A person needs protein for normal growth and development and maintenance of body protein stores. Proteins are made up of amino acids that are used for building and rebuilding the body. Proteins also act as enzymes, hormones, and antibodies. Proteins not needed for growth and development are converted into glycogen or fats and stored in the body until they're needed as energy. The recommended protein intake for a patient with diabetes is 10% to 20% of total daily calories. Eating too much protein increases the glomerular rate, which makes the kidneys work harder. If your patient develops nephropathy, teach her to restrict her protein to 0.8 g/kg of body weight per day. For example, a man who weighs 68 kilograms should consume 54 grams of protein per day. Reducing protein intake decreases proteinuria and eases the work performed by the kidneys. Large amounts of protein can raise blood glucose levels. Instruct your patient to monitor her blood glucose levels to determine if she should adjust her insulin dose for meals containing large amounts of protein. Common Caloric SweetenersSweeteners are classified as caloric or noncaloric. Sucrose, fructose, and alcohol sugars are the most common caloric sweeteners. Caloric sweet- eners are no longer banned from the diets of patients with diabetes. But if your patient consumes sucrose or fructose, she must exchange it for another carbohydrate. Just like other sources of carbohydrate, sucrose and fructose provide 4 calories per gram. However, your patient shouldn't consume more than 5% of her daily carbohydrate calories in the form of caloric sweeteners. Sugars in alcohol-sorbitol, xylitol, and mannitol-have little effect on blood glucose levels. Your patient shouldn't include them when calculating the carbohydrate content of foods. She also shouldn't use them to treat hypoglycemia. Patients with diabetes may eat all the noncaloric sweeteners currently approved for use in the United States- aspartame, acesulfame K, and saccharin. They contain virtually no calories and have a negligible effect on blood glucose. Obesity and Weight Control Obesity is a major risk factor in the development of Type 2 diabetes. As a patient's weight rises, so do her insulin resistance, glucose intolerance, lipid levels, and blood pressure. When outlining weight loss goals for your patient, consider her age, physical activity, general health, lifestyle, and current weight. Instruct her to ingest only the number of calories she needs. Children should consume enough calories to permit normal growth and development. For example, girls between ages 11 and 14 should consume 17 calories per pound of body weight per day, and boys between ages 11 and 14 should consume 30 calories per pound of body weight per day. Adults should maintain a reasonable body weight. If your patient is pregnant or breast-feeding, she should eat 300 to 500 more calories than is recommended for her age. Along with other members of your patient's health care team, devise weightloss programs that promote healthy eating habits. Tailor each program to your patient's lifestyle. Most people can safely and realistically expect to lose 12 to 3 pounds per week. If your patient is cutting back on calories, instruct her that fewer calories can cause blood glucose levels to fall. Teach your patient to monitor her blood glucose levels carefully and to adjust her medication as appropriate.