Pediatric Nutrition in Practice

Nutritional Management of Diabetes in Childhood 223

3

for meals very rich in fat and protein. An advan-
tage of insulin pump therapy is that it is possible
to t a i lor pr a nd i a l i n su l i n d e l i ve r y to me a l c omp o -
sition. Combination boluses have been recom-
mended for high-fat, high-protein meals and low-
glycemic index (GI) meals.

G l y c e m i c I n d e x

Nutrition therapy for young people with T1DM

should include education regarding the GI. This

is a ranking of foods based on their acute glycemic

impact. The GI has been shown to provide addi-

Ta b l e 2. Common issues to consider for each age group

Age group Issues to consider

Toddlers Encourage them to eat the usual family diet; offer finger foods to encourage self-feeding;
discourage offering a bottle for ‘easy’ carbohydrate intake
Decreased appetite, food refusal and food fads are common; it is important to avoid ‘grazing’ and
excessive milk consumption
Regular carbohydrate intake is required to prevent hypoglycemia on twice-daily insulin doses;
offer routine meals and 2 small snacks over the day
Insulin pump therapy is beneficial in managing toddler eating behaviors; it is preferable that
preprandial insulin doses are given, but the dose can be split to some before and some during
the meal when eating is erratic or new foods are offered; it is important that carbohydrate
quantities as small as 7 g are covered by insulin

School-aged
children

They become more independent and take on aspects of own care but always with parental

supervision and support

Blood testing during the school day is recommended for all children

The meal and snack routine is ideally incorporated into the usual school timetable

They need to have an understanding of carbohydrate quantities in foods to ensure an

appropriate distribution over the school day; labelling the carbohydrate quantities of foods in the

lunch box is recommended

Avoid excessive eating at afternoon tea contributing to predinner hyperglycemia by either eating

more during the day to spread carbohydrate more evenly or considering an additional dose of

insulin in the afternoon to cover the extra carbohydrate

Extra carbohydrate food is required only for additional strenuous activity and not needed for the

child’s usual active play

Teenagers Challenging behaviors including smoking, drinking, staying out late, sleeping in, skipping insulin
and missing meals
Emphasis should be placed on the importance of routine meals and snacks, particularly during
periods of rapid growth, to prevent excessive afternoon or evening snacking
Disordered eating habits can be an issue that clashes with diabetes management, and they may
require specialist dietetic support
Parental supervision and support continues to be essential, particularly at mealtimes, to ensure
insulin boluses are not missed
Alcohol can cause delayed hypoglycemia, and advice needs to be given about moderate alcohol
consumption and regular carbohydrate intake during drinking
Participation in competitive sports requires appropriate insulin adjustment as well as an
appropriate timing and quantity of carbohydrate intake and adequate fluid to optimize
performance

© 2013 Adapted from Australian Family Physician. Reproduced in part with permission from the Royal Australian Col-
lege 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