What is the role of dietary modification in the treatment of pediatric type 1 diabetes mellitus (DM)?

Updated: Jul 03, 2019
  • Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Dietary management is an essential component of diabetes care. Diabetes is an energy metabolism disorder, and consequently, before insulin was discovered, children with diabetes were kept alive by a diet severely restricted in carbohydrate and energy intake. These measures led to a long tradition of strict carbohydrate control and unbalanced diets. Current dietary management of diabetes emphasizes a healthy, balanced diet that is high in carbohydrates and fiber and low in fat.

The following are among the most recent dietary consensus recommendations (although they should be viewed in the context of the patient’s culture) [53] :

  • Carbohydrates - Should provide 50-55% of daily energy intake; no more than 10% of carbohydrates should be from sucrose or other refined carbohydrates

  • Fat - Should provide 30-35% of daily energy intake

  • Protein - Should provide 10-15% of daily energy intake

The aim of dietary management is to balance the child's food intake with insulin dose and activity and to keep blood glucose concentrations as close as possible to reference ranges, avoiding extremes of hyperglycemia and hypoglycemia.

The ability to estimate the carbohydrate content of food (carbohydrate counting) is particularly useful for children who receive fast-acting insulin at mealtimes either by injection or insulin pump, as it allows for a more precise matching of food and insulin. Adequate intake of complex carbohydrates (eg, cereals) is important before bedtime to avoid nocturnal hypoglycemia, especially for children getting twice-daily injections of mixed insulin.

The dietitian should develop a diet plan for each child to suit individual needs and circumstances. Regularly review and adjust the plan to accommodate the patient's growth and lifestyle changes.

Low-carbohydrate diets as a management option for diabetes control have regained popularity. Logic dictates that the lower the carbohydrate intake, the less insulin is required. No trials of low-carbohydrate diets in children with type 1 diabetes mellitus have been reported, and such diets cannot be recommended at the present.


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