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& u glucose levels for years until they achieved weight loss. In the current age of ''treat to target,'' if a patient cannot achieve weight loss within 6 months, then pharmacological therapy is indicated. Even though weight loss is the preferred treatment strategy, medications can be discontinued but microvascular and mac-rovascular disease cannot be reversed.

The recommended fat content of the diabetes meal plan is also based on an individual patients's lipid levels, blood glucose levels, and weight goal. In general, it is recommended that saturated fat intake comprise less than 10% of daily calories, and dietary cholesterol intake be less than 300 mg or less daily (9). Patients who are at a reasonable body weight and have normal lipid levels are encouraged to follow the recommendations of the National Cholesterol Education Program (NCEP) in order to reduce their risk for cardiovascular disease. In individuals over age 2, limiting fat intake to less than 30% of daily calories, with saturated fat restricted to less than 10% of total calories, polyunsaturated fat less than 10% of daily calories, and monounsaturated fat in the range of 10% to 15% of daily calories is recommended. For patients with type 2 diabetes and elevated LDL cholesterol, further restriction of saturated fat to 7% of total calories and dietary cholesterol to less than 200 mg per day is recommended.

The amount of fat that a patient chooses to consume is often linked not only to ethnic foods but regional American foods as well. In some parts of the country, a typical breakfast includes sausage, eggs, biscuits, and gravy. Although the dietitian can offer breakfast choices lower in fat, some patients are not willing to change. For them, the goal may be to limit the high-fat breakfast to three times per week instead of every day. Patients with diabetes who have not had the benefit of counseling by a dietitian commonly limit their carbohydrate intake in a fruitless effort to lower their blood glucose levels and are left with a diet high in fat from animal protein, dairy-fat-containing foods, and oils.

People with diabetes voice the common frustration that there is nothing left to eat since carbohydrate, fat, sodium, and alcohol are restricted. A moderate sodium intake (no more than 3000 mg/day) is recommended. For those with hypertension, sodium intake is limited to less than 2400 mg/day. The decision to include moderate amounts of alcohol in the meal plan is based on the patient's triglyceride levels, weight goals, usual habits, culture, and other medications. Based on an assessment of a patient's laboratory values, usual eating habits, cultural preferences, and weight goals, a meal plan can be created that includes a variety of foods in reasonable portions. |

There is much more that a patient with diabetes needs to know about what to eat. Table 2 lists both the skills that a patient needs to make management decisions and to solve problems. Because not every patient has the ability or the interest to learn new skills, some patients may be better served with focused educational sessions or lists of acceptable foods. J

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