**2.2. Diagnosis**

The diagnosis of T1DM in children is usually not difficult and needs little or no specialized testing. The most common symptoms and findings of T1DM in children and adolescents are the several-week histories of polyuria, polydipsia, polyphagia, and weight loss with hyperglycemia, glycosuria, ketonemia, and ketonuria. Approximately 30% of children with the T1DM present with diabetic ketoacidosis (DKA). A second confirmatory test should be performed in the asymptomatic child or adolescent who is screened for diabetes in case of a fasting plasma glucose (FPG) ≥126 mg/dL or a 2-h plasma glucose or random glucose ≥200 mg/dL; however, no further testing is required if specific signs and symptoms of diabetes are present [49]. Type 2 diabetic adolescents have approximately 50% lower insulin sensitivity and 75% lower first-phase insulin secretion when compared to nondiabetic adolescent [50]. Plasma glucose goals for youth diabetics were shown in **Table 3**.


\*A lower target (<7.0%) is amenable if excessive hypoglycemia can be prevented.

\*\*If excessive hypoglycemia can be avoided, a lower goal (7.5%) is reasonable.

\*\*\*If excessive hypoglycemia can be avoided, a lower goal (8%) is reasonable.

**Table 3.** Targets for plasma glucose [20].

#### **2.3. Dietary management**

**2. Medical nutrition therapy in youth diabetics**

Type 1 diabetes mellitus (T1DM), the most commonly encountered endocrine disease of childhood, is defined as a decrease and later an absence of pancreatic ß-cell function causing chronic insulin deficiency. Type 1 diabetic youth needs to use insulin to metabolize glucose [47]. The prevalence of T2DM in adolescents increase is accompanied by an increase in T2DM complications such as hypertension, hyperlipidemia, nephropathy, and retinopathy [48].

Involving of adults in the diabetes care of adolescents by professionals is a very important key point. Young children, including school-aged children, are not able to manage their diabetes care, and middle school and high school students need help in managing their diabetes care. Therefore, the education about how all family can be involved in the diabetes care of a diabetic child and adolescent should be ensured [49]. MNT is an essential part of diabetes care in the modern era. MNT is defined as a period of personal guidance to train patients and families related to healthy eating practices to provide a good glycemic control and to prevent or manage comorbidities including overweight, hyperlipidemia, and hypertension. Therefore, MNT is an important component of self-diabetes care [47].

The diagnosis of T1DM in children is usually not difficult and needs little or no specialized testing. The most common symptoms and findings of T1DM in children and adolescents are the several-week histories of polyuria, polydipsia, polyphagia, and weight loss with hyperglycemia, glycosuria, ketonemia, and ketonuria. Approximately 30% of children with the T1DM present with diabetic ketoacidosis (DKA). A second confirmatory test should be performed in the asymptomatic child or adolescent who is screened for diabetes in case of a fasting plasma glucose (FPG) ≥126 mg/dL or a 2-h plasma glucose or random glucose ≥200 mg/dL; however, no further testing is required if specific signs and symptoms of diabetes are present [49]. Type 2 diabetic adolescents have approximately 50% lower insulin sensitivity and 75% lower first-phase insulin secretion when compared to nondiabetic adolescent [50]. Plasma glucose goals for youth

**Adolescents/young adults** 

Fasting glucose (mg/dL) 90–130 90–180 100–180 Bedtime/overnight glucose (mg/dL) 90–150 100–180 110–200 HbA1c <7.5%\* <8%\*\* <8.5%\*\*\*

**School age (6–12 years) Toddlers and** 

**preschoolers (0–6 years)**

**(13–19 years)**

\*A lower target (<7.0%) is amenable if excessive hypoglycemia can be prevented. \*\*If excessive hypoglycemia can be avoided, a lower goal (7.5%) is reasonable. \*\*\*If excessive hypoglycemia can be avoided, a lower goal (8%) is reasonable.

**2.1. Introduction**

152 Diabetes Food Plan

**2.2. Diagnosis**

diabetics were shown in **Table 3**.

