Dietary intake for children and adolescents with type 1 diabetes

The nutritional management of children with type 1 diabetes focuses on providing adequate energy for growth and development. An experienced accredited practising dietitian is needed to provide advice at diagnosis, with review after 2 to 4 weeks, and then every 12 months (or more frequently if indicated). More frequent review is required for children with coeliac disease, which is commonly associated with type 1 diabetes.

At diagnosis, children frequently have increased energy requirements because they need to regain weight. Children younger than 2 years require full-fat dairy products to meet their energy needs. Appetite and activity levels change as children and adolescents grow; advice on diet needs to be modified accordingly.

A key aspect of management of dietary intake is advice on carbohydrate amount, type and distribution over the day, taking into account the patient’s insulin regimen. For children on intensive insulin treatment, education from an experienced accredited practising dietitian about carbohydrate quantification is essential to allow appropriate insulin dosing for carbohydrate intake. There is no evidence that one method of carbohydrate counting is better than another. Carbohydrate intake can be quantified using 1 g, 10 g or 15 g amounts.

Consumption of foods with a low glycaemic index (GI) (eg wholegrain breads, pasta, fruits, dairy products) helps optimise postprandial blood glucose concentrations. However, the GI value should not be interpreted in isolation. For example, foods rich in fat and refined carbohydrate (eg potato chips, ice cream, chocolate) have a low GI because fat delays gastric emptying.

A recommended meal plan considers the child’s usual appetite, food intake pattern and level of activity, and is based on healthy eating principles of three balanced meals daily with appropriate healthy snacks. It is important to involve the whole family in making changes. The focus is on decreasing the intake of sweetened soft drinks and saturated fat, while increasing the intake of fruit, vegetables and dairy products.

Specifically labelled diabetic foods are not recommended because they are unnecessary, expensive, often high in fat, and may contain sorbitol, which has a laxative effect.

Disordered eating is more common in children and adolescents with type 1 diabetes than those without diabetes. These patients require more frequent dietitian review to provide extra education and dietary intervention.