Sample Nursing Research Paper on Nutritional Advice for Children with Diabetes

            Nutritional intervention is one of the key aspects of diabetes management. Nutrition intervention provided to diabetic patients is based on scientific research, clinical expertise, and knowledge obtained from evidence-based studies. Management of diabetes entails integrating nutritional modification approaches with exercise, and the use of medication. Nutrition plays a major role in diabetes management and its exclusion in the intervention increases the risk of complications and higher mortality rates. Although different communities or countries may have specific management approaches related to their nutritional intake and socio-economic status, the key aspects of diabetes management through nutrition intervention is controlling meal portions.

Definition of Concepts

Nutrition is defined as the process of taking in food, breaching it down mechanically and chemically, digesting it, absorbing it, and assimilating it. Type 1 Diabetes is also known as insulin-dependent diabetes, childhood diabetes, or juvenile diabetes. This type of diabetes commonly affects children below the age of 18 years and can be detected during the early stages of life. It is a chronic condition characterized by the production of little to no insulin. Insulin triggers the conversion of glycogen to glucose for energy production in the body. Type 1 diabetes is considered a result of an immunological-related problem that destroys the pancreatic beta cells, which produce insulin (Atkinson, Eisenbarth and Michels 71). Lifetime treatment is needed for the management of patients with diabetes.

            Hyperglycemia refers to a condition where the blood glucose level is above the normal range. According to the World Health Organization, hyperglycemia refers to blood glucose levels that are higher than 7.0 mmol/L during fasting, and a blood glucose level that is higher than 11.0 mmol/L when measured approximately two hours after a meal. Hyperglycemia results from the intake of high-energy foods or missing a dose of diabetic medication. Hypoglycemia refers to a drop in the blood glucose levels to a dangerously low level. The World Health Organization referred to a blood glucose level of 3.0 mmol/L as hypoglycemia (Patell, Nigmatoulline and Bena). Controlling hyperglycemia and hypoglycemia is essential in promoting the quality of care offered to patients and reducing the risks of complications.

            Nutrition intervention is part of the nutrition care process. It entails the methods utilized to determine the nutrition diagnosis, provide advice, patient education, delivery of nutrition therapies, and planning appropriate diet tailored to the needs of the patient. These interventions focus on the patient’s intake, knowledge, and behavior about their nutritional needs, ability to access supportive care and services, and their interaction with their environment in relation to their condition (Aathira and Jain). Nutrition interventions promote the provision of proper care to patients with diabetes.

Goals of Nutrition Intervention

Provision of optimum nutrition care for diabetes patients entails understanding their needs and the goals of the intervention based on their diagnosis. Some of the goals include attaining and maintaining an ideal metabolic status by ensuring that the blood glucose levels are within the normal range to reduce the risk of developing diabetic complications, maintaining the correct lipid profile levels to reduce risk of cardiovascular diseases, and ensuring that the patient’s blood pressure is also within the required range. The goals on nutrition intervention also entail the need to prevent and treat any chronic complications that might be associated with the disease, modification of the patient’s lifestyle as a way of preventing and managing diabetic complications or risk factors that might be associated with these complications such as obesity (Franz, Boucher and Evert), improving health through the promotion of healthy nutrition habits, food choices, and involvement in physical activity, and addressing the nutritional needs of the individual and determining the changes that will be implemented while at the same time considering the patient’s preference, cultural background, and its influences on their diet, and the willingness of the patient to change their lifestyle (Rani and Bhadada). Specific goals related to the management of children with type 1 diabetes entails the need to provide them with adequate energy to promote growth and continued development while integrating diabetes management in their lifestyle (Franz, Boucher and Evert).

Recommendations for Children with Diabetes

Energy Balance. The energy intake for different diabetic patients varies depending on their needs and the types of medication prescribed to them. Energy intake among diabetes patients should be reduced to limit the risks of complications related to hyperglycemia. It is essential to monitor the patient to determine the blood glucose level and ensure that it is within the appropriate range. Energy intake varies among different patients due to factors such as age, metabolic rates, growth rates, levels of physical activity, types of foods consumed, and other factors such as productivity. Portion control is essential among these patients as they still require energy to sustain their growth and development. Provision of energy should also be focused on promoting an ideal body weight to reduce risks of obesity and its complications. In children, the level of insulin administered should be matched with the patient’s appetite and food intake to promote growth and development.

            Based on nutrition guidelines created for diabetic patients, the amount of carbohydrate intake should be 50 to 55 percent of the total energy intake. Although there are numerous arguments on the amount of carbohydrates that should be consumed by children with diabetes, portion control should be observed to promote growth and development. Parents and caregivers should be encouraged to offer children healthy sources of carbohydrates such as whole grains, legumes, vegetable, fruits, vegetables, and dairy products that have a low percentage of fat content. The child should be encouraged to take different sources of foods containing fiber, as they are useful in reducing the lipid levels in the body (Smart, Annan and Bruno 138). Aside from this, fiber-rich foods are also important in promoting glucose release for energy provision.

