Fact sheetDiet specifications

Published on 1 Nov 2012 ; Partial revision Apr 2021


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

  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 updatedChange
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
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