World Diabetes Day 2021: Living with diabetes is not exactly a cakewalk. Apart from regular medication that the doctor has advised, diet and other lifestyle modifications play a major role in management of the metabolic disorder. Managing diabetes in children is all the more challenging as this is the stage where the little ones are growing and developing and any compromises in nutrition could lead to deficiencies, malnutrition or delayed growth and development.
While the most common type of diabetes in children is type 1 diabetes, the cases of type 2 diabetes in children and adolescents too are on rise. In type 1 diabetes, the pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in the blood.
“Various hospital and clinic-based registries over India suggest that the percentage of type 2 diabetes in children is rising. Type 2 diabetes used to be called adult-onset diabetes. But now it is becoming more common in children and teens, due to more obesity. With type 2 diabetes, the body does not make or use insulin well,” says Dr. Phulrenu Chauhan, Consultant Endocrinologist at P.D.Hinduja Hospital & MRC.
The rise in sedentary lifestyle and faulty eating habits in children are a cause of concern as this may increase their chances of type 2 diabetes.
“Children have a higher risk of type 2 diabetes if they are overweight or have obesity, have a family history of diabetes, or are not active,” says Dr Chauhan.
Diet for diabetic children
“Diet therapy, exercise and pharmacotherapy form integral part of diabetes management. Nutrition requirements in children are different from those in adults as they are in growing stage. At the same time children with diabetes are not different from normal children when it comes to nutritional requirements. It becomes even more crucial to meet nutritional needs without compromising with the blood sugar levels,” says Sweedal Trinidade, HOD Dietary Services at P.D. Hinduja Hospital & MRC, Mahim, Mumbai.
With modern therapies like insulin pumps, flexible injection regimes, rigid diet regimes are no longer part of dietary management in children with type 1 diabetes enabling them to lead a more normal lifestyle.
“Customized meal plans considering food preferences, culture, physical activity, schedule are very important to strike a perfect balance between ideal therapeutic diet and occasional allowances to maintain optimum blood sugar levels,” says Trinidade.
Trinidade also suggests what all should be included in diet for children with diabetes:
Balanced Diet: It is very important to include all five food groups – Fruits, vegetables, cereals, pulses, milk and milk products so as to maintain variety in food and prevent deficiencies.
Carbohydrates: It has direct impact on blood sugar levels and require insulin for absorption. Matching insulin levels with carbohydrate intake is very important to maintain blood sugar levels. Depending upon the complexity it takes two hours for the sugars to enter the blood stream, hence the blood sugars have to be checked two hours post meals.
Simple carbohydrates include sugar, jaggery, honey can spike blood sugars and should be avoided. Complex carbohydrates like whole grains, millets, cereals, pulses, vegetables, whole fruits help in slow release of blood sugars and must be preferred to get good glycemic control.
Fiber: It should be a crucial part of diet for diabetic children. Fibres help maintain the glycemic index of the food and add to the bulk of the stools. It can be classified into soluble and insoluble fibre. Whole fruits, vegetables, whole grains and psyllium husk are some of the examples.
Proteins: Proteins are important for growth and development of the body. Foods rich in proteins and complex carbohydrates help in maintaining the glycemic index of the meals with slow sustained release of glucose. Pulses, meat, fish, chicken, eggs, soya, milk and milk products are loaded with protein and can be included in diet of children with diabetes.
Fats: Though it increases the satiety and reduces the glycemic index of the meals, according to studies, consumption of high fat diet in people with type 1 diet is linked with heart disease. Hence saturated and trans fat consumption should be restricted and over all oil consumption should not exceed half liter per person per month.
How to do carbohydrate counting
It is the most important part when it comes to blood sugar management in type 1 diabetes
* One carbohydrate serving is the choice of food portion that gives 15 gm of carbohydrates. Example: ½ vati cooked rice, ½ bhakri (jowar, bajra), apple (100g)
* Insulin-to-carbohydrate ratio = 1 unit of insulin for 15 grams of carbohydrate.
* Insulin to carbohydrate ratio varies from person to person may change from time to time.
* Every meal should contain carbohydrate serving that is well balanced with the insulin dose so as to maintain carbohydrate to insulin ratio.
* List of regional foods or food preferences need to be discussed with the qualified Dietician who can customize a diet plan, educate about self-monitoring of blood glucose.
Mid-meal options for children with diabetes
Children with diabetes should have well balanced meals with complex carbohydrates distributed in all five meals. The diet should be in coordination with insulin dosage prescribed by the doctor.
Here are some mid-meal options for diabetic kids by Sweedal Trinidade:
|Food items||Energy in kcal||Carbohydrates in grams|
|Sprouts Salad (100g cooked weight)||100||17|
|Moong Dhokla (100g cooked weight)||100||16|
|Chena/ tossed paneer /paneer tikka (40gm)||100||2|
|Roasted Chana (30 gm)||100||17|
|Boiled Egg (1whole)||85||0|