Chapter 10: Nutritional management
| 2
Thread Actions

1/24/2018 at 4:07:21 PM GMT
Posts: 40
Chapter 10: Nutritional management

Dear ISPAD member/friend,

Thank you for your continued interest in the 2018 ISPAD Clinical Practice Consensus Guidelines and in the previous drafts chapters we shared with you.

We are happy to announce that chapter 10 on Nutrional Management is now ready for you to read and comment on. We are looking forward to hearing your thoughts and input on this chapter. 

Kind regards,

David Maahs

ISPAD Secretary-General

 Attached Files: 

Last edited Wednesday, May 9, 2018
1/27/2018 at 5:09:01 PM GMT
Posts: 9
Nutrition Management
I enjoyed reading the informative chapter on Nutritional Management.
I offer the following comments for your consideration.

Executive summary

Suggest changing the sentence: "Nutrition therapy is recommended … as well as the cognitive abilities and psychosocial circumstances of the child and family (E)" 

5th bullet Perhaps it is implied, but I suggest explicitly stating that both growth (height) and weight should be monitored. 
In the US and Europe, excessive weight gain is common. This is mentioned later in the chapter.

I do not disagree with the last bullet, but I am not sure it is appropriate to include in an Executive Summary of Nutritional Management

P.8 Vitamins, minerals and antioxidants 
"… following a country's national dietary guidelines …"

P.12 Insulin regimens (not regimes)
Important to point out that there is a possibility of some meal time flexibility if rapid- or short-acting insulin is not a component of a premixed insulin formulation; i.e., is injected separately from NPH or long-acting analog

P.13 last paragraph
Here, it is important clarify that this is instead of a rapid-acting analog

P.18 The worldwide prevalence ranges from 1.6% to 16.4% according to Pham-Short et al. (review in Pediatrics 2015)

P.19 In these guidelines, I suggest providing more specific information concerning a widely used validated screening questionnaire for Eating Disorders so that the interested reader does not have to go searching. Perhaps provide this as a supplement at the end of the article? 

1/28/2018 at 8:59:14 PM GMT
Posts: 7
Dear Joe,

Thank you and all great points.

We will provide more detail on the current validated screening questionnaires for Eating Disorders in children and adolescents with diabetes. How they are used does vary with most clinics then referring to a psychologist or an Eating Disorder team for more detailed screening.

Best Wishes,

1/29/2018 at 3:23:22 PM GMT
Posts: 2
Comments on Chap. 10, Nutritional management

I enjoyed reading the draft Nutritional Management Guidelines for youth with diabetes - they look excellent. I especially love the inclusion of the Joslin Diabetes Center plate. I might include a note here that the plate can be thought of as a guide to both the individual meal and the day as a whole, as some people will choose to break it up and have dairy and fruit as a snack in between meals, rather than alongside of a meal.

Just a couple of other comments:

  • On page 7 "No more than 10% energy from saturated and trans fatty acids is recommended" - since evidence supports that there is no safe level of trans fats and that they are not necessary in the diet (1,2), and industrially produced trans fats are avoidable by examining ingredient lists for partially hydrogenated oils (3), it could be beneficial to make this distinction in the guidelines by saying "No more than 10% energy from saturated fats and no consumption of industrially manufactured trans fats is recommended."

1. German, J. B., & Dillard, C. J. (2004). Saturated fats: what dietary intake?. The American journal of clinical nutrition, 80(3), 550-559.

2. Trumbo, P., Schlicker, S., Yates, A. A., & Poos, M. (2002). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Journal of the American Dietetic Association, 102(11), 1621-1630.

3. Trans fat: Avoid this cholesterol double whammy - Mayo Clinic [Internet]. [cited 2018 Jan 29]. Available from:

  • On pg 17 and anywhere else where blood glucose is given in mmol/L, it would be nice to have mg/dl in parenthesis for easy conversion, i.e. "below 5mmol/L (90 mg/dl)..."

Thank you again,


Last edited Monday, January 29, 2018
1/30/2018 at 3:48:04 AM GMT
Posts: 7
Dear Katie,
Thank you so much for your feedback.
We will add the point that the plate is a guide to both daily and individual meal content.
I agree it is good to spell out that Trans fats need to be further limited.
Thanks again!

