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Nutrition & Type I Diabetes

Goals of therapy Type I diabetes:• Promote normal growth & development• Encourage good nutrition• Prevent (minimize) complications• Maintain near-normal blood glucose levels• Preprandial BG goals– Infants and toddlers: 100-180 mg/dL– Children: 90-180 mg/dL

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Delegation of Responsibilities

• Functionally able to do things long before cognitive understanding.

• Length of teaching sessions based on developmental age

• Learning theory

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Developmental Issues: Infancy• High caregiver

responsibility• Growing brain is

greedy: wants glucose!!

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Toddler

• Inconsistent dietary intake• Give choices when possible• Rituals and routines

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Developmental Issues: preschooler

• Understands simple explanations• Play therapy• More predictable appetite• Learn to identify CMs hypoglycemia– Avoid calling results “bad”

• High energy activities

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Developmental Issues: School-age

• Dislike being “different”• School personnel – fingersticks• Less parental control• Field trips, parties, athletic events• Eating habits more predictable; more

independent• Present oriented

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Developmental Issues: Adolescent

• Challenge: growth spurt & blood sugar • Body image, peer group acceptance• Risk-taking behaviors• Control shifting to adolescent• Not motivated by future complications

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Type 2 Diabetes

• Increased incidence in children• Metabolic syndrome (insulin-resistance

syndrome) = high risk factor• Sedentary lifestyle• Overeat• Family hx of diabetes• Metformin: only oral agent approved for

children

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Exercise

• Exercise decreased insulin need r/t insulin more efficient

• Avoid active exercise when insulin peaking• Maintain proper hydration• Watch for hypoglycemia after exercise• Avoid exercise if insulin level is too low

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ExerciseMcKinney:

• 15-30 Gm carb for each 45-60 min of exercise

• Check BG before, during & after• Be prepared w/additional carbs– BG up to 2 hours after exercise

• Coaches & teammates

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“Honeymoon Period”

• After new dx, 10-20% beta cells function for a time (ucsfhealth.org)

• Less insulin required• Potential denial of disease

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