Diets for Type 1 diabetic patients

Greater finesse is required in managing the diets of Type 1
diabetic patients; if they eat too much, diabetic control
deteriorates; if they eat too little they become hypoglycaemic.

The important principles are that carbohydrate intake should
be steady from day to day and that it should be taken at fairly
regular times each day. If this discipline is not followed diabetic
control becomes difficult, although new approaches to the
management of Type 1 diabetes such as dose adjustment for
normal eating (DAFNE)
may permit flexibility in
which calculation of carbohydrate intake is used to calculate
the insulin dose, thus freeing the patient from a rigidly
controlled dietary intake. Severe carbohydrate restriction is not
necessarily required; indeed, if the diet is fairly generous
patients are less likely to resort to a high fat intake, which may
be harmful in the long term.

The actual requirement for carbohydrate varies
considerably; it is unsatisfactory to recommend less than 100 g
daily, and control may become more difficult if more than
250 g daily is allowed.
The smaller amounts are more suitable
for elderly, sedentary patients while the larger amounts are
more appropriate for younger, very active people particularly
athletes who may need considerably more.

Although it hasbeen observed that not all carbohydrate-containing foodstuffs
are equally absorbed and that they do not have the same
influence on blood glucose values, it is impracticable to make
allowances for such variations other than recommending that
sugar (sucrose) should be avoided except for the treatment of
hypoglycaemia.

For social convenience it is customary to advise that most of
carbohydrate should be taken at the main meals—breakfast,
lunch, and dinner—even though these are not necessarily the
times when, according to blood glucose profiles, most
carbohydrate is needed; for example, less carbohydrate at
breakfast and more at mid-morning and lunch often improves
the profile.
Snacks should be taken between meals—that is, at
elevenses, during the afternoon, and at bedtime—to prevent
hypoglycaemia.

At least the morning and night snacks are
essential and should never be missed.
For the convenience of some, and for those adopting the

DAFNE method of controlling Type I diabetes and therefore
needing to calculate the carbohydrate content of their meals,
10 g of carbohydrate is described as “one portion” so that
a 170 g carbohydrate diet is described to patients as one of
“17 portions”. Patients sometimes find it valuable to know the
carbohydrate values of different foodstuffs