The Exchange Method for Managing Diabetes

How It's Used to Manage Carbohydrates in the Diet

In This Article

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A key component of managing type 2 diabetes—or preventing prediabetes from progressing—is adhering to a diet in which carbohydrate intake is limited in order to control blood glucose levels. One approach: using the carb (or food) exchange method.

The carb exchange method is simple: Foods that have similar nutrient profiles are grouped together in lists in such a way that they can easily be swapped one for another. The goal is to help people with diabetes maintain consistency in their diet in terms of carbs, protein, fat, and calories while still being able to enjoy a wide variety of foods.

Introduced in 1950 by the American Dietetic Association (now known as the Academy of Nutrition and Dietetics) as a publication titled Exchange Lists for Meal Planning, the carb exchange method has undergone several iterations. In 2008, the name was changed to Choose Your Foods: Exchange Lists for Diabetes and updated to reflect "evidence-based nutrition recommendations for individuals with diabetes, as well as changes in the food marketplace and the eating patterns of Americans," according to the American Diabetes Association (ADA).

The exchange lists are designed to be used by anyone who has worked with a dietitian or other medical professional to develop an eating plan based on his or her ideal intake of carbohydrates and other nutrients. Using the lists allows for a great deal of flexibility in meal planning, which can be especially welcome when it's necessary to eat within specific dietary limits.

Basics

According to the ADA, more than 700 foods are included in the current exchange lists, which has been designed to reflect key recommendations for diabetes. These are:

  • Adjusting insulin doses to match carbohydrate intake
  • Eating a consistent amount of carbohydrates at each meal
  • Managing bodyweight
  • Meeting recommendations for fiber—specifically, 14 grams of fiber per 1,000 calories
  • Limiting saturated fats to less than 7 percent of total calories
  • Keeping cholesterol to fewer than 200 milligrams (mg) per day
  • Lowering sodium intake to less than 2,300 mg per day

The 2008 plan also recommends increasing certain healthy foods in the diet including fruits, vegetables, whole grains, legumes, low-fat dairy products, lean meats, and unsaturated fats.

Goals

As with any dietary plan for managing diabetes or prediabetes, the exchange method is designed to:

  • Prevent prediabetes from progressing to full-blown type 2 diabetes
  • Promote weight loss in order to help lower the risk of cardiovascular disease
  • Achieve and maintain normal (or close to normal) blood glucose levels
  • Reach a lipid and lipoprotein profile that lowers the risk of vascular disease
  • Maintain blood pressure levels that are normal (or as close to normal as possible)
  • Prevent or slow the development of diabetes complications

The Exchange LIsts

The exchange meal plan divides foods into six categories: starch/bread, fruit, milk, vegetable, meat, and fat groups. Within each category are lists of specific foods that have around the same amounts of carbohydrate, protein, fat, and calories per serving, as illustrated in this chart:

The Exchange Lists At a Glance
Food type Carbohydrate (in grams) Protein (in grams) Fat (in grams) Calories
Starch/bread 15 3 trace 80
Meat
 
n/a 7 0 to 8 (depending on fat content) 35 to 100 (depending on fat content) 
Vegetable 5 2 n/a 25
Fruit 15 n/a n/a 60
Milk 12 8 0 - 8 (depending on fat content) 90 to 150 (depending on fat content)
Fat n/a n/a 5 45
Adapted from the Diabetic Exchange List (Exchange Diet) designed by the American Diabetes Association and the American Dietetic Association

In addition to the six main food categories, the exchange method includes two addition lists:

Free Foods

The items on this list are foods and beverages that contain fewer than 20 calories per serving. Many are listed without a specified serving size, meaning they can be eaten in any quantity. The foods that do have a specific serving size should be limited to two or three servings, ideally spread out throughout the day to prevent a rise in blood sugar.

Combination Foods

These are foods that do not fit into a single exchange list because they contain more than one food group. For example, a quarter of a 10-inch cheese pizza counts as 1 medium-fat meat exchange, 2 starches, and 1 fat.

Using the Exchange Method

Before you begin following the exchange method, you'll need to work with a dietitian to determine the specific number of grams of carbohydrate you should eat per day. The dietitian also will determine ideal parameters for protein, fat, and calories, and provide guidance for making food choices that are high in fiber and other important nutrients, as well as low in sodium and saturated fat.

