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

#### **2.1. Introduction**

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].

**2.3. Dietary management**

is recommended.

tion control [50]. Goals of MNT are

youth

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

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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

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 por-

**1.** Sufficient energy intake to provide normal growth and development and integration of insulin dosages with general eating and physical activity habits in type 1 diabetic

**2.** Modify eating and physical activity habits to decrease insulin resistance and enhance met-

• Adequate and appropriate intake of energy and nutrients to provide normal growth and

• Promote healthy, lifelong eating habits to provide and maintain social, cultural, and psychological well-being with considering the patient's wishes and willingness to change

• Manage normoglycemia and avoid hypoglycemia provided by a balance between food

• Recommend regular physical activity to avoid and manage acute diabetic complications including hypoglycemia, hyperglycemic crises, illness, and exercise-related problems

required changes with age, physical activity patterns, and growth rate [49].

abolic condition in type 2 diabetic youth [36]

development and good health

Goals of MNT in childhood according to expert consensus:

intake, metabolic needs, energy expenditure, and insulin regimens

• Maintaining the appropriate BMI and waist circumference.

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].
