224 Smart^tional benefit to glycemic control over that ob-
served when carbohydrate amount is considered
alone [13]. Low-GI foods lower the postprandial
glucose excursion compared to carbohydrates
with a higher GI. If possible, high-GI food choic-
es should be substituted with lower-GI foods. Ex-
amples of low-GI food choices include who-
legrain breads, pasta, many fruits, milk and yo-
ghurt. It is important that the GI is not taught in
isolation, as monitoring the amount of carbohy-
drate is a key strategy of care.
Specific Advice for Different Age Groups
At all ages, advice should focus on decreasing the
intake of sweetened drinks and saturated fat [7].
Specially labeled ‘diabetic foods’ are not necessary
and may contain sweeteners with laxative effects.
Missed meal boluses are a major cause of subop-
timal glycemic control at all ages, and it is advis-
able to always give insulin before meals. Common
dietary issues to consider at specific ages are out-
lined in table 2.
Nutritional Management of Type 2 Diabetes
in Children
Most children with type 2 diabetes are overweight
or obese; therefore, nutritional advice should be
focused on dietary changes and lifestyle interven-
tions to prevent further weight gain or to achieve
weight loss. The entire family should be included
in the education, since caregivers influence the
child’s food intake and physical activity. Families
should be counseled to decrease energy intake by
focusing on healthy eating and strategies to de-
crease portion sizes of foods as well as by lowering
the intake of high-energy-, high-fat- and high-
sugar-containing foods. Snacks should be limit-
ed. Those on medication or insulin therapy re-
quire more in-depth teaching on carbohydrate
management. Regular follow-up is essential to
monitor weight and glycemic control and to pre-
vent the development of diabetes-related compli-
cations.Conclusions- Nutrition therapy is one of the fundamental
elements of care and education for children
and adolescents with diabetes - Individualized nutritional education should
be provided at diagnosis by a dietitian with
experience in childhood diabetes. Regular
supportive contacts with dietetic health pro-
fessionals are required to increase dietary
knowledge and adherence across the life
span - Dietary recommendations should be based on
healthy eating guidelines suitable for all chil-
dren and families with the aim of improving
diabetes outcomes and reducing cardiovascu-
lar risks - Nutritional interventions should aim to main-
tain an ideal body weight, optimal growth as
well as health and development. Growth mon-
itoring is an important part of diabetes man-
agement - The optimal macronutrient distribution varies
depending on the individualized assessment of
a young person. As a guide, carbohydrate
should approximate 45–55%, fat <30–35%
(saturated fat <10%) and protein 15–20% of
the energy intake - The use of an insulin-to-carbohydrate ratio on
intensive insulin regimens allows greater flex-
ibility in carbohydrate intake and mealtimes,
with potential for improvements in glycemic
control and quality of life - Regularity in mealtimes and eating routines
are important for optimal glycemic outcomes
on all insulin regimens - Fixed insulin regimens require consistency in
the amount and timing of carbohydrate intake
over the day
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