June 7, 1999
Meal Planning, Food and Diet
Question from Maine, USA:
How would the amount of caloric increase in a cardiac diet for an elderly person with Type 1 diabetes that has a fever, plus a wound infection be determined? What type of drinks should be provided, since diet sodas have no calories to speak of, and calories are needed due to the increased metabolic rate?
Even uncomplicated infectious illnesses create many metabolic and nutritional changes. In a situation where the patient is also an elderly person with diabetes, things can get quite challenging. Caloric needs can rise dramatically, both due to increased metabolic rate and glucose losses through the urine. It is often hard to meet these needs because illness typically decreases appetite.
A rule of thumb for estimating extra calorie needs is: normal intake or basal needs plus an additional 13% for each degree of fever in Centigrade degrees. For example, a woman who normally ate 1600 calories to maintain weight when well would require approximately 2080 calories while running a 1degree centigrade fever. This is one good reason for treatment to reduce fever, because doing so reduces the nutritional needs.
To deal with the loss of appetite that can make it difficult to encourage a very sick patient to eat adequate amounts of calories, protein, and so on, offer whatever is desired and tolerated. frequent blood glucose monitoring with insulin adjustments to maintain the best degree of glucose control possible is very desirable. Humalog (a very short-acting insulin) can make it easier to dose three or more times a day in response to actual blood sugar levels. Nutritional supplement liquids, especially ones specifically formulated for diabetes, have some theoretic advantage. In my experience, however, sick patients with poor appetites seldom greet them with enthusiasm!
Beverages can provide both calories and badly needed fluids — sipping juices, milk drinks gradually can minimize their acute effect on blood sugar. If the blood sugar is high (above 200 for example) and the patient is eating solid food, offer water, diet soda without soft drinks and low sodium broths. If blood sugars are low, milk, juices, and even regular sodas taken in small portions over time can help support the blood sugar level while meeting fluid needs.