake for 10 to 12 minutes. Let cool on cookie sheet for 1 to 2 minutes. Remove to finish cooling on cooling rack.
  8. Store loosely covered.
Nutrition Facts per serving; 1 cookie per serving, 45 cookies per recipe
0 grams
10 grams
0 grams
Calories from fat
1 grams
4 mg
39 mg



Philly Steak Quesadilla


1 green pepper, thinly sliced 
½ medium onion, thinly sliced 
6 tablespoons shredded part-skim Mozzarella cheese 
4 slices deli-sliced roast beef 
2 low-fat 10 inch flour tortillas 
Cooking spray

  1. Cook peppers and onion on medium heat in a non-stick skillet until onions tender, stirring occasionally. Remove from skillet.
  2. Spray skillet with cooking spray. Add one tortilla. Sprinkle with 3 tablespoons cheese. Top with 4 slices beef. Add vegetables. Top with tortilla.
  3. Cook on medium heat about 3 minutes. Use spatula to flip the quesadilla. Cook additional 3 minutes. Slide from skillet onto cutting board. Cut into 6 slices.
Nutrition Facts per serving; makes 2 servings; 3 slices each
13 grams
30 grams
10 grams
Calories from fat
4 grams
18 mg
642 mg

This and other recipes available at


Menu Suggestions

Breakfast Amount/Portion
Scrambled egg substitute 3 serving
Whole wheat toast 2 slices
Sugar free blueberry jam
Whipped cream cheese

2 teaspoon
1 tablespoon

Orange juice, unsweetened 8 ounces
Skim milk 1 cup
465 Calories; 73 Carbohydrates; 5 Carbohydrate Choices
Philly Steak Quesadilla 1 serving
Baked chips 15
Chunky salsa 3 tablespoons
Tossed salad 1 medium
Low calorie Italian salad dressing 2 teaspoons
Skim milk 1 cup
470 Calories; 71 Carbohydrates; 5 Carbohydrate Choices
Meatloaf 3 ounces
Baked potato 1 cup
Fat free sour cream .25 cup
Carrots, cooked 1 cup
Skim milk 1 cup
Low fat cake mix cookies 2
523 Calories; 72 Carbohydrates; 5 Carbohydrate Choices
Total: 1458 Calorites, 216 Carbohydrates, 15 Carbohydrate Choices

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