Feeding diabetic children

The prevention and treatment of various chronic diseases in the pediatric population are directly related to children's eating habits and lifestyle.

Providing a balanced diet and encouraging an active lifestyle from childhood helps to protect children from overweight and obesity, which are risk factors for the development of cardiovascular diseases and type 2 diabetes, among others.

Diabetes mellitus is a group of metabolic disorders characterized by persistently high levels of glucose (sugar) in the blood. This condition can lead to complications in various body systems, including vision loss, impaired kidney function and cardiovascular problems, among others.

Main types of diabetes mellitus

Type 1 diabetes mellitus: constitutes between 5% and 10% of diabetes cases, and is characterized by the total absence of insulin.

Type 2 diabetes mellitus: represents between 90% and 95% of the population with diabetes. This type usually develops in adults over 40 years of age, but is increasingly common in young people, adolescents and children. It is associated with overweight and obesity, which are the consequence of poor eating habits and lack of exercise.

General information on diabetes mellitus in childhood

Diabetes mellitus is the most common endocrinological disease in childhood. In pediatrics, type 1 diabetes is significantly more prevalent. However, in recent years, an increase in cases of type 2 diabetes has been observed, probably linked to the increase in overweight, obesity and sedentary lifestyles among children.

Nutritional therapy, together with insulin treatment and physical activity, is fundamental to the management of type 1 diabetes in children. This approach should be tailored to the results of capillary glucose testing, which is performed by the family after appropriate training by professionals specialized in pediatric diabetes.

The role of carbohydrates in the diabetic diet

Adequate carbohydrate intake is essential in the diet of people with diabetes to prevent and control the disease.

The speed with which carbohydrates in food are digested affects their assimilation, the feeling of satiety they generate and their impact on the treatment of diabetes. Carbohydrates can be classified into two main groups according to their chemical structure:

• Simple carbohydrates: they are divided into monosaccharides (glucose, fructose, galactose) and disaccharides (sucrose, maltose, lactose). Examples of foods rich in simple carbohydrates are table sugar, sweets, cakes and soft drinks. These foods are rapidly absorbed by the body, which makes them less healthy compared to complex carbohydrates.

• Complex carbohydrates: include polysaccharides or long-chain carbohydrates, starch being the most common. Dietary fiber, which is also a non-digestible polysaccharide, provides important benefits. Foods rich in complex carbohydrates, such as legumes, whole grains, potatoes and vegetables, are digested more slowly, making them healthier choices.

Food selection based on carbohydrate absorption rate

The energy needs of children with diabetes are similar to those of healthy children of the same age, so carbohydrates should not be restricted and should provide between 50% and 60% of the energy needed.

To ensure adequate carbohydrate intake without causing spikes in blood sugar levels, it is essential to choose carbohydrates that require longer digestion and have slower absorption, which helps to maintain more stable glucose levels. Generally, foods rich in complex carbohydrates meet these criteria.

There are two indices that help to know how foods affect blood glucose:

• glycemic index (GI).

• Glycemic load (GL).

Glycemic index (GI): measures the ability of foods to raise glucose levels after ingestion. Foods with a high GI raise glucose more rapidly than those with a medium or low GI.

Glycemic load (GL): assesses how a specific amount of food impacts glucose levels. This parameter is more useful than the GI, as it provides information on the exact amount of food to consume to keep glucose stable.

Tables of glycemic indexes and glycemic loads of different foods facilitate the proper selection of foods and portions, according to the pediatrician's recommendations.

Calculating the glycemic load of a food

The glycemic load is calculated by multiplying the glycemic index of the food by the amount of carbohydrate in the serving and dividing the result by 100.

For example: the glycemic index of watermelon is high, but if a moderate portion is consumed, the glycemic load may be low. Let's look at the calculations:

• Glycemic index of watermelon: 75.

• Amount of carbohydrates in 100 grams of watermelon: 5 grams.

• Formula: GL = GI x (amount of carbohydrates in the serving) / 100.

Now, we substitute the values:

• CG = 75 x 5 grams / 100 = 3.75 glycemic load.
• The glycemic load obtained is less than 10, which classifies it as low.

Factors influencing the glycemic index

• Dietary fiber content: a higher amount of fiber in the food reduces absorption and therefore lowers the GI.
• Cooking intensity: prolonged and moist cooking increases the GI, so pasta or potatoes should not be excessively softened.
• Ingestion temperature: cooked foods that are cooled have a lower GI. It is recommended to consume them once they have lost most of their heat.
• Acidity of food: adding vinegar can slow down the rate of absorption and thus reduce the GI.
• Ripeness: very ripe fruits have a higher GI. It is ideal to choose fruits at their optimum ripeness.
• Food presentation: whole or chunked foods are absorbed more slowly than purees or liquids. It is recommended to consume tubers, vegetables and whole fruits, avoiding purees or juices that increase the GI.
• Food combinations: consuming foods with different GIs in the same meal can help reduce the GI of carbohydrates.

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