            Soluble fiber found in fruits and vegetables can be particularly helpful in promoting a healthy energy balance and lipid balance.[a1] Pectin obtained from fruits may also enhance patient protection against cardiovascular diseases. Aside from reducing the risks of cardiovascular diseases and hyperglycemia, insoluble fiber can be used to promote healthy bowel functions for the patient. Foods high in fiber increase the patient’s satiety level. Processed carbohydrates should be limited as they are low in fiber and high in readily available glucose, which increases the likelihood of hyperglycemia (Smart, Annan and Bruno 138). Increases in the amount of fiber consumed by the patient should be accompanied by increased water intake to reduce the risks of constipation.

            Intake of fats should also be regulated to reduce the risk of cardiovascular diseases. Nutritional guideline recommends that children with diabetes should limit their fat intake to 30 to 35 percent of the total energy needs. Intake of foods rich in fats has been associated with overweight and obesity. These conditions are, in turn, linked to the risk of cardiovascular diseases. The primary goal in catering for the dietary fat needs in these children is usually to decrease the intake of saturated fats and trans fatty acids (Smart, Annan and Bruno 138). Saturated and trans fatty acids can be substituted by healthy forms of fats.

            Regulating the level of protein intake is important during childhood. Among children, protein intake can be decreased from 2g per kg body weight per day taken during the early years of life to 1g per kg body weight per day while the child is between eight to ten years. During the later adolescent years, the protein intake can be reduced to 0.8 per kg body weight per day (Smart, Annan and Bruno 139). Among children with diabetes, intake of foods rich in proteins is not advisable as it is associated with growth inhibition and may affect vitamin and mineral intake.

            Children with diabetes who do not have any other underlying illnesses have the same vitamins and mineral requirements as other children. Since most of the fruits and vegetables naturally contain most of the vitamins and minerals required for growth and development, it is recommended that children should utilize these sources for optimum vitamins and minerals. Aside from vitamins and minerals, the amount of salt should also be considered in children with diabetes. Guidelines show that the salt intake of children should be 1500 mg per day for those aged nine years and below (Smart, Annan and Bruno 140). Although limitations should be considered for table salt, it is also important to limit the intake of processed foods as most of them are preserved with sodium benzoate.

Weight Maintenance. It is important to maintain an appropriate weight among children with diabetes. The ideal body weight should be calculated based on nutrition parameters that consider factors such as the child’s weight, height, and age. When there is abundant food, there is likelihood to eat more than the required amount. The amount of food intake should be limited to ensure that the child gets only the required amount. Promotion of weight maintenance can be done through guiding the family on the right food choices, discussing the importance of portion control, provision of foods that are energy dense, and promoting involvement in physical activity (Smart, Annan and Bruno 137). Aside from this, discussing with the family the importance of maintaining proper meal routines and ensuring that other children in the family adhere to these routines can promote proper management of diabetes.

Counselling the Child. It is important to inform the children of the reason for the restrictions placed on their dietary intake to promote adherence and ensure that they will not jeopardize their health. Offering counseling to the children also ensures that they know how to manage short-term complications such as hyperglycemia and hypoglycemia associated with food intake or physical activity. This can increase their levels of survival in cases where their caregivers are not around.

            Portion control is the key aspect in the dietary management of patients with diabetes. Controlling what children eat can be challenging especially when other children who are not diabetic consume processed foods and those that are likely to be hazardous to diabetic children. Ensuring that children take their meals at the right time is important to reduce the risk of hypoglycemia and to promote effective use of diabetic medication. While diet plays a role in diabetes management, parents and caregivers should also promote involvement in physical activity as a way of reducing the risks of obesity.

Works Cited

Aathira, Ravindranath and Vandana Jain. “Advances in Management of Type 1 Diabetes Mellitus.” World Journal of Diabetes (2014): 5(5), 689-696. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138592/

Atkinson, Mark A., George S Eisenbarth, and Aaron W Michels. “Type 1 Diabetes.” Lancet (2014): 383(9911), 69-82. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380133/.

Franz, Marion J., Jackie Boucher, and Alison B Evert. “Evidence-Based Diabetes Nutrition Therapy Recommendations are Effective: The Key is Individualization.” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy (2014): 7. 65-72. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938438/.

Patell, Rushad, et al. “Hyperglycemia and Hypoglycemia in Patients with Diabetes in Skilled Nursing Facilities.” AACE Journal (2017): 23(4), 458-465. Retrieved from http://journals.aace.com/doi/pdf/10.4158/EP161502.OR?code=aace-site.

Rani, K. Sandhya and Sanjay Kumar Bhadada. “Medical Nutrition Therapy in Type 1 Diabetes Mellitus.” Indian Journal of Endocrinology and Metabolism (2017): 21(5), 649-651. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628529/.

Smart, C. E., et al. “Nutritional Management in Children and Adolescents with Diabetes.” Pediatric Diabetes (2014): 15(Suppl. 20), 135-153. Retrieved from https://cdn.ymaws.com/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_10.pdf.


 [a1]Promote what?