**13. Conclusion**

In conclusion, dietary recommendations for diabetic patients should be based on healthy eating recommendations suitable for all children and adults. Generally, the ideal diet for the normalization of glycemic control in people with diabetes has not yet been designed. In fact, there may be as many diets for diabetes as people with diabetes, and they could be based on the many individual manifestations, presentations, and complications of the disease. Indi‐ viduals on insulin therapy need to eat at consistent times synchronized with the time-ac‐ tions of insulin, monitor blood glucose levels, and adjust insulin doses for the amount of food usually eaten.

Medical nutrition therapy is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. No nutrition recommendations can be made for the prevention of type 1diabetes at this time. 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 are likely to be beneficial.

The caloric mixture should comprise approximately 55% carbohydrate, 30% fat and 15% protein. A flexible dietary instruction based on the food pyramid and low-glycemic index choices achieved significantly better glycemic control than more traditional dietary advice.

Several prospective observational studies have shown that the overall glycemic index and glycemic load of the diet, but not total carbohydrate content, are independently related to the risk of developing type 2 diabetes. An intake of simple carbohydrates with high fiber foods - such as complex grains, vegetables and fruit slows the intestinal absorption. It also reduces postprandial hyperglycemia and lowers serum cholesterol levels.

The primary goal regarding dietary fat is to decrease the intake of total fat, saturated fat, and trans-fatty acids. Monounsaturated fat should be promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation and consequent lower atherogenic potential. Moderate intake of omega 3 and omega-9 fatty acids lowers LDL cholesterol.

If there was a family history of hypercholesterolemia or a family cardiovascular event before age of 55 years, or if family history was unknown, a fasting lipid profile should be per‐ formed on children >2 years of age soon after diagnosis (after glucose control has been es‐ tablished). All children diagnosed with diabetes at or after puberty should have a fasting lipid profile performed soon after diagnosis (after glucose control has been established. AHA categorizes children with type 1 diabetes in the highest for cardiovascular risk and recommends both lifestyle and pharmacologic treatment for those with elevated LDL cho‐ lesterol levels.

Proteins are an essential nutrient, necessary for normal growth and development in child‐ hood. The recommended intake is 15% of total caloric daily intake in older children and 20% in younger children. 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 puberty, when the requirements increase again. Only in poorly controlled diabetes or in a period of recovering from ketoacidosis, the amount of protein should be greater than 2g/kg. Variable dietary proteins may influence metabolic control by altering gluconeogenic substrate availability as well as insulin and contra-regulatory hormone secre‐ tion. Excessive protein intake has also been implicated in the pathogenesis of diabetic renal disease. In individuals with diabetes and macroalbuminuria, reducing protein from all sour‐ ces to 0.8 g • kg body wt−1 • day−1 has been associated with slowing the decline in renal function.

Hypertension can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH (Dietary Ap‐ proaches to Stop Hypertension. 2006). If target blood pressure is not reached with 3–6 months of lifestyle intervention, pharmacologic treatment should be considered. Insoluble dietary fibers have little effect on blood glucose and no effects on lipids, but they may in‐ crease satiety and inhibit hunger, thus inducing positive effects in obese diabetic patients.

By complying with a proper and balanced diet, people with diabetes take adequate amount of vitamins and minerals, so there is usually no need for pharmacological supplements. Zinc replacement is only suggested to be of benefit in helping to heal venous leg ulcer.
