Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Diet · Type 1 diabetes · Glycemic index · Intensive

insulin therapy · Carbohydrate counting

Key Messages

• Nutrition management is one of the fundamental
  elements of care and education for children with
  type 1 diabetes


• Medical nutrition therapy should be provided at di-
  agnosis of diabetes and reviewed at least annually
  to increase dietary knowledge and adherence


• Healthy eating recommendations suitable for all
  children should underlie all education. Education
  on carbohydrate counting should be given with
  consideration of dietary quality and low-glycemic
  index food choices


• Matching of the insulin dose to carbohydrate intake
  is recommended for children using intensive insu-
  lin therapy. Carbohydrate counting has the poten-
  tial to increase flexibility in food intake and quality
  of life. However, regularity in meal routines remains
  important for optimal metabolic outcomes


• There is increasing evidence that other macronutri-
  ents impact postprandial blood glucose levels. Re-
  cent studies have shown that it is important to con-
  sider both protein and fat in the calculation of the
  meal insulin dose and how it is delivered
  © 2015 S. Karger AG, Basel

Introduction

Type 1 diabetes mellitus (T1DM) is one of the

most common chronic diseases in childhood [1].

Nutritional management is fundamental to dia-

betes care and education. Nutrition therapy

should focus on interventions to ensure normal

growth and development, promote lifelong

healthy eating habits and optimize glycemic con-

trol as well as assist with prevention of the com-

plications associated with diabetes.

Dietary recommendations for children with

diabetes are based on healthy eating recommen-

dations suitable for all children – and thus the

entire family [2]. Nutrition education should be

individualized and adapted to cultural, ethnic,

religious and family traditions. Regular dietetic

assessment is necessary to adapt nutritional ad-

vice to growth, diabetes management and life-

style changes as well as to permit the identifica-

tion and treatment of disordered eating patterns.

Eating disorders and celiac disease occur more

commonly in T1DM and require specialized di-

etetic support. All children with diabetes and

their families should have access to a specialist

pediatric dietitian with experience in childhood

diabetes as part of the interdisciplinary diabetes

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 218–225
DOI: 10.1159/000367863

3.15 Nutritional Management of Diabetes in

Childhood

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