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216 7.3 Nutrition for Children with Chronic Diseases and Syndromes
supplemented by tube feeding. Overnight tube eating routine for each individual child is planned
feeding is commonly used, particularly in teenagers. in consultation with a dietitian around the energy
and carbohydrate needed by that child depending
Diabetes on:
There are two types of diabetes: ●● their age and appetite
●● Type 1 diabetes is an autoimmune disease in ●● activity levels
which the cells in the pancreas that produce the
hormone insulin are destroyed. It affects about ●● growth rate.
25 000 children in the UK and can be diagnosed
at any age. It is treated with insulin. NICE guidelines (NICE 2011) recommend that the
energy content of the diet is:
●● Type 2 diabetes develops when the cells in the
body become resistant to insulin. It affects ●● >50 per cent carbohydrate
around 400 children in the UK, usually arising
in obese teenage children. It may be controlled ●● 10–15 per cent protein
initially just by diet or hyperglycaemic agents
but insulin treatment may be instigated as the ●● 30–35 per cent fat.
disease progresses.
Carbohydrate is digested in the small intestine into
Without enough insulin or with insulin resistance, sugars that are absorbed into the blood and
glucose in the blood will not pass into the body’s transported as glucose. The amounts and timing of
cells to provide a source of energy. The glucose the carbohydrate eaten should balance the effects
remains in the blood, resulting in hyperglycaemia. of the insulin administered or vice versa so that
When this occurs before children are diagnosed blood glucose levels remain relatively close to the
they may lose weight and complain of excessive normal range.
thirst. Ketones may be smelt in the breath as they
are released when cells break down fat as a source When physically active for any length of time
of energy in the absence of glucose. without extra carbohydrate, blood glucose levels
can fall as exercise increases the non-insulin-
Type 1 diabetes dependent uptake of glucose by cells as well as
There are several options for giving the insulin and insulin sensitivity. Hence before extra physical
the medical team will discuss and agree what is the activity children should eat some extra
best regimen for each child. Insulin may be given via: carbohydrate as rapidly absorbable sugary food
(e.g. confectionery or chocolate snack bars). With
●● a number of injections throughout each day. experience, children and parents learn to estimate
This may be a set regimen or calculated at how much should be eaten to avoid hypoglycaemia
several points during the day after measuring during sustained physical activity.
the blood glucose levels with a finger prick test.
When advising on a diabetic diet parents and
●● a small insulin pump. A fine tube from the pump older children need to understand or be taught:
is inserted under the skin. The pump is set to
automatically provide around half of the daily dose ●● how much carbohydrate is to be consumed
of insulin as a low continuous basal dose. The child
then controls the pump to give a calculated bolus ●● how to distribute it through the day and load it
dose just prior to each meal or snack. at times just before the child is going to be
particularly physically active
A balanced, nutritious diet based on the five food
groups as described in Chapter 1.2 is the basis of a ●● how to calculate how much carbohydrate has
diabetic diet for diabetic children. The diet and been ingested when the whole meal or snack is
not consumed.
Often, a list of foods each containing 10 g
carbohydrate is used to help work out how much
food will provide the appropriate amount of
