Dietary Management of Type 1 Diabetes

Type 1 diabetes is also known as Insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes. It is a disorder caused by auto immune destruction of pancreatic beta cells resulting in hyperglycemia (elevated blood glucose levels) and with complete absence of insulin. In most cases children and adolescents suffer from this type of diabetes. The treatment involves insulin administration, diet and exercise. It is necessary to maintain adequate nutrition and balanced calorie to meet the growth of a child. The diet is unrestricted except for the avoidance of simple sugars like sugar, jaggery, concentrated sweets, etc.

The goals of dietary management are to aid in normal growth and development, manage blood sugar levels (hypoglycemia and hyperglycemia) and to facilitate healthy eating habits and physical activity to improve metabolic control. Good glycemic control can be maintained only when the child and families learn to balance food, insulin doses and exercise.

The personal preferences and lifestyle habits are taken into account in nutritional care plan. For the children receiving Neutral Protamine Hagedorn (NPH) insulin (twice a day); carbohydrate intake in each meal, timing of meals and physical activity are considered. Children using insulin pumps can be liberal in timing of meal and the amount of carbohydrate ingested.

Type 1 diabetes develops when the beta cells of pancreas that produce insulin are destroyed by the body's immune system. This can also be hereditary, as well as viral infections can lead to this condition.

Following dietary modifications are recommended for this condition:

NUTRIENT	NOTE
Carbohydrate	It is necessary to avoid simple sugars in the child’s diet. The distribution of carbohydrate in the meal of a young child can be- breakfast (20%), mid-morning snack (10%), lunch (10%), evening snack (10%), dinner (30%) and bed time snack (10%). The more the family knows about the maintenance of carbohydrate in the food and the effect of this on the blood glucose levels and the insulin dosage, the more will be the flexibility in the choices of the meals of the child.
Fat	There is an increased risk for cardiovascular diseases for patients with diabetes. Not more than 30% of calories should come from fat and no more than 10% of saturated fat. The normal intake can be 20-25g of fats and oils.
Protein	Protein is required for the growth and development during this stage. Protein should be restricted if there is any renal impairments. Protein rich sources are meat, egg, pulses, poultry, fish, paneer, soya, etc. can otherwise be provided taking into account their fat content.
Fiber	Fiber rich diet helps to reduce the glycemic effect of food. On a nutritional fact label, the grams of fiber are included in the total grams of carbohydrate.
Exercise	Children with diabetes are encouraged to exercise regularly. Families must be taught to monitor blood glucose levels before the exercise and give appropriate snacks based on the blood glucose levels and the type of exercise to prevent hypoglycemia. Carbohydrate should be ingested if the blood glucose level is below 100mg/dL before exercise.

The complications associated with Type 1 Diabetes Mellitus are Hypoglycemia and Hyperglycemia. In hypoglycemia, the blood glucose levels become very low because of not taking meals on time or excess physical activity or high insulin dosage. Hypoglycaemia can cause fainting, sweaty, confused and heart pounding feeling. If not treated, it can cause seizure or can be fatal. In hyperglycemia, the blood glucose level goes higher than the normal levels. It causes more thirst than usual, tiredness and headaches. If not treated, it can lead to other metabolic diseases like renal failure, heart diseases, stroke, blindness, etc.

Foods Allowed	Foods to be avoided
Cereals - Wheat, Jowar, Ragi etc.  Whole grams – Bengal gram, green gram, and dals. Vegetables – Beans, bitter gourd, brinjal, bottle gourd, cauliflower, cabbage, drumstick, ladies finger, onions, garlic, ginger etc. Green leafy vegetables Fruits – Apple, citrus fruits, papaya, Guava, Watermelon, Musk melon, Plum, Pomegranate.	Sugar, jaggery, honey, glucose, sweets etc. Soft drinks, alcoholic drinks, Commercial Beverages. Pastries, cookies, cakes, jams, jellies, ice creams, Maida (refined flour), chocolates etc. Potatoes, yam, sweet potato, banana, grapes, custard apple, chikoo, mangoes and Jackfruit.

A good diet schedule is essential to manage diabetes. Foods should be distributed into five or six small frequent meals rather than three large meals. Fasting and Feasting is not recommended to a Diabetic patient. Intermediary foods like Buttermilk, Tomato juice, Lime juice, Soups and Salads can be taken in-between meals. Fruits should also be taken in-between meals, when the blood sugar in under good control.

Always consult your Doctor or Diabetologist or Dietician before planning diets for your child with Type 1 Diabetes Mellitus.

Post by Divya Konamme