Role of nutrition in juvenile, obese, normal-weight and pregnant diabetics: position statement

The most traditional approach to nutrition and childhood diabetes speaks to the role of diet therapy of Type I diabetes. A traditional discussion could be launched on this subject. While useful and perhaps beneficial to children with diabetes, I choose a different tact for this discussion and will only comment on nutrition and Type I diabetes after diagnosis. The most important aspects of nutrition therapy for Type I diabetes involve adequate calories dispersed throughout the 24 hours day to protect from Hypo-and hyper-glycemia and provide adequate nutrition for normal growth and development. That, simply said, is very difficult to implement with total success. Intervening variables include appetite of small children and peer pressure during adolescence. Differing schemes have been proposed. I like carbohydrate counting schemes, especially when intensive insulin therapy is contemplated. This mode of therapy, when combined with frequent glucose monitoring as well as multiple injections of rapid acting insulin, allows the most flexibility in management routines. Parents can learn this form of treatment for smaller children and teenagers can tailor the management of daily life. I recognize that this might be more aggressive than many recommend; however, for discussion purposes, the very best seems to be the starting point. Any lesser therapy would be the result of discussions. While the above is important for Type I diabetes, this disease afflicts only one to 3 children per thousand. More importantly, diabetes will affect 20 to 30 times as many individuals during their lifetime. Attitudes and behaviors learned in childhood can and will affect individuals throughout their lifetimes. To continue to ignore this reality dooms children at risk to the development of Type II diabetes. Interestly, at a recent conference a presenter was discussing the more recently recognized Type I diabetes that presents in adults after a slow onset. Many are thought to have Type II, but when carefully diagnosed, have autoimmune diabetes. The presenter thought that it was better to develop this disease rather than Type II because the person with Type II has had abnormalities all of his/her life. This is an interesting proposition. Any hope at intervention in Type II diabetes must take nutrition into account. While under-nutrition continues to be a problem in some parts of the world, most of the developed and developing world suffers from over-nutrition(AU)