The issue of children who have diabetes has gained a lot of attention in recent years due to the overwhelming number of consequences that influence their health on a daily basis. Being diagnosed with the condition calls for a drastic lifestyle and dietary change to account for the fact that the child’s body cannot produce insulin, an important hormone needed for survival. Usually, when children are diagnosed with type 1 diabetes, it shows that they rely on their insulin production. The condition is accompanied by a number of symptoms such as weight loss, fatigue, extreme hunger and thirst, behavioral changes, blurred vision, and others. Because these symptoms significantly decrease the quality of children’s lives, knowing how to manage the condition is essential. In this report, nutritional advice for children with diabetes will be discussed.
Etiology, Epidemiology, Pathophysiology
When it comes to the etiology of type 1 diabetes in children, both environmental and genetic factors can contribute to the development of the condition. However, it should be noted that in individuals at risk of developing diabetes, the human leukocyte antigen (HLA) can account for 30-50% of risks linked to genetic factors (Los & Wilt, 2018). If a person is at risk of having diabetes, the presence of a “triggering” insult such as virus exposure, poor diet, or an unhealthy environment is likely to start the process that leads to the first stages of pediatric diabetes. Importantly, there was a recent development in recognizing three preclinical stages of type 1 diabetes. Stage 1 is characterized by the appearance of beta-cell autoimmunity, but the body’s normal handling of glucose. Stage 2 is associated with a patient’s abnormal handling of glucose without the appearance of any severe symptoms. Stage 3 is the final preclinical stage and is characterized by apparent symptoms linked to insulinopenia (Los & Wilt, 2018).
The epidemiology of pediatric diabetes suggests that the condition can be diagnosed at almost any age, with peaks occurring at ages 5-7 as well as puberty. Also, there can be seasonal changes, and more cases are diagnosed in winter and fall. It should also be mentioned that in contrast to other autoimmune disorders, pediatric diabetes is more prevalent in boys. The prevalence and incidence of the condition have been recently increasing not only in most age, race, and sex groups but also in young children particularly. In terms of geographic variability of diabetes, there are significant changes. For instance, in China, the variability is 0.1 per 100,000 people while in the United States it is between 20 and 30 new diabetes diagnoses per 100,000 people each year (Los & Wilt, 2018).
The pathophysiology of the condition is as follows: “insufficient endogenous insulin leads to hyperglycemia, hyperglucagonemia, glucosuria, and without treatment, eventually ketosis, acidosis, dehydration, and death” (Los & Wilt, 2018, para. 4). Around a third of patients who have recently been diagnosed with type 1 diabetes will have diabetic ketoacidosis that has a mortality rate of 0.5% regardless of whether aggressive treatment was administered. In the last several decades, researchers have focused on therapies targeted normalizing glucose levels within the body while balancing out hypoglycemia risks.
Nutritional management has shown to be among the most popular and reliable methods of managing type 1 diabetes, especially among children. Objectives of nutritional management include the following:
- Achieving a balance between the intake of food, the requirements associated with a child’s metabolism, the expenditure of energy, and insulin action;
- Preserving a beneficial relationship between children and their diet and thus facilitating positive behavioral modifications;
- Providing the sufficient and appropriate intake of nutrients in order to maintain children’s appropriate growth, physical and psychological development, as well as overall good health;
- Preventing and addressing possible complications of pediatric diabetes that can range from micro- and macro-vascular complications to hypoglycemia.
In contrast to common misconceptions that children with diabetes require complex diet, the reality is that the recommended nutrition is no different from the choices that should be made for children who do not have diabetes. While there are certain considerations that must be taken into consideration, there is no such specific thing as a diabetic diet. Because of this, dietary recommendations for children with diabetes follow nutritional basics while considering insulin adjustment.
According to Gray (2015), monitoring the total number of carbohydrates, which is important for any diet, can be a beneficial tool for achieving the effective glycemic control for patients diagnosed with type 1 diabetes. The total among of carbohydrates that patients consume has the strongest influence on their glycemic response. Nutritional advice for children with diabetes is the following:
- Monitoring the total among of carbohydrates consumed with each meal through either preside counting or experience-based estimation;
- Consuming at least the recommended amount of grains and fiber;
- Substituting sugar with nonnutritive sweeteners to decrease the total intake of calories and carbohydrates;
- Replacing low-glycemic products for high-glycemic foods for improving the overall glycemic control of the organism;
- Avoiding foods that contain high amounts of added fats, sodium, and sugars.
Thus, the dietary recommendations for children diagnosed with type 1 diabetes can be applied to any person trying to maintain a healthy diet. The regulation of carbohydrate intake has been shown to be the most effective and widespread method of managing children’s glycemic control. In terms of specific recommendations, some of them will be explored further. First, consuming at least the among of whole grains and fiber recommended to the general public is among the most beneficial practices that children with diabetes can follow. It is advised to consumer fiber because fiber-rich meals are usually processed slower than usual, thus promoting earlier satisfaction, being less caloric, and be lower in added sugars and fat (Van Kleef, Van Trijp, Van Den Borne, & Zondervan, 2012). Second, non-nutritive sweeteners are recommended for children with diabetes because they provide low amounts of energy and allow patients to elicit a sweet sensation without contributing to the rise of insulin and blood glucose concentrations. Some of the non-nutritive sweeteners approved by the FDA include Sucralose (Splenda), Acesulfame K (Ace K, Sunette), Neotame, Stevia (Truvia), and several others.
Third, regulating the amount and type of carbohydrates is the strongest recommendation that diabetic patients receive (Evert et al., 2014). Counting the amounts of foods that contain high carbohydrates is essential because carbs affect blood sugar levels. However, their intake is important, but patients with diabetes should choose carbohydrates that can be found in vegetables, fruits, whole grains, fibers, and other healthy products. Overall, it can be concluded that pediatric diabetes does not require a lot of nutritional changes; although, some minor adjustments and a generally positive attitude toward food intake.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., … Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 37(1), 120-143.
Gray, A. (2015). Web.
Los, E., & Wilt, A. S. (2018).Web.
Van Kleef, E., Van Trijp, J. C. M., Van Den Borne, J. J. G. C., & Zondervan, C. (2012). Successful development of satiety enhancing food products: Towards a multidisciplinary agenda of research challenges. Critical Reviews in Food Science and Nutrition, 52(7), 611-628.