Pediatric Nutrition in Practice

Nutritional Management of Diabetes in Childhood 219

3

care team. However, every team member should
have an understanding of the principles of nutri-
tional management.
Advice on carbohydrate quantity, type and
distribution is important as carbohydrate is the
main determinant of postprandial glucose re-
sponse. Education should take into account an
i nd iv idu a l ’s energ y need s , eat i ng a nd physic a l ac-
tivity patterns and insulin regimen. Matching in-
sulin to carbohydrate intake for those on inten-
sive insulin therapy requires comprehensive edu-
cation in carbohydrate counting. It is vital that
healthy eating principles targeting an increased
consumption of fruit and vegetables and a de-
creased saturated fat intake underlie education.

Goals of Nutrition Therapy

The main aims of nutritional management in pe-
diatric diabetes are to

• encourage healthy lifelong eating habits;


• achieve and maintain blood glucose levels in
  the normal range by a balance between food
  intake, energy expenditure and insulin action
  profiles;


• provide appropriate energy intake and nutri-
  ents for optimal growth, development and
  good health;


• consider personal and cultural food preferenc-
  es to preserve social, cultural and psychologi-
  cal well-being;


• achieve and maintain an appropriate body
  mass index and waist circumference through
  healthy eating and regular physical activity;


• optimize lipid and lipoprotein profiles to re-
  duce cardiovascular disease risk, and


• maintain the pleasure of eating by encourag-
  ing a wide variety in food choices.
  Dietetic advice is required at the initial diag-
  nosis of diabetes, with follow-up 2–4 weeks later
  and regular (at least annual) review to meet
  changes in appetite and to provide ongoing age-
  appropriate education [3]. Circumstances such as

changes in the insulin regimen, dyslipidemia, ex-

cessive weight gain or loss as wel l as t he diagnosis

of a comorbidity such as celiac disease require ad-

ditional dietary intervention with more frequent

review.

E a t i n g P a t t e r n s

The key dietary behaviors that have been associ-

ated with improved glycemic outcomes in people

with T1DM are adherence to an individualized

meal plan, particularly carbohydrate intake rec-

ommendations [4] , avoidance of frequent snack-

ing episodes or large snacks without adequate in-

sulin coverage, regular meals and avoidance of

skipping meals [5] , avoidance of overtreatment of

hypoglycemia and insulin boluses before meals

[6]. Regularity in mealtimes and routines where

the child and family sit down and eat together –

helping to establish better eating practices and

monitoring of food intake – has been shown to be

associated with better glycemic outcomes across

all insulin regimens.

The recommended meal plan should consider

usual appetite, food intake and exercise patterns

(including at school or preschool), activity level

and insulin regimen. A key aspect of nutrition

therapy is advice on the amount, type and distri-

bution of carbohydrate over the day. Nutritional

advice regarding carbohydrate distribution, in-

cluding the need for snacks, differs according to

the insulin regimen [7]. Recommendations for dif-

ferent insulin regimens are presented in table 1.

E n e r g y B a l a n c e

At diagnosis, appetite and energy intake are often

high to compensate for catabolic weight loss. En-

ergy intake should be reduced when an appropri-

ate healthy weight is restored. Regular monitor-

ing by the diabetes team should assess appropri-

ate weight gain.

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