Pediatric Nutrition in Practice

222 Smart^

Carbohydrate Assessment

Children and adolescents with T1DM require ed-
ucation regarding the amount, type and distribu-
tion of carbohydrate over the day, taking into ac-
count their age, food intake patterns and insulin
regimens ( table  1 ). Day-to-day consistency in
carbohydrate intake using serves or 15-gram car-
bohydrate exchanges is encouraged for those re-
ceiving fixed mealtime insulin doses. A more flex-
ible carbohydrate intake can be achieved using an
insulin-to-carbohydrate ratio for those on inten-
sive insulin therapy.
Carbohydrate counting is a key nutritional in-
tervention for young people using insulin pump
or multiple daily injection therapy. It enables ad-
justment of the prandial insulin dose according
to carbohydrate consumption, thus permitting
carbohydrate intake to be varied. Multiple bene-
f i t s h a v e b e e n r e p o r t e d w h e n c a r b o hyd r a t e c o u nt-
ing is used as an intervention, including improve-
ments in glycemic control, diabetes-specific
quality of life and coping ability [10]. Advice on
carbohydrate quantification should be given

within the context of a healthy diet as focusing

only on the amount of carbohydrate can lead to

unhealthy food choices.

In clinical practice, a number of methods

for carbohydrate quantification are commonly

taught, including 1-gram increments, 10-gram

carbohydrate portions and 15-gram carbohy-

drate exchanges. Research has demonstrated that

carbohydrate counting is difficult, and repeated

age-appropriate education by experienced health

professionals is necessary to maintain accuracy

in estimations [11]. Inaccurate carbohydrate

counting has been associated with higher daily

blood glucose variability.

It is becoming increasing ly recognized t hat fat

and protein also contribute to postprandial hy-

perglycemia. Fat and protein have been found to

increase the delayed postprandial glucose rise

( fig. 2 ) [1 2]. Consideration of the impact of fat and

protein on glucose levels involves the application

of advanced nutritional concepts that are best

taught after basic carbohydrate counting skills

are established. Alterations to the insulin dose

and distribution at a mealtime may be necessary

4

2

0

–2

6

–4

Mean glucose excursion (mmol/l)

030030 60 90 120 150 180 210 240 270

Time from meal (min)

Fig. 1. Australian guide to healthy
eating. Canberra, National Health
and Medical Research Council, 2013
[9].
Fig. 2. Mean postprandial glucose
excursions from 0 to 300 min for 33
subjects after test meals of low fat/
low protein (⚫), low fat/high protein
( ◆ ), high fat/low protein ( ▲ ) and
high fat/high protein (◻) content.
The carbohydrate amount was the
same in all meals. There were signifi-
cant differences in glucose excur-
sions between meal types from 150
to 300 min (p < 0.03). © American
Diabetes Association. Reproduced
from Smart et al. [12]. 2

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