Type 2 diabetics are at increased risk of morbidity and mortality from heart disease, strokes, and amputations. Numerous conditions such as insulin resistance associated with obesity and hyperlipidemia increase the risk of developing heart disease. (10) Lifestyle factors such as smoking also increases heart disease risk and people with diabetes who smoke need more intensive support and treatment. (11) Smoking raises the body's blood glucose level, damages blood vessels and increases insulin requirements and triglycerides. (2)
 
 

	Even though they may not be overweight, people with persistently high triglycerides may benefit from a very low-fat diet. (9) Recommendations for treating HIV-positive people with glucose abnormalities include maintaining an appropriate weight, appropriate nutrient intake and timing of meals (following the revised American Diabetes Associations Dietary Recommendation's), exercising, and medications as necessary. (1, 2, 12) Weight management in Type 2 diabetics is crucial to avoid secondary complications. Dietary therapy also includes following the revised National Cholesterol Education Program (NCEP) guidelines for lowering cholesterol. Appropriate nutrient intake includes limiting fat intake to 25-35% of total calories, substituting whole grains for refined foods and increasing fiber intake to 20-35 grams (both soluble and insoluble fiber) each day. It's notable that an increase in carbohydrate intake with a concomitant decrease in fat intake may increase triglyceride levels. (13) The use of plant sterols and fish oil is encouraged. Awareness of medications with the ability to increase or decrease glucose is also helpful to control blood sugar levels. Additional methods to assist with dietary treatment are in the Jan/Feb 2001 HIV ReSource Review issue. (2)