Pediatric Nutrition in Practice

220 Smart^

The prevention or treatment of overweight or
obesity is a key strategy of care, and guidance on
appropriate serving sizes, frequency of snacking
and appropriate hypoglycemia treatment is im-
portant. Additionally, advice should be provided
on food and insulin adjustment for exercise.
The total daily energy intake should be distrib-
uted as fol lows: 45 – 65% ca rbohydrate, 30 –35% fat
and 15–25% protein [8]. Carbohydrate should not

be restricted, as it is essential for growth. Carbo-

hydrate intake should come predominantly from

wholegrain breads and cereals, legumes, fruit,

vegetables and low-fat dairy foods (except for

children <2 years). Food models such as the plate

food model ( fig.  1 ) are useful in providing basic

nutritional information and healthy eating con-

cepts [9]. They also illustrate carbohydrate-con-

taining foods in relation to other foods visually.

Ta b l e 1. Nutritional recommendations for different insulin regimens

Insulin regimen Meal structure

Twice daily mixed insulin doses Three meals and 3 snacks per day at regular times to balance the
insulin action profile
Consistent carbohydrate quantities at each meal and snack on a
daily basis
Treat hypoglycemia with short-acting carbohydrate
followed by long-acting carbohydrate

Multiple daily injections using rapid-acting
insulin premeals and long-acting insulin as
the basal dose; greater flexibility in meal
timing and food quantity as one is able to
change the mealtime insulin dose and timing

Snacks between meals should not exceed 1 – 2 carbohydrate serves

(e.g. 15 – 30 g of carbohydrate) unless an additional injection is

given

Requires knowledge of carbohydrate counting for insulin dose

adjustment at mealtimes

Treat hypoglycemia with short-acting carbohydrate only

Insulin pump therapy provides a continuous
subcutaneous infusion of basal insulin, with
bolus doses given to match the carbohydrate
amount to be eaten

Offers the greatest flexibility in meal timing and quantities; hence,

it is particularly helpful for toddlers to decrease parental anxiety at

mealtimes

Good knowledge of carbohydrate counting is essential as bolus

insulin is matched to the carbohydrate eaten at all meals and

snacks

Insulin for food must be given prior to eating for the best glycemic

outcome

A missed mealtime insulin bolus is the biggest contributor to poor

glycemic outcome

Basal rates, insulin-to-carbohydrate ratios and correction factors

are individually calculated

The bolus type and dose can be adjusted to match the meal

composition and, hence, better mimics the physiological

absorption profile

Treat hypoglycemia with short-acting carbohydrate only

With all insulin regimens, individualized advice regarding carbohydrate amount and distribution should consider
usual appetite, food intake patterns, exercise and energy requirements of the person with diabetes.
© 2013 Adapted from Australian Family Physician. Reproduced in part with permission from the Royal Australian
College of General Practitioners from Barclay et al. [7].

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