Pediatric Nutrition & Child Health

There is a steady rise in the number of individuals with type 1 diabetes now, previously known as Juvenile diabetes or Insulin Dependent Diabetes Mellitus (IDDM). Nutritional management is one of the cornerstones of diabetes care and education. Dietary recommendations for children with diabetes are based on healthy eating recommendations suitable for all children and adults and therefore, the entire family, A guide to the distribution of macronutrients, Carbohydrate 45% to 55% energy, Moderate sucrose intake (up to 10% total energy), Fat 30% to 35% energy, <10% saturated fat + trans fatty acids, Protein 15% to 20% energy Carbohydrate requirements in children and adolescents are individually determined based on age, gender, activity and previous intake. Clinical evidence suggests that individuals typically consume 45% to 50% energy from carbohydrate and can achieve optimal postprandial glycemic control with appropriately matched insulin to carbohydrate ratios and insulin delivery. Healthy sources of carbohydrate foods should be encouraged to minimize glycemic excursions and improve dietary quality. Addition of a moderate amount of protein to a meal containing predominantly carbohydrate can assist in reducing postprandial excursions. Substituting low-Glycemic Index (GI) for High-GI carbohydrate and increasing dietary fiber intake are other useful dietary option. Sucrose can provide up to 10% of total daily energy intake. A more flexible approach using individualized insulin to carbohydrate ratios (ICR), which enables the pre-prandial insulin dose to be matched to carbohydrate intake, should be used for children and adolescents on intensive insulin therapy. The ICR is individualized for each child according to age, sex, pubertal status, duration of diagnosis and activity. Although this method increases flexibility of the meal timing and the carbohydrate amount, mealtime routines and dietary quality remain important, for high fat and highprotein meals, combination bolus with sufficient insulin upfront to control the initial postprandial rise is needed. Pre- and post-prandial blood glucose testing at 3, 5 and 7 hours or continuous glucose monitoring systems can be useful in guiding insulin adjustments and evaluating the outcomes of changes to the insulin dose or timing