46 JH Yoo • Nonpharmacological management for children with T1DM Introduction Nutritional support Type 1 diabetes mellitus (T1DM) is caused by immune-mediated mechanisms or direct destruction of insulin-secreting βcells of the islets of Langerhans. Globally, it generally occurs in childhood through adolescence, but its incidence is quite diverse among different ethnic groups. In Caucasian individuals younger than 14 years of age, the incidence rates of T1DM are roughly 20–30 cases/year/100,000 individuals, but the incidence rates of T1DM are very low in Asia including Korea1, 2). From 1995 to 2000, the incidence rates of T1DM in children and adolescents younger than 15 years of age in Korea were reported as 1.36 cases/year/100,000 individuals on average. The ages at which T1DM occurred most frequently were 10 years in boys and 12 years in girls, and T1DM occurred most frequently in those aged 10–15 years. That is, the highest incidence rates were shown in peripubertal school-age children3). Children who have been newly diagnosed with diabetes are placed in completely new environments to manage their diabetes. For appropriate control of diabetes, they must self-monitor the blood glucose levels and inject insulin several times a day, and must use extreme self-control when eating foods to avoid increases in blood glucose levels. In addition, these patients require more exercise than other children in the same age groups. Blood glucose excursions resulting from impaired pancreatic β-cell functions cause mental stress due to vague fears of chronic complications of diabetes. In addition, children with diabetes cannot be exempted from the substantial amount of studies required of Korean adolescents, and the absolute shortage of time for ideal control of diabetes increases their mental stress. In particular, as children with T1DM in Korea are rare to the extent that there is only 1 per school, many of them are psychologically isolated in school where they spend most of the time, and they are not appropriately considered or supported with respect to blood glucose control in many cases. In Korea, insulin lispro, insulin aspart, insulin glargine, and insulin detemir were individually introduced more than 10 years ago and accordingly, conventional NPH-based insulin therapy has been replaced by multiple daily insulin injection regimens in an increasing number of cases4, 5). Compared to recent developments in pharmacological therapy applicable to Korean children with T1DM, interest in nonpharmacological therapy and psychosocial support systems remains low, as is the development of Korean-style T1DM education programs for therapeutic application. In this respect, this author will introduce some of the newest views on nonpharmacological therapy and psychosocial support systems that account for important parts of T1DM management and seek measures to apply them in conformity with the social characteristics of Korea. Nutritional therapy is a core component of T1DM treatment. However, better clinical outcomes can be expected only when nutritional therapy is harmonized with insulin treatment and exercise6). Therefore, dieticians should consider the planning, contents, and timing of snacks/meals so that nutritional therapy can be applied in conformity with individuals’ insulin action profiles and lifestyles7, 8). Therefore, dieticians should periodically evaluate nutritional management together with diabetes care teams and families including children. Children who have been newly diagnosed with diabetes or those who poorly control diabetes sometimes exhibit excessive appetite and unnecessarily large energy intake because catabolic states have been prolonged. When blood glucose has been stabilized and decreases in body weight have been recovered, energy intake should be reduced. However, children and adolescents with T1DM require sufficient energy intake for optimal growth and maintenance of ideal body weight. In particular, as adolescents exhibit rapid increases in energy intake and nutritional demands, along with insulin dosage adjustment, changes in nutritional therapy should be pursued. It is recommended that carbohydrates should account for 50–55% of the total daily energy intake. This recommendation is shared by healthy children during growth periods and children and adolescents with T1DM for optimal growth9-11). However, it is recommended that they consume rough rice, which is a healthy carbohydrate food. Fat intake is recommended to be 30–35% of the total daily energy intake10-12). Saturated fat and trans-fatty acid intake is recommended to be maintained within 10%6). It is recommended to increase the intake of lean meats, fish, and low-fat dairy products and the use of olive and sesame oils to increase the intake of monounsaturated fatty acids and polyunsaturated fatty acids. Protein intake is recommended to be 10–15% of the total daily energy intake13). The recommended consumption amount is 0.8–1 g/(kg ∙ day), and the demand will be reduced as people age. The consumption of vegetable-derived proteins such as Tofu is recommended, as is the consumption of proteins through fish, lean meats, and low-fat dairy products8). Fiber intake is recommended to be “age in years + 5 = grams of fiber per day” for children aged 2 years or more11). That is, the consumption of 15 g of fiber per day is recommended for 10-year-old children. The consumption of foods with large amounts of fibers such as fruits, vegetables, and wholegrain cereals is recommended, and because these foods increase satiety and suppress the intake of foods with higher calories, it is necessary to encourage children to consume these foods sufficiently. Children and adolescents with diabetes are not recommended to supplement their intake of vitamins, minerals,