**2. Guidelines on energy balance, energy intake and food components**

No nutrition recommendations can be made for the prevention of type 1 diabetes at this time. (Franz MJ, et al., 2002), but increasing overweight and obesity in youth appears to be related to the increased prevalence of type 2 diabetes, particularly in minority adolescents. Although there are insufficient data at present to warrant any specific recommendations for

the prevention of type 2 diabetes in youth, interventions similar to those shown to be effec‐ tive for prevention of type 2 diabetes in adults (lifestyle changes including reduced energy intake and regular physical activity) are likely to be beneficial. Clinical trials of such inter‐ ventions are ongoing in children.

A recommendations and plans on intake of certain kinds of foods depends on daily energy expenditure which is determined by the individual patient's age, gender and level of physi‐ cal activity. (Lean, M.E. J et al. 1980) In reality, the practical assessment of energy intake re‐ lies on follow-up of the patients' growth and body mass gain. If the tendency towards obesity has been identified (which usually occurs in the puberty and after the growth spurt cessation, most often in female patients) the energy intake should be reduced to 80-90% of standard calculated intake. On the other hand, in children with insufficient body weight a body mass deficit can be corrected using foods with high energy content. (Stepanović R., et al. 1991)/ An adequate diet enables a pediatric patient to utilize ingested food effectively even though the spontaneous endogenous insulin secretion ceased and life depends on ana‐ bolic effects of exogenous insulin administered usually in 2-3 daily doses. Since the insulin doses are delivered in the regular diurnal manner, at the same time every day, the food in‐ take must be adjusted according to the dosage schedule, amount and type of administered insulin. A meal should be placed 30-60 minutes after regular insulin dose (in fact, regular insulin has an onset of action 15–60 min after injection, a peak effect 2–4 h after injection, and a duration of action of ranging from 5 to 8 h) comparing to 15 min with the newer syn‐ thetic insulin analogues. Synthetic insulin analogues, both lispro and aspart have an onset of action within 15 min, a peak in activity at 60–90 min, and a duration of action of 3–5 h. Therefore, a total daily food intake should be divided into six meals. Breakfast/ lunch / sup‐ per ratio should comprise 20% / 30% / 20% of a total daily intake while two snacks and a bedtime meal should consist of 10% of the daily intake each. Also, it is important to ingest about the same amount of carbohydrates at the regullar time every day and to eat meals reg‐ ullarily in order to avoid the occurrence of hypoglycemic episodes. (Stepanović R., et al.

Nutritional Management in Type 1 Diabetes Mellitus

http://dx.doi.org/10.5772/52465

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Dietary carbohydrate has both chemical structural features and form which have gained in importance in recent years. The process of digestion of carbohydrate has been known for many years and instinctively it is held that a monosaccharide must be absorbed more readi‐

The recommended dietary allowance (RDA) for digestible carbohydrate is 130 g/day and is based on providing adequate glucose as the required fuel for the central nervous system without reliance on glucose production from ingested proteins and fats. Although brain fuel needs can be met on lower-carbohydrate diets, long-term metabolic effects of very-low-car‐ bohydrate diets are unclear, and such diets eliminate many foods that are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability (Institute of Medicine:2002). There are no trials specifically in patients with diabetes restricting total car‐ bohydrate to <130 g/day. However, 1-year follow-up data from a weight-loss trialamong the subset with diabetes indicated that the reduction in fasting glucose was 21 mg/dl (1.17 mmol/l) and 28 mg/dl (1.55 mmol/l) for the low-carbohydrate and low-fat diets, respectively,

ly than an oligosaccharide, which requires hydrolysis before absorption.

with no significant difference in A1C levels (Stern L., et al. 2004).

1991)

**3. Carbohydrate**

Individuals who have pre-diabetes or diabetes should receive individualized medical nutri‐ tion therapy (MNT); such therapy is best provided by a registered dietitian familiar with the components of diabetes MNT. Meta-analysis of studies in non-diabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by 15–25 mg/dl. (Yu-Poth S. et al., 1999. Grundy SM., et al. 1997 )

The prevalence of overweight children and adolescents with type I Diabetes mellitus has tri‐ pled over the past 20 years, which appears to correspond to the increasing prevalence of obesity in the general population. The authors (Kliegman M Robert et al., 2007), have ob‐ served patients with type I diabetes, normal-weight preschool children have better glycemic control than age-matched overweight children. This may mean that excess body weight sta‐ tus may impede achievement of therapeutic goals in this group of patients.

The basis for energy requirements calculations is the determination of ideal body-weight. It is assessed corresponding to the respective tables comprising child's age, gender and body size data.

Guidelines for daily caloric requirements in children



**Table 1.**

A recommendations and plans on intake of certain kinds of foods depends on daily energy expenditure which is determined by the individual patient's age, gender and level of physi‐ cal activity. (Lean, M.E. J et al. 1980) In reality, the practical assessment of energy intake re‐ lies on follow-up of the patients' growth and body mass gain. If the tendency towards obesity has been identified (which usually occurs in the puberty and after the growth spurt cessation, most often in female patients) the energy intake should be reduced to 80-90% of standard calculated intake. On the other hand, in children with insufficient body weight a body mass deficit can be corrected using foods with high energy content. (Stepanović R., et al. 1991)/ An adequate diet enables a pediatric patient to utilize ingested food effectively even though the spontaneous endogenous insulin secretion ceased and life depends on ana‐ bolic effects of exogenous insulin administered usually in 2-3 daily doses. Since the insulin doses are delivered in the regular diurnal manner, at the same time every day, the food in‐ take must be adjusted according to the dosage schedule, amount and type of administered insulin. A meal should be placed 30-60 minutes after regular insulin dose (in fact, regular insulin has an onset of action 15–60 min after injection, a peak effect 2–4 h after injection, and a duration of action of ranging from 5 to 8 h) comparing to 15 min with the newer syn‐ thetic insulin analogues. Synthetic insulin analogues, both lispro and aspart have an onset of action within 15 min, a peak in activity at 60–90 min, and a duration of action of 3–5 h. Therefore, a total daily food intake should be divided into six meals. Breakfast/ lunch / sup‐ per ratio should comprise 20% / 30% / 20% of a total daily intake while two snacks and a bedtime meal should consist of 10% of the daily intake each. Also, it is important to ingest about the same amount of carbohydrates at the regullar time every day and to eat meals reg‐ ullarily in order to avoid the occurrence of hypoglycemic episodes. (Stepanović R., et al. 1991)