**Table 3.** Targets for plasma glucose [20].

Nutritional suggestions for children and adolescents with T1DM should focus on a good glycemic control that provides normal growth and development and avoid hypoglycemia [36]. One of the main components of diabetes care and education is the nutritional management. Dietary habits vary according to the culture and socioeconomic status. Cultural, ethnic, and family traditions and the psychosocial requirements should be taken into account in providing nutritional recommendations for children. The entire family should be involved in making the food plan to provide healthy eating habits [51]. MNT is one of the cornerstones of the management of type 1 diabetes in children; however, it is generally one of the most difficult parts of the treatment. Food preferences, cultural influences, physical activity patterns, and family eating habits and schedules should be considered in making an individualized meal plan. Consultation with a registered dietitian to develop a personalized nutrition plan is recommended.

Premeal insulin dosages should be calculated according to the amount of carbohydrate intake that should be consistent. Most of type 1 diabetic children present with weight loss that has to be restored with appropriate management including insulin therapy, hydration, and sufficient energy intake. A nutrition plan updated every year is recommended, since the energy required changes with age, physical activity patterns, and growth rate [49].

Management of type 2 diabetic youth should focus on avoiding sugar-containing beverages and high-fat/high-energy containing foods and providing a regular meal schedule and portion control [50].

Goals of MNT are


Goals of MNT in childhood according to expert consensus:


guidelines. Using glycemic index is an option in making a diabetic food plan; however, it is

Medical Nutrition Therapy for Special Groups with Diabetes Mellitus

http://dx.doi.org/10.5772/intechopen.70815

155

Diabetes education is described as the condition of ensuring an individual with the knowledge and skills required to carry out diabetes self-care and control crises and performing lifestyle modifications to successfully manage the disease. Educational programs with specific aims and learning objectives should be involving diabetic patients, their carers, and families

Appropriate diabetes education is compact and complicated and have the need for educators with a number of abilities such as good communication, compassion, sensitivity, humor, and a comprehensive knowledge of childhood diabetes. The age and developmental stage of the child is a cornerstone of the education such that it should be parents and primary caregivers

Diabetes education should have continuity and repeatability for its effectiveness [57]. Behavioral focus involving the whole family is the key point of a nutrition plan because parents substantially have an impact on eating habits of diabetic children by ensuring the food

Diabetes mellitus is a very common disease among elderly individuals, affecting approximately 20% of older adults aged 65–75 years and 40% of adults older than 80 years [58]. Fifty years and older men and women with diabetes live an average 7.5 and 8.2 years less than nondiabetic individuals [59]. Diabetic individuals are 2 to 4 times more likely to have coronary heart disease (CHD) than nondiabetics, and approximately 70–80% of diabetics are dying from CHD [60]. Elderly diabetics have increased the risk of premature death, functional disability, and comorbidities including hypertension, CHD, and stroke. Elderly diabetics also have a higher risk for various known geriatric disorders including depression, cognitive dysfunction, urinary incontinence, fall-related injuries, and persis-

Worldwide lifestyle changes cause elevated prevalence of obesity and urbanization, accompanied with higher predicted prevalence of diabetes, particularly among persons 75 years and older [41]. According to national population estimates, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries between 2010 and 2030. Currently, the highest number of people with diabetes around the world is in the 40–59-year-old age-group; however, there will be slightly more people with diabetes in the 60–79-year-old age-group by 2030 [62]. Nutritional evaluation is suggested for all elderly diabetics at the diagnosis time and regularly thereafter, which provide the deter-

oriented for a preschooler diabetic as well as patient oriented for most adolescent [49].

and promoting to develop food attitudes, preferences, and values.

**3. Medical nutrition therapy in elderly diabetics**

mination of patients with undernutrition [63].

not the main suggested method for diabetic food plan in pediatric patients [56].

**2.4. Diabetes education**

[57].

**3.1. Introduction**

tent pain [61].

