MEDICAL NUTRITION THERAPHY (MNT GOALS)

J. MARY SHALINI M.sc -DIETITIAN

* T1DM is an autoimmune condition— the immune system has “attacked” the insulin-producing beta cells of the pancreas, creating a total insulin deficiency.

*It is a common pediatric chronic illness that impairs glucose functioning and increase the blood glucose levels than the normal range.

*Diet and physical activity are critically important in the management of type 1 diabetes.

*It is important to understand how to balance food intake with physical activity, and insulin. Make healthy food choices every day to improve overall health.

MEDICAL NUTRITION THERAPHY (MNT GOALS)

*Attain and maintain optimal – Blood Glucose and Lipids.
*Provide adequate calories for maintaining normal growth and development in children.
*Improve health through optimal nutrition and physical activity.
*Integrate insulin regimen into usual eating and physical activity.
*Prevent and treat acute complications.
NUTRITIONAL NEEDS

ENERGY

• Sufficient calories to be provided for normal growth and development.

• Calorie requirement should be according to their activities.

Calorie Requirements can calculate using this formula

Up to 12 yrs of age

Total Kilocalories = 1000 + (100 × age)

CARBOHYDRATES



•Carbohydrate awareness is essential in treating T1DM, so that they know the effect of the meal on blood glucose and can better match food intake to insulin doses.
•For better glycemic control carbohydrate restriction is not recommended, 40-55% of carbohydrate from total caloric intake must be given to manage the insulin dose.

*Encourage intake of complex carbohydrates
*Avoid direct sugars soft drinks, candy, table sugar, jaggery, sweets, etc.
*If feasible, adjustments in insulin can be taught to child/parent on occasional intake of sugar containing foods.

PROTIENS





*Proteins are needed for normal growth and development.
*Should constitute 15–20 % of the Calories.

Good sources of protein: legumes, pulses, nuts, milk and milk products, eggs and non-vegetarian foods.

FATS



*Concentrated sources of energy.
*About 25–30% of total calories should be from fat.
*Use combination of oils in prescribed amount.
*Deep Fried non veg foods have more cholesterol and fats.
VITAMINS AND MINERALS



•Requirements are same for diabetic & and non-diabetic children.
•This can be obtained in a well balanced meal plan.
•Special attention should be given to calcium, iron and iodine.

Balancing Diet and Insulin

•This can be achieved with a consistent meal pattern adjusted with appropriate insulin doses.
•Insulin action (duration, starting and peak action time) should be kept in mind for meal planning.

Good Meal Planning

A good plan will make it easier to control blood glucose levels.

Eating plan should…..

*Include foods which the child likes.
*Take daily activities and schedule of the child into account.
*Be flexible.
*Keep blood glucose level within the target range.
*Help to reach and maintain a healthy weight.
*Help to prevent disease conditions.

Eating out

•Most of children enjoy eating out.
•There is no reason to avoid it just because they have diabetes.
•It is important to know what they should eat.
•Parents should be guided in this matter. Discuss healthy food choices with them.

FINE TUNING YOUR DIET

*Increase milk intake as it is essential for growth and development of bones and teeth’s.
*Include fruits and vegetables as it is a source of ANTIOXIDANTS which enhances the immune system.
*Include dhal, sprouts, whole grams, nuts which are good sources of protein which is essential for body building.
*As Junk foods have high calories, fats and less in nutrient’s it can be taken sparingly in small quantity.
*Refined products like pasta, noodles, spaghetti can be taken in prescribed amounts with addition of vegetables.
*Spending more time in watching T.V and playing videogames, should be replaced by outdoor games such as playing crickets, cycling swimming skipping, jogging,( spare at least an hour)
*Be cautious of HYPOGLYCEMIC symptoms. Check blood sugar before and after activities/exercise, if the blood sugar is low, carbohydrate snacks should be emphasized.


If your blood sugar goes low during exercise, eat a snack according to the guidelines below,

•If the blood glucose is 51 to 70 mg/dL eat 10 to 15 grams of fast-acting carbohydrate (eg, 1/2 cup fruit juice, 3 to 4 hard candies, 2 to 3 tsp of sugar with milk).

Retest after 15 minutes and repeat treatment if needed. If the next meal is more than an hour away, eat an additional 15 grams of carbohydrate.

Try not to eat too much because this can raise blood sugar levels above the target level and lead to weight gain over the long term.

Exercise

Moderate to intense exercise

*Insulin should be adjusted with increased physical activity/exercise.
*CHO-based snack can be consumed before exercise to avoid hypoglycemia Sports drinks before/during vigorous exercise is encouraged to prevent late onset hypoglycemia.
*Make changes in your lifestyle that incorporates exercise. Instead of the car, computer and a sedentary lifestyle, make yourself active, walk, and play outdoor games.

As this celebrate WASIM AKRAM is a well known challenging cricket player is also a type1 diabetic quoted as follows,

“I WOULD TELL PEOPLE THAT IF YOU HAVE DIABETES DON'T BLAME
YOURSELF OR ANYBODY, FIGHT IT. BE HEALTHY AND DEAL WITH IT”