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Meal Planning With Diabetes Exchanges


What are diabetes exchanges?

Diabetes exchanges are groups of food with similar amounts of carbohydrate, fat, protein, and calories. The exchanges can be used to develop a healthy meal plan to control your blood sugar level.

Why are diabetes exchanges important?

Diabetes exchanges can help keep your blood sugar level steady. A meal plan with the right amount of carbohydrates is especially important. Your blood sugar naturally rises after you eat carbohydrates. Too many carbohydrates in 1 meal or snack can raise your blood sugar level. Carbohydrates are found in starches, fruit, milk, yogurt, and sweets. Do not skip meals or avoid carbohydrates, because your blood sugar level can fall too low.

How do I create a meal plan with exchanges?

A dietitian will develop a healthy meal plan that is right for you. This meal plan will include the amount of exchanges you should have from each food group throughout the day. Your meal plan will be based on your age, weight, blood sugar levels, medicine, and activity level.

What are the exchange food groups?

Once you know how many exchanges you should have for each meal, you can exchange foods within the same group. This allows you to eat a variety of food while you keep your intake of carbohydrates and other nutrients the same. Follow your meal plan by keeping track of the amount of exchanges you eat for each meal and snack.

  • Starches: The following foods contain about 15 grams of carbohydrate, 3 grams of protein, 1 gram of fat, and 80 calories. Each serving counts as 1 exchange of starch .
    • 1 ounce of bread
    • 1 ounce of bagel (about ¼ of a bagel)
    • 1 4-inch pancake (about ¼ inch thick)
    • 1 6-inch flour or corn tortilla
    • ⅓ cup of cooked pasta or rice
    • ¾ cup of dry, ready-to-eat cereal with no sugar added
    • ½ cup of cooked cereal, such as oatmeal
    • 3 graham cracker squares or 8 animal crackers
    • 6 saltine-type crackers
    • 3 cups of popcorn
    • ¾ ounce of pretzels
    • Starchy vegetables and cooked legumes:
      • ½ cup of corn, green peas, sweet potatoes, or mashed potatoes
      • ¼ of a large baked potato
      • 1 cup of acorn, butternut squash, or pumpkin
      • ½ cup of beans and peas (such as pinto, kidney, or black-eyed)
      • ⅔ cup of lima beans
      • ½ cup of lentils
  • Fruit: The following foods contain about 15 grams of carbohydrate and 60 calories. Each serving counts as 1 exchange of fruit .
    • 1 small (4 ounce) piece of fresh fruit. Weigh fresh fruit at the grocery store. Large pieces of fruit usually weigh more than 4 ounces and count as more than 1 serving.
    • ½ cup of canned or fresh fruit
    • ½ cup (4 ounces) of unsweetened fruit juice
    • ¼ cup of dried fruit
  • Milk: The following foods contain about 12 grams of carbohydrate and 8 grams of protein. The amount of fat and calories in each serving depends on the type of milk (such as whole, low-fat, or fat-free). Each serving counts as 1 exchange of milk .
    • 1 cup low-fat milk
    • ¾ cup of plain, nonfat yogurt
    • 1 cup fat-free, flavored yogurt with artificial (no calorie) sweetener
  • Non-starchy vegetables: The following foods contain about 5 grams of carbohydrate, 2 grams of protein, and 25 calories. Each serving counts as 1 exchange of vegetables . Examples include beets, broccoli, cabbage, carrots, cauliflower, cucumber, mushrooms, tomatoes, and zucchini.
    • ½ cup of cooked vegetables or 1 cup of raw vegetables
    • ½ cup of vegetable juice
  • Meat and meat substitutes: The following foods contain no carbohydrate and about 7 grams of protein. Meats with greater amounts of fat have more calories. Each serving counts as 1 exchange of meat or meat substitute .
    • 1 ounce of chicken or turkey without skin, or 1 ounce of fish (not breaded or fried)
    • 1 ounce of lean beef, pork, or lamb
    • 1-inch cube or 1 ounce of low-fat cheese
    • 1 large egg (limit eggs to 3 each week) or ¼ cup of egg substitute
    • ½ cup of tofu
  • Sweets and other desserts: Each of the following has about 15 grams of carbohydrate.
    • 1 ounce of angel food cake (each serving counts as 1 carbohydrate exchange )
    • 1 2-inch square of a brownie that is not frosted (each serving counts as 1 carbohydrate and 1 fat exchange )
    • 2 small cookies (each serving counts as 1 carbohydrate and 1 fat exchange )
    • ½ cup of sugar-free, fat-free ice cream (each serving counts as 1 carbohydrate exchange )
  • Combination foods:
    • 1 cup of an entrée, such as lasagna, spaghetti with meatballs, macaroni and cheese, and chili with beans (each serving counts as 2 carbohydrate and 2 fat exchanges )
    • 1 cup of tomato or vegetable beef soup (each serving counts as 1 carbohydrate exchange )
  • Fats: Each serving below contains 5 grams of fat and 45 calories. Each serving counts as 1 fat exchange .
    • 1 teaspoon of oil (such as canola, olive, or corn oil)
    • 6 almonds or cashews, 10 peanuts, or 4 pecan halves
    • 2 tablespoons of avocado
    • ½ tablespoon of peanut butter
    • 1 teaspoon of regular margarine or 2 teaspoons of low-fat margarine
    • 1 teaspoon of regular butter or 1 tablespoon of low-fat butter
    • 1 teaspoon of regular mayonnaise or 1 tablespoon of low-fat mayonnaise
    • 1 tablespoon of regular salad dressing or 2 tablespoons of low-fat salad dressing
  • Free foods:
    • The foods on this list are called free foods because they have very few calories. Free foods usually do not increase your blood sugar if you limit them. You may have 3 servings each day from this list. Do not eat all 3 servings at the same time, because your blood sugar level may increase.
      • 1 tablespoon of catsup or taco sauce
      • ¼ cup of salsa
      • 2 tablespoons of sugar-free syrup or 2 teaspoons of light jam or jelly
      • 1 tablespoon of fat-free salad dressing or fat-free sour cream
      • 4 tablespoons of fat-free margarine or fat-free mayonnaise
    • You can eat the following foods as often as you like.
      • Sugar-free drinks: diet soda, sugar-free drink mixes, or mineral water
      • Low-sodium bouillon or fat-free broth
      • Mustard
      • Seasonings such as spices, herbs, and garlic
      • Sugar-free gelatin without added fruit

