Diabetes paediatric diet - CHO in grams - pump

Aim

To provide a diet that optimises blood glucose and lipid levels in patients with diabetes and specifies carbohydrate (CHO) content of items to allow precise insulin dosage. Intake can be individualised meal by meal according to age, weight, appetite, activity and growth needs.

Characteristics

Specified CHO intake.

Reduced simple carbohydrate, low Glycaemic Index, reduced fat diet with lower saturated and higher poly-monounsaturated fats. 50-60% energy from carbohydrate, ≤ 30% energy from total fat and ≤ 10% energy from saturated fat. Inclusion of one low Glycaemic Index food (GI≤55) at each meal and snack. Special sugar-free, diabetic foods and artificial sweeteners as sachets are not required.

Menu item choices include foods with and without carbohydrate.

Indications

• Children and adolescents with diabetes on insulin pump therapy or being initiated on pump therapy where exact CHO content of foods chosen need to be measured and indicated to allow precise insulin dosing.

Nutritional adequacy

Nutritionally adequate.

Precautions

Intake is chosen on menu selection by the patient, as determined by appetite, along with considerations of age, weight, growth needs and usual intake.

Use of and age-appropriate diet will adjust fat content in dairy to provide full fat dairy for children 3 years of age and under.

Education and support by a clinical dietitian is essential to ensure effectiveness and for monitoring of diet.

The safety of long term use of artificial sweeteners for children is unknown so has been excluded for children under 13 years of age.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All others	Dishes in cream sauces Pies and pastries High fat meats (e.g. sausages, bacon)
Sauces, gravies	40mL serve gravies and sauces Cranberry and mint sauces (portion control or single serve only)	White/cream/cheese based sauces, sour cream
Starchy vegetables/pasta/rice	All without fat or using mono- or polyunsaturated oil (e.g. mashed and steamed potato, potato baked in allowed oils) Use low GI rice (e.g. basmati or doongara) if possible (See GI website for full list)	Cooked in saturated fat White/cream/cheese based sauces
Vegetables	All others	Served with white cheese sauces Cooked in saturated fat
Soups	All	-
Sandwiches	Preferably made with mono- or polyunsaturated margarines	Butter
Salads, dressings	All Low joule dressings or made with mono- or polyunsaturated oils	Cream or full fat dressings or mayonnaise
Breads, cereals	Wholegrain/wholemeal breads (preferably grainy low GI breads) are default. White bread may also be made available Higher fibre breakfast cereals are default (e.g. rolled oats, muesli, bran cereals, Guardian®, Weet-Bix™) At least 2 low GI cereal choices per breakfast (See GI website for full list)	Highly sugared breakfast cereals (> 30% sugar, unless primarily from added fruit) Sweetbreads
Spreads	Jam, Vegemite™, honey, peanut butter Preferably mono- or polyunsaturated margarines/oils/mayonnaise	Saturated fats (e.g. butter, shortening, lard, cooking margarine, coconut milk, palm oil)
Hot breakfast choices	Boiled, poached or scrambled egg Mushrooms, baked beans, tomatoes	Fried egg, bacon, sausages Hash browns
Fruit	Unsweetened fresh/frozen/canned fruit in natural juice or light syrup. Fruit juices and dried fruit in moderation (≤2 serves per day)	Fruit canned in syrup
Yoghurt	Full fat yoghurt < 3 years of age Reduced fat yoghurt from 3 years of age	Reduced fat yoghurt < 3 years of age Full fat yoghurt from 3 years of age
Desserts	Ice-cream maximum 2 serves per week Low fat custards and creamy rice Tapioca, sago	High fat and sugar pastries/pies Sugared jelly
Milk and cheese	Full dairy < 3 years of age Reduced fat dairy from 3 years of age	Reduced fat dairy < 3 years of age Full fat dairy from 3 years of age
Beverages	Water, low fat milk, low joule soft drinks/ cordials, plain mineral water Fruit juice maximum 2 serves per day	Regular soft drinks, cordial, flavoured mineral water, tea, coffee, alcoholic drinks
Biscuits	Plain biscuits, Milk Arrowroot™	Cream or chocolate biscuits
Miscellaneous	All herbs and spices, nuts 1 sachet sugar per breakfast tray 1 sachet artificial sugar per breakfast tray (if > 13 years)	Sachets of artificial sweetener (for children < 13 years)
Celebratory Foods/ Special Occasions	20g chocolate easter eggs on Easter Sunday

References

1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
3. Dietitians Association of Australia. 2009. Nutrition manual 8th ed. Canberra: DAA.
4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
5. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Nutritional management in children and adolescents with diabetes. Pediatric Diabetes 2009: 10(Suppl.12): 100-117.
6. Australian Clinical Practice Guidelines on the management of type1 diabetes in children and adolescents APEG. 2005:
7. Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
8. University of Sydney Glycemic Index.
9. Diabetes Australia Glycaemic Index.

Change log

Change date	Section updated	Change
April 2021	Title of specification	Title changed from Diabetic diet - diabetes in pregnancy to Diabetes diets - diabetes in pregnancy
September 2022	Specific menu planning guidelines	Created a new food group row under Miscellaneous, titled Celebratory foods, special occasions
September 2022	Specific menu planning guidelines - Celebratory foods, special occasions	In Allowed, added 20g chocolate easter eggs on Easter Sunday