Nutritional management

Special groups, events and problems

Infants and toddlers

• Breastfeeding of infants should be encouraged
• Frequent small meals (‘grazing’) may promote better glycemic control, depending on the insulin regimen
• Participation in family meals may promote improved cooperation
• A variety of tastes, colours and textures should be encouraged
• Food substitutes and flexibility in food intake and insulin (e.g. rapid analogs) may be useful for episodes of food refusal or ‘sickness’

Schoolchildren

• Require advice on prevention of hypoglycemia. Food planning for episodic or planned physical activity is advisable
• Need to double their energy intake for optimal growth between ages 6 and 12 years
• Should receive specific holiday and travel advice, particularly for school events

Adolescents

• Weight monitoring is important in the early recognition of weight loss or excessive weight gain
• Excessive weight gain (and obesity) may be associated with attempts to obtain excellent glycemic control by matching insulin levels with food intake. Careful review of insulin dosage, energy input and output is advisable to help resolve this difficult problem
• Poor growth may be a sign of insufficient energy intake, inappropriate or missed insulin doses and/or poor glycemic control
• Rebellion, binges and erratic eating behavior may require expert (psychological) support and counseling
• The association between weight loss and eating disorders needs to be recognized
• Advice on drinking alcohol and food intake is important in certain societies

Parties, festivities and special events

• Special dispensation is usually given to children with diabetes during fasts such as Ramadan
• Parents are recommended to advise other care givers on food preferences and low sugar drinks
• Occasional sugary food treats may not provoke hyperglycemia if physical activity levels are also high or insulin dose adjustments are made
• Advice on additional (short or rapid-acting) insulin may be useful to prevent or treat hyperglycemia
• Friends and other care givers should know how to recognize and treat hypoglycemia