1/30/2018 at 8:11:05 PM GMT
Posts: -10
Thank you team for this comprehensive chapter on Nutrition Management.
It will form a very integral part of the 2018 guidelines.
I have a few inputs.

pg 6 under low carbohydrate diets, last sentence " caregivers need reassurance that optimal glycemic.........quality carbohydrate. I think the phrase quality carbohydrate is vague and I suggests a more specific recommendation such as "complex".

Pg 6. Sucrose - bullet 2, second and final sentence. " Diet or light drinks can be ......
have you had any consideration of the research and evidence on diet sodas and the following:
- T2 DM
- Gut microbiome
-Weight gain
-Cardiovascular diseases?

pg 9 Specially labeled Foods, bullet 4-6
saccharin .... If they are all speaking to the same thing they need to be linked, maybe a shorter sentence.

Great work, I await the final guidelines.

Best Regards


1/31/2018 at 5:47:48 AM GMT
Posts: 7
Thank you very much Rosalee for these comments.

We are only suggesting the inclusion of diet drinks at events such as birthday parties, so very infrequent consumption (and also space limited!). However, to address your point a sentence has been added to encourage water consumption.

Thanks again for your feedback!

2/20/2018 at 9:10:29 AM GMT
Posts: 2
This is an excellent and very practical review.  I note that the overall message regarding low carb diets is quite negative and may not adequately address interests of the parents/patients who are using some degree of low carbohydrate intake with good results. The guidelines are not actually inconsistent with recognizing that in the process of individualizing care, some patients may wish to consume fairly low amounts of carbohydrate.  The guidelines  provide all the very appropriate caveats (particularly for young children) but I think could be more effectively presented by recognizing and providing additional specific guidance to ensure appropriate use of such diets in a safe manner, including ranges of carbohydrate intake (e.g., < 20%, 20-30%, 30-40%).

2/23/2018 at 5:20:53 AM GMT
Posts: 7
Dear Beth,
Thank you so much for your comments on the important issue of low carbohydrate diets in childhood.
Low carbohydrate diets have not been well studied in children with type 1 diabetes. There is no published literature that shows carbohydrate intakes < 40% energy improve glycaemic or other health outcomes in children with Type 1 diabetes. However, clinical experience indicates an increased risk of poor growth, dietary restriction with major changes in dietary habits, and a prescribed reduction in the intake of fruits, vegetables and wholegrains. This contrasts with Dietary Guidelines from many countries that support eating patterns that focus on variety and encourage fresh fruit and wholegrains. Clinical experience also shows optimal glycaemic outcomes can be achieved in children consuming 45-50% energy from CHO with appropriate insulin dosing and change in type of carbohydrate.

We totally agree our advice must be individualised and also agree that it is vital to discuss this topic respectfully and sensitively.I will emphasise these points more strongly.

In light of the significant potential risks, our overall message is to discourage the routine use of low carbohydrate diets in growing children and adolescents. We have noted in the previous paragraph that an optimal percentage of energy from macronutrients has not been defined and that individual and family preferences should be taken into account. We have also acknowledged higher protein diets can be useful for weight management in obese adolescents. We would welcome more discussion on this topic.

Thank you again Beth for raising this!

2/23/2018 at 2:19:12 PM GMT
Posts: 2
Thanks Carmel - all makes good sense and i appreciate the note re respectful and sensitive discussion to be sure those trying low carbohydrate diets remain engaged with guidelines, and are open to all the concerns which are so important and well stated. We do need more research in this area for sure given that patients are pursuing low carb diets with or without us! Thanks again, Beth

Contact Us

ISPAD Executive Office
c/o K.I.T. Group GmbH
Association & Conference Management
Kurfürstendamm 71
10709 Berlin, Germany


Click the link below to join the Society!

Join Today!

Phone: +49 (0)30 24603-210
Fax: +49 (0)30 24603-200
Email: secretariat@ispad.or

Privacy Policy
Terms of Service
Legal Notice    


 © 2020 International Society for Pediatric and Adolescent Diabetes (ISPAD)

Association Management Software Powered by YourMembership  ::  Legal
This website uses cookies to store information on your computer. Some of these cookies are used for visitor analysis, others are essential to making our site function properly and improve the user experience. By using this site, you consent to the placement of these cookies. Click Accept to consent and dismiss this message or Deny to leave this website. Read our Privacy Statement for more.