As a dietitian and diabetes educator, some of the comments I’ve repeatedly heard from many people with diabetes over the years are "I need a diabetic diet" and "I can’t figure out those exchanges. Just tell me what to eat." It’s true that meal planning can be challenging when you have diabetes. The good news, though, is that meal planning has changed quite a bit over the years. In fact, there’s no such thing as a "diabetic diet" anymore. The best "diet" for you is one that is flexible enough to fit in with your lifestyle and help you control your blood glucose levels. In fact, there are many different ways to help you eat and manage your diabetes at the same time. This week, we’ll explore a couple of different meal planning methods that are available. Next week, we’ll look at some more.
If you’re a history buff, you might be interested to know that before insulin was discovered in 1921, the only way to “treat” diabetes was essentially by starvation. People with Type 1 diabetes were fed diets that were very low in calories, high in fat, and contained very little carbohydrate. Later, in 1950, the American Diabetes Association introduced the exchange system. The exchange system is still used today, although other meal planning methods, such as carbohydrate counting, have become more popular.
The exchange system is a meal planning method that divides foods into six different groups: starches/breads, fruit, milk, vegetables, meat/protein and fat. The foods in each group have specific portion sizes, and are all similar in calories, carbohydrate, protein and fat. You can “exchange” a food on the list for another food on the same list. For example, instead of eating 1 slice of bread, you can eat 1/3 cup cooked rice. Your dietitian figures out how many exchanges (also called “servings” or “choices”) you should aim for from each food group for each meal and snack. The number of exchanges you need is based, in part, on your calorie needs, activity level and eating style. While some people find the concept of “exchanging” to be confusing, this meal planning approach is actually pretty helpful and flexible once you get the hang of it.
Another meal planning approach that is well suited for people new to diabetes is called the plate method. No complicated lists or counting is needed. All you need is your plate! First, start off with a 9-inch dinner plate. Fill half your plate with non-starchy vegetables, such as broccoli, green beans, carrots, summer squash, or salad. Then, in one quarter of the plate, put 3 to 4 ounces of lean protein (poultry, fish, lean meat). Fill the other quarter with a carbohydrate food, such as brown rice, whole grain pasta, or a small baked potato. Supplement your meal with either an 8 ounce glass of skim or lowfat milk or a small piece of fruit, as well as 1 to 2 teaspoons of a heart healthy fat (tub margarine, olive oil or salad dressing), and there’s your meal! Pretty easy, right? The Plate Method is great for people with diabetes, but is also useful for anyone trying to control portions.
Talk with your dietitian if you’re interested in learning more about either the exchange system or the plate method. Next week, we’ll look at two different ways of carbohydrate counting.
my dietitian and i discussed the weight watchers and she said that it was the perfect diet for someone with diabetes. because it helps you keep track of your portion sizes and helps you to make better choices in food because friut and vegetables and less points so you can eat more healthy foods to stay satisfied and less junk food that doesn’t stay with as long. the only problem i have with being able to stick with that diet is that we’re staying with my in-laws and she puts bacon grease or butter and lots of salt in her vegetables when she cooks them.
Posted by crushing2004 | Aug 26, 2006 at 8:35 pmI appreciate your insights regarding diabetes. I was diagnosed with Type II diabetes in 2000. Right afterwards I lost 25 pounds and guarded what I ate. After awhile I gave up the discipline and went back to the way I was eating before. I gained the weight and had to increase the Metformin. Recently I started being more careful with my eating plan. I have lost 22 pounds and have been able to cut back on Metformin and blood pressure medicine. I am walking 30-60 minutes every day. My blood sugars have been great. I am planning to make this a way of life and eventually get off the Metformin completely. I feel so much better!
Posted by cgause58 | Oct 14, 2006 at 11:11 amDoes anyone have trouble taking Metformin? One of the side effects is diaarehia, whichI get about twice a week. I then take an Imodenine pill to stop the diaarehia. Anyone else solved this problem. I don’t want to give up Metformin because it works enough not to drop my readings to low like Glyabride did. I also take Byetta and have lost 14 Lbs.
Posted by roca | Jul 01, 2007 at 5:41 pmAny help with Metformin is appreciated.
what is the maximum amount of carbs type 2 diabetic should intake per day?
Posted by karen | Mar 04, 2009 at 11:09 amthanks,
Hi Karen,
There’s really not a set answer to your question. The max number of carbs one can have is dependent on many factors, such as weight, gender, calorie needs, activity level and level of blood glucose control. For this reason, it’s usually best if a dietitian can help determine what your specific carb needs are. Also, it’s more important to think about number of carb grams or servings per meal, rather than per day. To get you started, you could aim for about 45 grams of carb (3 carb servings) per meal and then if you eat a snack, keep your snacks at no more than 15 grams of carb. Hope this helps.
Posted by acampbell | Mar 05, 2009 at 4:05 pmHi Karen. I am the care giver of my husband Michael he is 41 and got diagnosed with type 1 diabetes 5 years ago. I need help to know exactly the portions he should be eating, and what can we do to ease his cravings which some times are hell for him and we both get the sabotaging ball rolling.
Pleas help us.
Posted by Ileana | Jul 21, 2009 at 1:23 pmHi Ileana,
It sounds like your husband (and you) should meet with a dietitian who will help him determine how many calories and carbs he needs (and who will also help with portion sizes). There’s no one meal plan for diabetes that works for everyone — much of it is based on age, gender, activity level, weight, and food preferences. A dietitian can also help with curbing cravings (his cravings may be due, in part, to his blood glucose levels). Your husband’s doctor may be able to refer him to a dietitian; if not, you could try calling your local hospital or diabetes center, or go to and click on “Find a Nutrition Professional.”
Posted by acampbell | Jul 22, 2009 at 7:40 am