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Abstract:
Diabetic children should consume the number of calories normal for their age, with an ideal % nutrient distribution: +/- 55% carbohydrate (especially delayed-resorption carbohydrates), +/- 30% lipid and +/- 15% protein. In some countries e.g. Belgium, the excessive proportion of fat in the diet must be reduced. Calorie requirements may vary a lot from one day to the next, but nutrient fluctuations do not entail proportional changes in metabolic control, as long as insulin adaptation is adequate. It is essential that diabetic children adapt their food intake to their appetite; they do not have set needs, since they are growing and their physical activity varies. Imposing a weighed and measured diet is neither desirable for diabetic control nor for the psychological factor. A diet which reduces only carbohydrates automatically favours an excessive supply of lipids which is bad for the blood vessels. A general calorie restriction prevents normal growth and this, in extreme cases, can lead to Mauriac's syndrome. At the other extreme, a disordered diet causes large glycaemic fluctuations with hypoglycaemic accidents and hyperglycaemic spurts responsible for degenerative complications. Dietary democracy, rather than anarchy or authoritarianism, leads to better control of diabetics. The diet must be well-balanced and individually adapted, bearing in mind insulin, physical activity, etc. Where two daily insulin injections are given, what is most important is the distribution of glucides over the various meals. The use of pen-injector provides for greater freedom in the diet. It must be borne in mind that the hyperglycaemic effect of sucrose is restrained if the sucrose is mixed with proteins and lipids during a meal; some sweets may be allowed even in the absence of intense physical activity or hypoglycaemia. The use of synthetic sweeteners and "diabetic" diet products, often useless and expensive, is not recommended.