Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.

No abstract

General Recommendations: 1. Children with diabetes mellitus have the same basic nutritional requirements as other children. 2. Dietary recommendations should be based on good eating habits for the whole family. Radical changes in diet involving unusual foods or eating patterns for the child with diabetes alone are not appropriate. 3. Energy requirements of children vary widely and the energy content of the diet should be based on what the child usually eats. The diet should be reviewed regularly to meet the changing needs of growth and physical exercise without obesity. 4. The insulin regimen should, as far as is possible, be chosen to fit the child's daily lifestyle and preferred eating habits. Insulin type, dose, and frequency should be reviewed with the diet as the child develops. 5. Regular distribution of meals and snacks throughout the day remains the most important way to avoid extremes of hyperglycaemia and hypoglycaemia. This distribution should be based on an exchange system, using handy measures and taking into account food and meal type, the particular insulin regimen and the child's exercise patterns and usual eating habits. Currently this exchange system is based on carbohydrate foods but in the future the energy and fat contents will need further consideration. 6. Most special 'diabetic foods' are unnecessary. Low calorie sweeteners, as used in low calorie fruit squashes and fizzy drinks, are useful. 7. Children with diabetes from specific ethnic minority groups, or on vegan diets or living in deprived circumstances require special dietary attention for their diabetes. Those with coexisting chronic disorders such as cystic fibrosis or coeliac disease, should receive dietary advice from professionals with specialist knowledge. 8. Translating the principles of diabetic dietary management into a varied diet, arranged readily by the parents and eaten by the child, is demanding. It can best be met by a skilled dietitian working in close co-operation with child, parents, diabetes specialist nurse and doctor. Infancy 9. The diet should not differ from that of infants without diabetes. Breast feeding should be encouraged or a standard infant formula-feed used. Solids may be introduced from 3-6 months, but breast milk or a modified infant formula is encouraged as part of the increasingly mixed diet to at least the end of the first year. 10. Diabetes is rare in infancy so expert advice should be sought from dietitians experienced in paediatric diabetes. Under fives: 11.(ABSTRACT TRUNCATED AT 400 WORDS)

The broad principles of the 1982 British Diabetic Association recommendations remain valid. For the overweight, reduction in energy intake remains the most important aim. Carbohydrate should make up about 50–55% of the dietary energy intake, the majority of this coming from complex sources. preferably foods naturally high in dietary fibre or hydrolysis resistant starch. Up to 25 g of added sucrose may be allowed, provided it is part of a diet low in fat, high in fibre and that it substitutes for an isocaloric amount of fat or a high, glycaemic index food or other nutritive sweeteners. Some high carbohydrate diets have been shown to worsen glucose control and serum lipid abnormalities. Some previous recommendations for fibre intake have proved unrealistically high and of limited value. A modest increase to 30 g/d, concentrating on soluble fibre is recommended. Reduction of fat intake to 30–35% of energy intake remains an important goal which should help to reduce the incidence of cardiovascular disease in people with diabetes and aid weight loss. Of this, only 10% of total energy should be saturated, 10% polyunsaturated and 10–15% may be mono‐unsaturated fat. The latter has been shown to provide a useful alternative energy source which may have beneficial effects on glucose control and serum lipids. Cholesterol intake should not exceed 300 mg/day. Protein should comprise about 10–15% of energy intake. Reduction in protein intake and associated nutrients may help to slow down progression of nephropathy. Limitation of salt intake to 6 g/d is recommended Reduction in fat intake may be relatively more important in Type 2 diabetic patients, whereas limitation in protein intake more so in Type 1 diabetes.

In 1297 a parliament was convened at Dublin one of the main purposes of which was to defend more effectively the borders of the English lordship of Ireland. The conquest of Ireland had never been complete. Several of the pre-conquest kingdoms survived beyond the effective edge of the English lordship and elsewhere the actions of conquistador and settler had pushed the native Irish up into the hills. Consequently, the settler population in many parts of Ireland lived in close proximity to areas under Gaelic control. This was not a particular problem in the eastern province of Leinster until the 1270s when the Irish of the Wicklow mountains began to raid settler manors. It has recently been suggested that the effects of this 'Gaelic revival' and the legislation passed at the Dublin parliament to deal with its effects led several English lords to cut their landholding ties with Ireland. This article questions how important a factor conflict actually was in the decision-making processes of such English lords by examining their withdrawal from Ireland in a wider context. It concludes by pointing out that withdrawals from a landholding community were not necessarily negative in their effect or cause.