Current nutrition recommendations for children and adolescents with type 1 diabetes mellitus are rooted in the same principles as those established for all healthy children and adolescents without diabetes. Individualized meal plans should emphasize a wide variety of healthy food choices to meet the recommended nutrient intakes for essential vitamins and minerals, energy, and fiber and to provide for normal growth and development.

The individual should be advised of the following:

  • Adhering to the negotiated meal plan
  • Adjusting food and/or insulin in response to hyperglycemia
  • Adjusting insulin dose for meal size and content
  • Appropriately treating hypoglycemia

Diet should consider five key aspects:

  1. Establishing carbohydrate consistency at meals and snacks
  2. Adjusting insulin for variations in blood glucose, food, or physical activity
  3. Balancing caloric intake and expenditure for optimum weight management
  4. Balancing the nutritional content of selected protein, carbohydrates, and fats
  5. Adjusting meal-insulin timing

Carbohydrate Consistency

  • Variations in food intake, particularly carbohydrate, should be minimized to avoid fluctu‐ ations in blood glucose. Reductions in medication or insulin doses are necessary when there is decrease in carbohydrate intake.
  • When using a long-acting basal insulin and a rapid-acting insulin as bolus doses, this allows flexibility in adjustments of insulin dose according to carbohydrate intake. On the other hand, using fixed doses of short- and intermediate-acting insulin require more carbohydrate consistency in timing and amounts.
  • Patients who use short-acting insulin analogs or who use insulin pumps may need to take additional bolus insulin injections with snacks that contain more than 10–15 g of carbohydrate.

Meal planning

There are several meal planning approaches to achieve carbohydrate consistency, including

  1. Carbohydrate counting by reading food labels: looking at the grams of carbohydrates on the label.
  2. Using the exchange system: estimation of carbohydrate content can be broken down into three food groups that are standardized for carbohydrate content according to particular portions, which are carbohydrate, meat and meat substitutes and fat. The exchange lists also identify foods that are good sources of fiber and foods that have high sodium content.
  3. Use sample meal plans: These are defined meal menus that specify the time and amounts of food to be eaten at each meal and snack. Dietitians typically tailor the menus to incorporate food preferences and medical nutrition therapy (MNT) goals. Sample menus are created after review of a person’s typical food intake; they are best suited for patients who have fairly routine eating habits and who do not eat a wide variety of foods. They also are appropriate for patients who need structured guidance on what to eat.