The management goal is to achieve and maintain optimal blood glucose and lipid control by making nutrition and lifestyle changes. Recommendations are to space meals and snacks throughout the day. make healthy food choices. moderate total fat, saturated fat. and calorie intake, and increase physical activity. Insulin sensitivity improves with even a modest amount of weight loss. It is recommended that a moderate calorie restriction. 250 to 500 calories less than average daily intake, be implemented. The long-term goal is to attain and maintain the healthiest weight possible.
Tables 23-2 and 23-3 summarize the nutritional assessment and therapy of pediatric patients with diabetes.
Table 23-2. Special Aspects of Nutritional Assessment in Diabetes
History Duration of disease, nutrition history, pattern of growth and weight gain, activity pattern, psychosocial/ economic issues, smoking, medical history (celiac disease, nephropathy, hyperllpidemia, eating disorder, high blood pressure, asthma, attention deficit disorder, hypothyroidism, and other autoimmune diseases), insulin regimen, oral glucose-lowering medications, blood glucose monitoring schedule
Physical Current height/weight examination
Laboratory HbAic, lipid profile, urine ketones/protein, microalbuminuria, blood pressure, fasting/nonfasting blood glucose
Adapted from The American Dietetic Association. Type 1 diabetes mellitus in children and adolescents medical nutrition therapy protocol. Medical nutrition therapy across the continuum of care. 1999. [In press].
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