What other important guidelines should I follow?

  • Eat more fiber: Choose foods that are good sources of fiber, such as fruits, vegetables, and whole grains. Cereals that contain 5 or more grams of fiber per serving are good sources of fiber. Legumes such as garbanzo, pinto beans, kidney beans, and lentils are also good sources.
  • Limit fat: Ask your dietitian or caregiver how much fat you should eat each day. Choose foods low in fat, saturated fat, trans fat, and cholesterol. Examples include turkey or chicken without the skin, fish, lean cuts of meat, and beans. Low-fat dairy foods, such as low-fat or fat-free milk and low-fat yogurt are also good choices. Omega-3 fatty acids are found in fish. They are healthy for your heart and should be included in your meal plan. Eat 2 or more servings of fish each week. Do not eat fried fish.
  • Limit sugar: Sugar and sweets must be counted towards the carbohydrate exchanges that you can have within your meal plan. Limit sugar and sweets because they are usually also high in calories, fat, and cholesterol. Eat smaller portions of sweets by sharing a dessert or asking for a child-size portion at a restaurant.
  • Limit sodium: Limit sodium (salt) to about 2,300 mg per day. You may need to eat even less sodium if you have certain medical conditions. Foods high in sodium include soy sauce, potato chips, and soup.
  • Limit alcohol: Ask your caregiver if it is safe for you to drink alcohol. If alcohol is safe for you, eat a meal when you drink alcohol. Alcohol on an empty stomach may cause a drop in your blood sugar level. Women should limit alcohol to 1 drink per day. Men should limit alcohol to 2 drinks per day. A drink of alcohol is 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor.

What else can I do to manage my diabetes?

  • Control your blood sugar level: Test your blood sugar level regularly and keep a record of the results. Ask your caregiver how, when, and how often to test your blood sugar levels. You may need to check your blood sugar level at least 3 times each day.
  • Ask about your weight: Ask caregivers if you need to lose weight, and how much you need to lose. If you are overweight, you may need to make other changes to your diet to lose weight. Ask them to help you create a weight loss program.
  • Exercise: Exercise helps to keep your blood sugar level steady, decreases your risk of heart disease, and helps you lose weight. Do at least 30 minutes of exercise, 5 times each week. Do resistance training (using weights) 3 times each week. Work with your caregiver to plan the best exercise program for you.

When should I contact my caregiver?

Contact your caregiver if:

  • You have high blood sugar levels during a certain time of day, or almost all of the time.
  • You often have low blood sugar levels.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.