Diet

Nutrition for Young Athletes with Type 1 Diabetes

Francesca Annan, Paediatric Diabetes Dietitian, Royal Liverpool Children's NHS Trust, Alder Hey

Young people with diabetes have the same nutritional requirements as their peers. The diet should comprise at least 50% of energy from carbohydrate foods, no more than 30% energy from fat with saturated fat being no more than 10%, and 10 -20% of energy from protein, depending an age and requirements for growth.This is true for young sports people with diabetes, they need high quality fuel to grow and perform, but they also face the challenge of diabetes management

Essentials for young athletes

Understanding of the effects of exercise on blood glucose.

Food for growth & development

Food for sports performance

Fluid for sports performance

Management of diabetes

Insulin adjustment to allow for food and exercise.

Food for Growth & Development

Adequate energy for growth without causing overweight

50% energy as carbohydrate

10 – 20% energy as protein, age dependant

30% energy from fat

Energy Requirements

A child who is growing well, and has the energy to perform sport, is in good general health is usually getting sufficient calories.

Food for Sports Performance - Carbohydrate

Carbohydrates are the primary fuel for sport.

Training and diet influence the amount of glycogen that is stored in muscles.

At least 50% of the calories in an athlete’s daily diet should be carbohydrate. This does not include the additional carbohydrate taken for activity.

Young sportspeople with diabetes need eating plans to ensure they achieve this carbohydrate intake on a regular basis.

This table below gives a guide to the expected daily carbohydrate intake based on the Estimated Average Energy Requirements for children.

Age	Boys 50%	Boys 60%	Boys 70%	Girls 50%	Girls 60%	Girls 70%
1-3	150g	185g	-	145g	175g	-
4-6	215g	260g	190g	230g
7-10	245g	295g	345g	220g	260g	300g
11-14	280g	330g	390g	230g	275g	320g
15-18	345g	415g	485g	260g	315g	370g

(Department of Health, Report on Health and Social Subjects 41, Dietary Reference Values for Food Energy and Nutrients for the United Kingdom)

This can be used as a guide to the minimum amount of carbohydrate required per day.

Choice of Carbohydrate -see table below

Choice of carbohydrate is important to the young athlete.

Even though they may require more calories a day than their peers, attention must be paid to the type of carbohydrate consumed.

The glycaemic index is a very useful tool for sports advice.¡

High GI immediately before, during and after¡

Low GI throughout the rest of the day.

Using Glycaemic Index

High GI carbohydrate sources before and during exercise provides an almost immediate fuel source for exercising muscles.
Immediately post exercise a high GI carbohydrate source will help aid muscle recovery.
Effect of foods depends on the individual, exceptions to the GI rule include low GI fluids.
Fruit Juice can be used as the basis of a sports drink effectively despite it’s low glycaemic index.
Avoid high fat and high fibre foods (generally low GI) prior to activity, as they generally cause abdominal discomfort.
Meals consumed before (3 hours) and after exercise should be based on more slowly released forms of carbohydrate – low GI meals.

When to eat Carbohydrate

Eating 3 meals a day helps ensure an adequate carbohydrate intake.
Regular snacks also contribute to achieving total carbohydrate intake.
Pre exercise an easily digested carbohydrate snack an hour before will ensure carbohydrate is available for the activity.
Practise eating before exercise in training situations.
Eating a good supper on exercise days helps to prevent night time hypoglycaemia and refill the fuel tanks.

Food for Sport - Protein

Growing athletes need appropriate amount of protein for muscle development.
Younger children have higher protein requirements due to the demands of growth. Protein requirements decrease with age as growth slows. An older adolescent with diabetes will require around 1g/kg bw/day compared to a younger child needing 2g/kg bw/day.
Training for sports will increase a child’s protein requirement; this can be easily met in a balanced diet.

Fluid and Sports

Fluid is the other important component of an athlete’s diet.
Dehydration is dangerous and impairs performance
Poor glycaemic control and dehydration during exercise should be avoided.
Young athletes require more fluid than adults as they are less efficient at transferring heat from muscles to skin.
Getting a young athlete to drink enough fluid requires encouragement and a plan.
Often young athletes will forget to drink as well as having limited opportunities to drink during school days.

A drinking plan

Drink at least 500ml in the hour before you exercise.
Do the pee test before you start exercise.
Have another 200ml to drink at the beginning of exercise.
Drink 200ml for every 20 minutes of exercise you do
If you exercise for longer than 60 minutes use a sports drink, this helps hydration and provides fuel.
Drink at least another 500ml after the exercise is finished, do the pee test again.
Keep drinking until you don’t feel thirstyFood & Fluid for exercise recovery

Post exercise muscles need to recover.

Essentially this means replacing glycogen stores and rehydration.
This is a period which carries increased risk of hypoglycaemia for the young athlete with diabetes.
They should eat high GI carbohydrate and drink within an hour of finishing exercise.
A meal should be eaten ideally within 2 -4 hours of finishing sport, and this should include low GI carbohydratel Post exercise carbohydrate may or may not need insulin, generally reduction in insulin is required at meal times
Pre bed a substantial low GI snack is usually necessary to reduce the risk of overnight hypoglycaemia.

30g carbohydrate	15g carbohydrate
4 Jaffa cakes	2 Jaffa cakes
500ml sports drink	250ml sports drink
2 breakfast cereal bars (check the labels)	1 breakfast cereal bar (check the label)
40g jelly type sweets eg. jelly beans/jelly babies/ fruit pastilles	20g sweets eg. jelly beans/jelly beans/fruit pastilles
250ml fruit juice mixed with 250ml water	125ml fruit juice mixed with 125ml water
3 morning coffee biscuits