**6. Proteins**

**5. Fat**

474 Type 1 Diabetes

children, and 25-30% in older children.

terol, a predisposing factor to atherosclerotic disease.

acids should optimally correspond to 1.2: 1.0 ratios.

should be taken 2-3 times a week.

within recommended ranges or to improve the lipid profile.

The proportion of fat content in total energy intake should be approximately 35% in young

The vegetable fats have clearly advantage over animal ones. Intake decreases during child‐ hood from approximately 2 g/kg/day in early infancy to 1 g/kg/day for a ten year old and to 0.8–0.9 g/kg/day in late adolescence. (Kauffman FR, 2005). Substituting butter with margar‐ ine, vegetable oil for animal oil, and lean cuts of meat, poultry, and fish for fatty meats, such as bacon, is advisable. These simple measures reduce serum low-density lipoprotein choles‐

Uncontrolled type I diabetes is associated with elevated plasma lipids, but adequate insulin therapy usually restores lipid levels to normal. People with type I diabetes who are treated with insulin generally have plasma cholesterol, VLDL cholesterol and triglyceride concen‐ trations similar to those of the general population of the same age and sex (Kern P, 1987). Although not all studies agree, it appears that blood glucose control may directly influence the levels of several plasma lipid components. Qualitative abnormalities such as changes in a density of lipoprotein composition may exist even when the usual clinical measurements of plasma lipids are normal (Dunn FL, 1992). Evidence that dietary fat and the development of atherosclerosis are linked is controversial and there is little sign that a reduction in dietary fat would reduce atherosclerotic disease. Epidemiological studies from Japan are often quot‐ ed and in other populations a fall in cardiovascular morbidity has coincided with alterations in eating habits. (Nattras M., 1996) The dietary contents of polyunsaturated / saturated fatty

The primary goal regarding management of dietary fat is to decrease the intake of total fat, saturated fat, and trans-fatty acids (Franz MJ et al, 2002). Monounsaturated fatty acids (MU‐ FA) and polyunsaturated fatty acids (PUFA) can be used as substitutes to keep lipid intake

Polyunsaturated fatty acids increase the production of lipid peroxides; some experimental studies considered their influence on occurrence of certain malignancies. They are rich in omega-6 fatty acids from sunflower oil and corn; moderate intake of these fatty acids lowers LDL cholesterol, while high intake lowers HDL cholesterol. Omega-3 fatty acids are found in deep sea blue fish (herring, mackerel, tuna and salmon). Their utilization from fish meat is more effective than the utilization from pharmacological supplements. The recommended intake of fish oil is 1.5-2.0 g / day. Omega-3 fatty acids moderately lower total cholesterol, significantly reduce triglyceride levels and reduce platelet aggregation, blood pressure and cardiovascular risk. However, they may increase hepatic glucose production, thus increas‐ ing blood glucose and hemoglobin A1-c levels. Therefore, in patients with impaired carbo‐ hydrate metabolism, the use of fish oil is not recommended; instead, blue sea fish meals

Monounsaturated fatty acids are found in olive oil, walnuts and sesame. Studies have shown that application of these fatty acids for one month reduces insulin requirements and Proteins are an essential nutrient, necessary for normal growth and development in child‐ hood. Adequate protein ingestion is critical in normal muscle development. Proteins are an essential source of nitrogen.

The recommended intake is 15% of total caloric daily intake in older children and 20% in younger. The intake of proteins per kilogram of body weight should be higher in infants, children and adolescents in comparison to adults in order to support growth and develop‐ ment. The daily requirements are about 1.5g/kg for preschool children for and somewhat less -1g/kg for the children in school age –e.g., until the period of rapid growth during pub‐ erty, when the requirements increase again. (Stepanović R. et al 1991)

In diabetes variation in dietary protein may influence metabolic control by altering gluco‐ neogenic substrate availability as well as insulin and contra-regulatory hormone secretion (Nuttall FQ., 1983).

Only in poorly controlled diabetes or in a period of recovering from ketoacidosis, the amount of protein should be greater than 2g/kg. The most important sources of protein are meat, fish and egg whites, but proteins are also represented in foods rich in carbohydrates (legumes, bread and cereals)

1977). While serum zinc levels are generally lower in people with diabetes, zinc replacement is only suggested to be of benefit in helping to heal venous leg ulcer (Hoolbook T., et al 1979). There may be a need for magnesium replacement in patients with poor glycemic con‐ trol or who are on diuretics. Magnesium depletion has been associated with decreased insu‐ lin sensitivity, which may improve with oral supplementation (Beaugerie L et al, 1990).

Nutritional Management in Type 1 Diabetes Mellitus

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

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Some studies indicated that magnesium is a novel factor implicated to the pathogenesis of the diabetic complications. Magnesium plays a fundamental role as a cofactor in various en‐ zymatic reactions of energy metabolism. Magnesium is a cofactor in cell membrane glucose – transporting mechanisms, as well as in various enzymes in carbohydrate oxidation. It is also involved, at multiple levels, in insulin secretion, binding and activity. Magnesium defi‐ cit has been described in patients with type I diabetes. Hypomagnesemia can also be the cause or a result of diabetes complications. If it is followed by diabetes, osmotic dieresis may play a role in the mechanisms responsible for magnesium deficiency. Magnesium loss may be linked to the development of diabetes complications via a reduction in the rate of inositol transport and its subsequent intracellular depletion that might enhance the development of complications. Magnesium is also taking part as a cofactor in many enzymes which are in‐ volved in lipid metabolism. Magnesium administration could decrease triglyceride, choles‐

terol and LDL cholesterol levels and also increase HDL cholesterol (Soltani N., 2011).

The American Heart Association recommends that sodium intake should not exceed 3000 mg/day, while other authors (National High Blood Pressure Education Program, 1993) rec‐ ommend not more than 2400mg/day. Individuals with mild to moderate hypertension should ingest no more than 2400mg of sodium daily (or less than 6 g/day of sodium chlor‐ ide). A study performed in mildly hypertensive subjects with diabetes on moderate dietary sodium restriction showed a reduction of approximately 20 mmHg in systolic blood pres‐ sure. A difference in diastolic blood pressure was not achieved (Dodson PM., et al 1989).

Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.

A dietary intake of dark bread, rye, whole-meal bread, oats and barley flakes, porridge of maize flour, rice, spaghetti, potatoes, beans and lentils as a substitute for bread is recom‐ mended. Also, use of all kinds of vegetables (legumes, root and leafy vegetables) in the amount of 400-500 g/d (250g boiled, 250g fresh). All kinds of fruits are allowed, except for grapes, figs, prunes. The amount of fruit should be 500 g per day, divided into several in‐ stallments. In addition, fresh fruit has an advantage over the pressed juice, since it is rich in

**9. Sodium**

**10. Recommended foods**

dietary fibers.

Excessive protein intake has also been implicated in the pathogenesis of diabetic renal disease and restricting its intake may retard the progression of nephropathy (Brenner BM., et al 1982)

The caloric mixture should comprise approximately 55% carbohydrate, 30% fat and 15% protein. A daily intake should be divided in 6-7 meals; breakfast and lunch should be repre‐ sented with 20% of total caloric needs, dinner with 30% and each snack should contain 10% of daily calorie inputs. Each meal should be taken at certain time during the day with no major or frequent deviations. A bed time snack is considered an essential part of the regi‐ men. This is necessary to prevent nocturnal hypoglycemia. The bed time snack includesat least 7-8g of protein, the amount equivalent to that in a meat or a milk exchange (7 to 8g). (Rudolph AM et al 1996)
