A CHILD WITH DIABETES 'NEEDS SPECIAL ATTENTION PAID TO HER DIET, SAYS G PADMA VIJAY

MUMMY, may I have a sweet?" A common enough request from most children, and one which parents often give in to. But in some cases, saying 'Yes' could be dangerous. Juvenile diabetes can be difficult to explain to a child who has to watch all her friends eat anything they want. But without diet control, your child's health is at risk.

In juvenile-onset diabetes, also known as Type 1 Diabetes, or insulin-dependent diabetes mellitus (IDDM), the cells in the pancreas that produce insulin known as beta cells of the islets of Langerhans - are gradually destroyed, resulting in an insulin deficiency.

This deficiency can cause blood sugar levels to become excessively high, a condition known as hyperglycaemia. Weakness, weight loss, thirst and excessive hunger are the main symptoms. The peak incidence for the age of onset of IDDM in children is between 8 to 15 years, or before 25 years of age.

Maintaining healthy eating habits, along with prescribed doses of insulin, are the basic steps towards managing this disorder.

It is important to consider the timing of meals, composition of the diet, energy content of the diet and physical activity of the child. The nutrient requirements of children, relative to their body weight, are generally higher than those of adults to take care of their growth and developmental needs. Some Children with diabetes are undernourished. They require a high calorie and a high protein diet. The same is true of a highly active juvenile diabetic.

The challenges of being a teen with Type 1 diabetes are many. Forget the junk food and the partying; the child can't sleep late because the blood sugar levels can drop and the day-to-day insulin shots are more troublesome.

It is possible, however, to stay on top of the condition and still do most things a typical teenager does. But this requires full family support and continuous attention till the child is able to adapt to a lifestyle appropriate for diabetes management.

With the exception of a reduced amount of simple sugars and foods prepared with sugars, the juvenile diabetic can eat the same normal variety of foods as the rest of the family. The diet for children should be as flexible as possible in order to break the monotony.

FISH IS A GOOD SOURCE OF PROTEIN FOR A DIABETIC

Dietary fibre: The fibre present in vegetables, fruits, legumes, oats, barley and fenugreek seeds is soluble in nature and is more effective in controlling blood sugar and serum lipids than the insoluble fibre present in other cereals and millet, which of course, prevents constipation.

IT IS IMPORTANT TO EXPLAIN TO YOUR CHILD WHY SHE CAN'T EAT EVERYTHING THE OTHERS CAN

Dieticians suggesting a high fibre diet for children should keep in mind the requirement of supplements of calcium or trace minerals.The doctor should monitor the blood glucose levels and insulin requirements of these children and should adjust the insulin dosage. Around 25 g to 30 g of fibre is recommended.

Foods to be consumed freely: Green leafy vegetables and most other vegetables, herbs, spices, clear soups, high-fibre foods, water and sugar-free drinks.

Foods to be eaten in moderation: Milk, milk products, thick soups, cereals, fresh and dried fruits, nuts, legumes, pulses, breads, biscuits, breakfast cereals, pastas, custard and foods with a lot of flour, vegetable oils, root and stem tubers, salt, salty foods, fish, chicken without skin, and eggs.

Foods to be avoided: Sugar, glucose, honey, jaggery, jam, marmalade, syrups, fruits in syrup, fruit squashes, sweets, carbonated beverages, soft drinks, cakes, pastries, pies, puddings, jelly, ice cream, cream biscuits, sweetened milk, thick sauces, cream, alcoholic drinks, salad dressings, beverage mixes like Ovaltine, Complan, etc, artificial sweeteners, saturated fats like butter, ghee, coconut oil, hydrogenated fats like vegetable vanaspati, mutton, organ meats, pork, beef, and tinned, smoked and processed meats.`

Insulin should be adjusted to fit a preferred eating plan, though sometimes the diet has to be adjusted to fit the insulin dosage. Generally children with diabetes are given short-acting insulin. When regular, short-acting insulin is given before meals, the amount is adjusted to match the usual meal or snack size. The patient should eat within 30 minutes after regular insulin is taken.

Maintaining the diet is also important during the'remission period'.

patient' on insulin therapy sometimes experiences a stage when insulin is not required. This is a temporary phase when the pancreas secretes insulin and controls the blood glucose level. However, you should not become lax with your diet during this period.

• Eat three meals each day, at regular intervals. Snacks should be included in-between meals as part of the total daily calorie requirement.
• Avoid fasting, as it can result hypoglycaemia.
• If hypoglycaemia occurs, glucose is needed immediately. Children should be taught to carry candies, sugar packets and fruit juices but only for consumption in situations like these.
• Avoid skipping a meal and compensating at the next one.
• The timing of meals and snacks is very important.
• The types and amounts of foods are also important.
• Eat more high fibre foods. Another approach to increasing fibre content is by the addition of fibre supplements such as wheat bran, guargum, oatmeal and isabgol to the diet.
• Cut down on sugar and other sweet foods and prefer starches.
• Consumption of special commercially-produced diabetic foods should be discouraged, because though these are low in sugar, they are high in fat and are costly. Moreover, the use of artificial sweeteners should be discouraged.
• Eat fresh fruits and vegetables with their peels, as they are rich in antioxidants and some phytochemicals.
• Give preference to whole legumes rather than split pulses and 'dals'.
• Soya bean or gram flour can be incorporated into wheat flour to increase the protein content of the food.
• Increase the intake of some special foods such as fenugreek seeds, bitter gourd, jamun, oats, barley, dried beans (legumes), apples and citrus fruits which help lower the blood sugar levels. They also reduce lipid levels.
• Since people with diabetes are susceptible to increased serum cholesterol and serum triglyceride levels, increase their intake of some special foods like onion, garlic, ginger, Bengal gram and alfalfa sprouts.
• Use cooking methods which require a minimum amount of fat. Eat boiled, steamed and grilled foods.

These diets are not only beneficial in the control of blood sugar and serum lipids, but also reduce the risk of hypoglycemia and prevent long-term complications associated with diabetes such as heart disease, eye problems, kidney failure, etc which mainly affects those with IDDM.