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adversely effect plasma lipids by increasing triglycerides. But there is no reason to recommend that persons with diabetes avoid naturally occurring fructose, e.g., in fruits, vegetables and other foods. A moderate intake of fructose (up to 30g/day) appears to have no deleterious effects on plasma insulin and lipids in persons with type 2 diabetes (8). Adding fructose, sugar alcohols, and other nutritive sweeteners, all of which are energy sources, does not have substantial advantage over added sucrose as a sweetener for people with diabetes and therefore should not to be encouraged (6,7,10). Intake of food containing sugar alcohols has been reported to cause diarrhea. Furthermore, it is unlikely that sugar alcohols in the amounts likely to be ingested in foods or meals will contribute to a significant reduction in total energy or carbohydrate intake, although they are only partially absorbed from the small intestine.

Approved nonnutritive sweeteners may be used by people with diabetes to sweeten beverages, desserts, fruits, etc. (6,14,55). The recommended acceptable daily intake (ADI), defined as the amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without risk, should be considered when nonnutritive sweeteners are chosen. However, it is unknown whether the use of nonnutritive sweeteners improves glycemic control or assists in weight loss in persons with diabetes.

For individuals with type 2 diabetes treated with insulin, to avoid hypoglycemia and excessive postprandial hyperglycemia it is important that the timing and dose of insulin match the amount, type, and time of carbohydrate-containing food intake (8,9). Individuals receiving intensive insulin therapy should adjust their premeal insulin dose based on the content and glycemic load of carbohydrate-containing snacks and meals. In persons with type 2 diabetes postprandial glucose responses to a variety of carbohydrates are similar if the amount of carbohydrate is constant (14). Patients should therefore try to be consistent in day-to-day carbohydrate intake when they are treated with fixed daily insulin doses or with high doses of sulfonylurea or glitinides to avoid hypoglycemic episodes. Self-monitoring of blood glucose is helpful in determining the most appropriate timing of food intake and optimal food choices for the individual patient. There are no general principles regarding the optimum frequency of snacks and meals. Individual preferences, the needs of different treatment regimes and total energy requirements are the main determinants of meal frequency and portion sizes (6).

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