Pediatric, adolescent, and young-adult nutrition issues in IDDM

Although insulin is life sustaining for patients with insulin-dependent diabetes mellitus (IDDM), the meal plan is of critical importance for avoiding hyperglycemia, preventing hypoglycemia, and maintaining metabolic balance. Consistency, timing, composition, and caloric content of food intake and physical activity, age, sex, growth, and pubertal status alter meal-plan needs. Self-monitoring of blood glucose should be used to individualize the meal plan. The general American Diabetes Association recommendations suggest that 50-65% of total calories be from carbohydrates from foods with a lower glycemic index and/or high fiber content. Protein should contribute 12-20% of total calories and fat less than 30%, with less than 10% saturated fat and less than 300 mg/day cholesterol. More severe fat restriction should be considered in individuals with persistent lipid abnormalities when compared with sex- and age-adjusted values. Calories should be sufficient for growth and development, with growth data obtained several times a year and plotted on standardized weight, height, and velocity charts. Blood pressure should be similarly plotted on age- and sex-standardized curves.(ABSTRACT TRUNCATED AT 250 WORDS)