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"No concentrated sweets" diets are not recommended as a meal planning option due to the similar effect of all carbohydrate-containing foods on blood glucose level.

Infection, illness, and surgery all make glucose control difficult due to multiple factors, including increased counter-regulatory hormones, anorexia, and altered meals and snacks. In general, sick children should be given their usual insulin dose. Insulin should never be skipped, and extra insulin is often required. Blood glucose levels should be checked every 3 to 4 hours and urine ketones should be checked if the blood glucose level is over 240 mg/dL. If the child is able to eat. he or she should be given 4 to 6 oz of sugar-free fluid each hour in addition to regular meals. If the child is not able to eat his usual meals and snacks, sugar-free drinks should be alternated with sugar-containing drinks. The carbohydrate grams or servings allotted in the meal plan should be replaced with sugar-containing sodas, popsicles, juices, and gelatin.

Exercise, whether gym class, a soccer game, or a bike ride, lowers the blood glucose level both during and for up to 6 to 24 hours after the exercise. This delayed effect of exercise is called the "lag effect." To evaluate the effect of exercise, the blood glucose level should be checked before and after exercise. Exercise is not recommended if the blood glucose level is > 250 mg/dl. with ketones in the urine or > 300 mg/dl. without ketones in the urine. The safest time to exercise is after a meal or snack, when the blood glucose level is slightly higher. Basic snack guidelines are to add one starch or fruit exchange (15 g carbohydrate) for every 30 to 60 minutes of exercise.

Table 23-5. Blood Glucose Goals for Children with Diabetes

Children < 5 years of age: 100-200 mg/dL Children 5-11 years of age: B0-180 mg/dL Children 12-18 years of age: 70-150 mg/dL

Reproduced with permission from A balancing act. Children's Hospital, Boston guide to caring for a child with diabetes. 1999.

Table 23-5 provides age-dependent blood glucose targets for pediatric patients with diabetes.

Stages of Life Infants and Toddlers

Since young children are not consistent in their eating habits and cannot recognize symptoms of hypoglycemia, strict blood glucose control is not usually attainable. Generally, higher blood glucose goals are accepted (see Table 23-5), and the main goal is to avoid hypoglycemia. Infants with diabetes may certainly continue to breastfeed. Toddlers are more independent in their eating habits. Their appetites are decreasing, and they are often more selective in their food choices. Toddlers should be allowed to eat in a calm, relaxed manner and should never be force-fed. Meal plans encouraging consistent meals and snacks should be taught at this age but the variability in a toddler's eating habits must be acknowledged and accepted. Parents are ultimately responsible for providing appropriate meals and snacks; the child will decide how much and what to eat. Insulin can be given after meals for young children who are especially unpredictable in their eating habits, with the dose based on the amount of food the child actually eats.

Preschool and School Age

More structured meal and snack times should be established at this time. Limit snacks to regularly scheduled times as much as possible. School, sports, and the physical education schedule should be reviewed. Most school lunches lit into a child's meal plun. School lunch menus should be reviewed for the child's preferences and for acceptability within the meal plan. The child with diabetes should be encouraged to help with menu planning, buying groceries, preparing meals, and choosing snacks. Information should be provided on how to make the best food choices at parties, sleepovers, and restaurants.

Adolescents

Diabetes management is often most challenging at this time as the teenager is becoming more independent in managing his or her diabetes care. There are more meals away from home, with less parental supervision. Appetite and growth parameters should be monitored to guide the teenager toward making appropriate food choices. Practical information should be provided on accommodating fast food, managing restaurant eating, and adjusting the meal plan for school sports, activities, jobs, and other times away from home.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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