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Ask a Doctor: Helping manage childhood diabetes

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Ask a Doctor: Helping manage childhood diabetes

Question: A friend with a child with Type 1 diabetes frequently lets the child have high carbs, saying she just ups the quantity of insulin to counteract. Isn’t this extremely detrimental to his health? Won’t his long-term health be affected? — Beverly

Your question about carbohydrates is particularly important. It is not easy to take care of a diabetic child.

Your friend should seek consultation with a registered dietitian or a certified diabetes educator to seek nutritional advice.

There are a lot of opinions in the internet and the medical literature about carbohydrates.

Some people carry around the notion that carbohydrate is the enemy. They avoid carbohydrates and take protein to control blood sugar. It is important to realize that whatever we put in the mouth, be it carbohydrate, protein or fat, ultimately the body converts it into sugar. The brain can only consume sugar for energy. Some people persist with high protein and high fat diet. There might be transient weight loss, but eventually this leads to weight gain. The long-term safety of high-protein diet and high-fat diet is not established.

The food should be balanced with proper proportion of carbohydrate, protein and fat. Carbohydrate is needed for energy; protein is needed for repair and growth and fat is largely used for storage of energy and is used as source of energy when we do not eat at night.

How much carbohydrate, protein and fat do we need? The calculation is based on ideal body weight of a person. There are tables available to find out how much is the ideal body weight for you. In general, adults need about 1 gram of protein per kilogram of ideal body weight. The children need 1.5 grams per kilogram of body weight. Twenty percent of the total calories may come from fats. The balance may come from carbohydrates.

Eating too much protein puts a strain on the kidneys, and eventually they get damaged. Consuming the wrong kind of fat in excess leads to hardening of the arteries leading to heart disease, kidney disease, eye disease and stroke.

Proper food intake is the foundation of the care of diabetes. The rest of the treatment plan is based on this. The processing of food is defective in diabetes. The treatment is tailored to improve the food processing.

The goal of treatment for type 1 diabetes is not just controlling blood sugar. Blood sugar should be controlled the best possible for the individual, avoiding low blood sugar. The other goals are controlling blood pressure, maintaining normal body weight, allowing for normal growth and development in children and normalizing the lipid profile. Enough calories must be provided for the needs of the individual based on how active they are and what is their calorie requirement.

Medical nutrition therapy is the process by which the nutrition prescription is tailored for people with diabetes based on medical, lifestyle and personal factors.

The nutrition prescription for patients with type 1 diabetes should aim to optimally manage the “ABCs” of diabetes control: glycated hemoglobin (A1C), blood pressure and low-density lipoprotein cholesterol. The prescription must also be tailored for the individual patient to address diabetes complications and other concomitant conditions like heart disease, high blood pressure and kidney disease. The nutritional goals for people with type 1 diabetes are to:

• Provide for insulin therapy tailored into everyone’s diet and physical activity patterns.

• Provide adequate calories for achieving and maintaining a reasonable body weight, normal growth and development.

• Provide for managing the risk factors and prevent complications of diabetes, both acute complication like low blood sugar and long-term complications like high blood pressure, high cholesterol, heart disease, eye disease and nerve damage or stroke.

Nutrition therapy must incorporate personal and cultural preferences, willingness to change and maintaining the pleasure of eating by restricting choice only when clearly appropriate.

A person with diabetes is trained to self -manage his or her condition.

Your question deals with carbohydrates. Consistency in day-to-day carbohydrate intake at meals and snacks is important.

Variations in food intake, particularly carbohydrate intake, can result in erratic blood glucose levels and hypoglycemia in patients with type 1 diabetes. Intensive insulin regimens, which combine a basal insulin with short-acting pre-meal insulins, do allow for some flexibility in the carbohydrate content of meals.

It is not a good idea to keep adding extra insulin and allow a diabetic child to consume high-carbohydrate meals. It will lead to weight gain and obesity. Weight gain in a diabetic may lead to insulin resistance. In insulin resistance the body fights the insulin and the need for insulin goes up based on the weight of the person. Taking more insulin may put on more weight.

There should be proper distribution of carbohydrates throughout the day including provision for snacks if the person is taking insulin.

I hope this is helpful.

Dr. Suman Kumar Mishr at his office in Cridersville. Craig J. Orosz | The Lima News

Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville

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