I am more strict with my younger patients, though I proceed gently with those who come in frightened and discouraged at the diabetes mellitus diagnosis. At the first visit no concentrated sweets, low fat (especially low Saturated Fats) and low salt diet, with high vegetable and whole grain intake is recommended. If there is a follow up, then I train them regarding exchange lists and carbohydrate counting. A group setting would be ideal to teach patients about diabetic control, but that option remains a dream right now. If they have a family history of heart disease, hypertension or are obese, have proteinurea obviously tighter control (6 or so corresponding to a value of 115mg/dl glucose) would be ideal with adequate food intake to take care of hypoglycemia I feel. I have learned this from working with a doctor at my clinic and it has worked well.
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