Goals for the distribution of total daily energy intake [52];

	- <10% saturated fat + trans fatty acids
	- <10% polyunsaturated fat
	- >10% monounsaturated fat (should be less than 20% of total energy)
	- n-3 fatty acids: 0.15 g/d

LDL cholesterol and total cholesterol target for diabetic children and adolescents should be <110 mg/dL and <170 mg/dL, respectively [53].

Suggestions for Food Group/Nutrient:


Family education for choosing foods containing lower saturated and higher monounsaturated fat can ameliorate hyperlipidemia. Approximately 60–70% of total calories consisting of carbohydrate and monounsaturated fat are recommended for diabetic patients by current guidelines. Using glycemic index is an option in making a diabetic food plan; however, it is not the main suggested method for diabetic food plan in pediatric patients [56].

## **2.4. Diabetes education**

• Decrease the risk for microvascular complications by providing normoglycemia

• >10% monounsaturated fat (should be less than 20% of total energy)

sion, and nephropathy [52]

• <10% polyunsaturated fat

• n-3 fatty acids: 0.15 g/d

• Carbohydrate 50–55%:

fruits and vegetables

recommended.

day.

• Fat 30–35%:

154 Diabetes Food Plan

• Protein 10–15% (decrease by the aging)

• <10% saturated fat + trans fatty acids

Goals for the distribution of total daily energy intake [52];

• Sucrose intake should be less than 10% of total energy

<110 mg/dL and <170 mg/dL, respectively [53].

Suggestions for Food Group/Nutrient:

stitute at least half of the grains.

• Encourage appropriate nutrient intake and lifestyle to prevent and manage the chronic complications of diabetes, obesity, hyperlipidemia, cardiovascular disorders, hyperten-

• Mainly nonstarch polysaccharide (fiber) containing foods including whole-grain cereals,

LDL cholesterol and total cholesterol target for diabetic children and adolescents should be

• Fruits/vegetables: Daily 2 cups of fruit and 2.5 cups of vegetables (dark green, orange, legumes, starchy vegetables, and other vegetables) as an approximate total of 2.000 calorie intake is

• Dairy: Daily 2 cups of fat-free or low-fat milk or equivalent milk products are recommended for children with age between 2 and 8 years. Children ≥9 years old should take 3 cups/

• Whole grains: Grains product is frequently recommended, and whole grains should con-

• Carbohydrates: Adequate amount of fiber with fruits, vegetables, and whole grains should be consumed. Excessive amounts of calories from carbohydrates should be prevented. • Fat: The recommended amount of fat intake is 30–35% of calories for children 2–3 years of age and 25–35% for 4–18 years of age. Avoid excessive intake of fat high in saturated and/or trans fatty acids. Fat-containing more polyunsaturated and monounsaturated fatty acids should be consumed [54]. Carbohydrate counting is an effective way of improving glycemic control,

Family education for choosing foods containing lower saturated and higher monounsaturated fat can ameliorate hyperlipidemia. Approximately 60–70% of total calories consisting of carbohydrate and monounsaturated fat are recommended for diabetic patients by current

while allowing flexibility in food choice of diabetic children [55].

Diabetes education is described as the condition of ensuring an individual with the knowledge and skills required to carry out diabetes self-care and control crises and performing lifestyle modifications to successfully manage the disease. Educational programs with specific aims and learning objectives should be involving diabetic patients, their carers, and families [57].

Appropriate diabetes education is compact and complicated and have the need for educators with a number of abilities such as good communication, compassion, sensitivity, humor, and a comprehensive knowledge of childhood diabetes. The age and developmental stage of the child is a cornerstone of the education such that it should be parents and primary caregivers oriented for a preschooler diabetic as well as patient oriented for most adolescent [49].

Diabetes education should have continuity and repeatability for its effectiveness [57]. Behavioral focus involving the whole family is the key point of a nutrition plan because parents substantially have an impact on eating habits of diabetic children by ensuring the food and promoting to develop food attitudes, preferences, and values.
