Diabetes Meal Planning: Exchanges

If you have diabetes, chances are, at some point, your doctor or maybe a dietitian has talked to you about your “diet.” Maybe you were given a “diabetic diet” to follow at some point. Or maybe you were given a list of foods to eat and foods to avoid. Perhaps you’re counting carbs or fat grams. Meal planning is a key part of diabetes self-management.

Medical nutrition therapy
Medical nutrition therapy (MNT) is the term used to describe the “diagnostic, therapy, and counseling services” provided by a registered dietitian (RD) for disease management — in this case, for diabetes. The goals of MNT are to:


• Promote and support healthful eating patterns to improve overall health
• Reach individualized blood sugar, blood pressure, and lipid goals
• Achieve and maintain a healthy body weight
• Delay or prevent complications of diabetes

Meal-planning approaches are not “diabetic diets.” Rather, they’re meant to be viewed as healthful ways of eating that can lead to improved diabetes and weight control. An RD can help you determine what approach is best for you, especially if you’re unsure. This week, we’ll look at one of the approaches that’s been around for a long time: the diabetes exchange system.

Diabetes exchanges
The diabetes or food exchanges have been around since about 1950. Prior to this time, there was no organized way of helping people with diabetes manage their food choices. The American Diabetes Association, the American Dietetic Association, and the U.S. Public Health Service teamed up to provide a solution, creating what is known as the exchange system. The goal was to provide an educational tool for people with diabetes that would provide consistency with meal planning while promoting a wide variety of foods for overall health.

How exchanges work
The term “exchange” refers to the fact that each item on a specific food list (e.g., fruit) can be swapped or “exchanged” with any other item on that list. So, for example, an orange can be exchanged for a peach or an apple. The word “exchange” may also be called a serving or a choice; they mean the same thing. One exchange is approximately equal to another in terms of calories, carbohydrate, protein, and fat.

The exchange system categorizes foods into three main groups: Carbohydrates, Meat and Meat Substitutes, and Fats. Foods are further categorized into exchange lists:

Carbohydrates: Starch, Fruit, Milk, Vegetables, Other Carbohydrates (which includes sweets)
Meat and Meat Substitutes: Very Lean Meats, Lean Meats, Medium-Fat Meats, High-Fat Meats
Fats: Monounsaturated Fats, Polyunsaturated Fats, Saturated Fats

Foods in the carbohydrate group contain between 60 and 90 calories and 15 grams of carb. For this reason, a serving or exchange from the starch list can be substituted for a serving from the fruit list. For example: 1 slice (1 ounce) of whole wheat bread equals 1 small (4 ounce) apple. A serving of starch is 1 ounce of a bread product, 1/3 cup of rice or pasta, or 1/2 cup of beans. A serving of fruit is 4 ounces of juice, 1 small piece of fruit, or 1/4 cup of dried fruit. A serving of milk is 8 ounces of milk or 3/4 cup of plain yogurt, for example. A serving of vegetables is 1/2 cup of cooked vegetables or 1 cup of raw vegetables.

Foods in the meat/meat substitutes group contain anywhere from 35 to 100 calories, 7 grams of protein, and 0–8 grams of fat per serving (generally, 1 ounce is a serving.).

Foods in the fat group contain 45 calories and 5 grams of fat per serving. One teaspoon of oil, butter, or margarine is a serving, as are 6 almonds or 2 tablespoons of avocado.

And then there are the free foods, which contain less than 20 calories and less than 5 grams of carb per serving. Examples of free foods include diet soda, sugar-free gelatin, salsa, and fat-free cream cheese. The catch with free foods is that you still need to watch portions of at least some of them; eat too much and the calories and carbs can quickly add up.

Pulling it all together
I know what some of you might be thinking: “A serving of chicken is only 1 ounce?” or “Who can eat just 1/3 a cup of pasta?” Remember that these are examples of one serving. For most foods, you’d have more than one serving of a particular food group at each meal. Here’s where the meal plan comes in. Your dietitian can provide guidance as to how many servings, or exchanges, from each food group you should aim for at each of your meals and snacks. Here’s an example of what a breakfast might look like:

2 starches: 2 slices whole wheat toast
1 fruit: 1 cup cantaloupe cubes
1 meat: 1 hard-boiled egg
2 fats: 2 teaspoons tub margarine

The number of servings or exchanges that you might get at your meals and snacks depends on several factors, including your age, gender, weight, and activity levels. Your eating habits and preferences also play a role. You can hopefully see how a dietitian can be helpful in designing a meal plan that best meets your needs. Of course, you can find many “canned” or premade meal plans in books and on the Internet. They’re often OK to use until you see a dietitian for your own personalized meal plan.

The exchange system certainly isn’t for everyone. In fact, many people feel that it’s complicated to use. However, it’s actually a well-balanced eating approach that can provide consistency and save you the hassle of counting calories and carbs. Interested? Talk with your dietitian or ask your doctor to refer you to a dietitian if you’d like to learn more. And if exchanges aren’t your cup of tea, no worries. We’ll be looking at some other meal-planning approaches in the weeks ahead.

If you’ve battled self-pity now and then during your diabetes journey, you’re not alone. Bookmark DiabetesSelfManagement.com and tune in tomorrow to learn what Type 2 veteran Martha Zimmer recommends for moving through the feelings.

  • Joan McKniff

    I use myplate.gov. wish there were a version for diabetics.