Diabetes paediatric diet - no set CHO
This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.
Aim
To provide a reduced simple carbohydrate (CHO), low Glycaemic Index, reduced fat diet with lower saturated and higher poly- and mono-unsaturated fats. The meal plan provides an even and regular intake of carbohydrate containing foods that optimises blood glucose and lipid levels in patients with diabetes. Carbohydrate exchanges are not fixed and thus the meal plan can be individualised according to age, weight, appetite, growth needs, activity and insulin regimen.
Characteristics
Reduced simple carbohydrate, reduced fat diet with lower saturated and higher mono and polyunsaturated fats. ≤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 items are labeled to indicate carbohydrate content expressed as exchanges/portions (15g CHO = 1 exchange/portion).
Indications
- Children and adolescents with diabetes on insulin injection therapy where CHO containing foods need to be eaten regularly and evenly distributed throughout the day.
- Children and adolescents with diabetes on no set exchange pattern. Suitable for children with a new diagnosis of diabetes prior to meal plan development by a dietitian. This may be useful in the initial period after diagnosis when appetite may be larger than usual.
- Children and adolescents with a high diabetes risk.
Nutritional adequacy
Nutritionally adequate.
Precautions
Default: Minimum 2 exchanges at meals. Minimum 1 exchange at snacks.
Each individual meal plan is set by the dietitian and needs to be carefully developed, taking into account insulin plan, appetite, feeding pattern and nutrient requirements.
Standardised food servings (as indicated on tray ticket labels) must be adhered to, to prevent post-prandial hyperglycaemia or hypoglycaemia.
Use of age-appropriate diet will adjust fat content in dairy to provide full fat dairy for children 3 years of age and under. Education by a clinical dietitian is essential.
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 Wholegrain/wholemeal breads (preferably grainy low GI breads) are default. White bread may be made available | 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, and 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
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2009. Nutrition manual 8th ed. Canberra: DAA.
- American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
- ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Nutritional management in children and adolescents with diabetes. Pediatric Diabetes 2009: 10 (Suppl.12): 100-117.
- Australian Clinical Practice Guidelines on the management of type1 diabetes in children and adolescents APEG. 2005
- Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
- University of Sydney Glycemic Index
- 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 |