You will then use this information to determine how many of each type of exchange you should eat each day and at each meal. For example, each carbohydrate exchange is equal to 15 grams of carbohydrate. Therefore, if your goal is to stick to 45 grams of carbohydrate per meal, that would mean you could choose three carb exchanges at each meal.

Examples of Foods

As already stated, there are more than 700 individual foods on the Diabetic Exchange List. Here are samples of common foods from each list.

Starch/Bread List

  • 1/2 cup cooked cereal
  • 1/2 cup pasta
  • 1/3 cup brown or white rice
  • 1/3 cup beans, peas, or lentils
  • 1/2 cup corn
  • 1/2 cup green peas or lima beans
  • Small baked potato (3 ounces)
  • 1/2 bagel (1 ounce)
  • 1/2 hamburger or hot dog bun (1 ounce)
  • 1 slice rye, pumpernickel, white, wheat, or whole wheat bread (1 ounce)
  • 3 cups popcorn (no butter or fat)
  • 6 saltine-type crackers
  • 2 4-inch pancakes
  • 2 6-inch taco shells

Meat List

All of these selections have 7 grams of protein; the differences between them will be in the amounts of fat and calories each contains.

  • 1 ounce beef, pork, veal, poultry, or fish
  • 2 ounces crab, lobster, scallops, shrimp, clams
  • 1/4 cup water-packed tuna or canned salmon
  • 2 medium sardines
  • 1/4 cottage cheese or ricotta cheese
  • 2 Tbsp grated parmesan
  • 1 ounce mozzarella, American, blue, cheddar, Monterey Jack, or Swiss cheese
  • 1 ounce deli meat
  • 1 egg

Vegetable List

As reflected in the chart above, each item listed here contains about 5 grams of carb, 2 grams of protein, 25 calories. Unless otherwise noted, the serving size for cooked vegetables or vegetable juice is 1/2 cup and the serving size for raw veggies is 1 cup. These and similar vegetables are generally regarded as non-starchy vegetables.

  • 1/2 artichoke
  • Beans (green, wax, Italian)
  • Beets
  • Broccoli
  • Brussels sprouts
  • Carrots
  • Cauliflower
  • Spinach (cooked)
  • Eggplant
  • Mushrooms (cooked)
  • Onions
  • Peppers (green)
  • Tomato (1 large)
  • Tomato/vegetable juice
  • Zucchini (cooked)

Fruit List

Unless otherwise noted, the serving size for one fruit is 1/2 cup fresh fruit or fruit juice and 1/4 cup dried fruit.

  • 2- inch apple
  • 9-inch banana
  • 3/4 cup blueberries
  • 12 large cherries
  • 1/2 medium grapefruit
  • 15 small grapes
  • 1 cup papaya
  • 1 peach
  • 1 1/4 cup strawberries
  • 1 1/2 dates
  • 1 1/2 dried figs
  • 2 tbsp raisins
  • 1/3 cranberry juice cocktail
  • 1/3 cup prune juice

Milk List

Regardless of whether whole, low-fat, or skim, the milk and dairy products listed here have 12 grams of carbohydrate each.

  • 1 cup milk (skim, 1%, 2%, whole, or low-fat buttermilk)
  • 1/2 cup evaporated skim milk
  • 8 ounces plain yogurt

Fat List

Although the foods on this list do not contain carbs, they are high in fat and calories and should be measured carefully.

  • 1/8 medium avocado
  • 1 tsp margarine or butter
  • 1 Tbsp diet margarine
  • 1 tsp mayonnaise
  • 6 dry-roasted almonds
  • 2 whole walnuts
  • 1 tsp oil (corn, olive, safflower, etc.)
  • 10 small or 5 large olives
  • 1 slice bacon
  • 2 Tbsp shredded coconut
  • 2 Tbsp. sour cream
  • 1 Tbsp cream cheese

You can mix, match, and double up on foods however you'd like, as long as you stick to the prescribed number of exchanges and the ideal amount of carb, protein, fat, and calories you should eat each day.

For example, 1/3 cup of rice equals one carb exchange. If you would like to enjoy an entire cup of rice (as the base for a stir-fry of a no-carb protein and vegetables), you would count the cup of rice as three carb exchanges. With this kind of flexibility, using the exchange method can be simple, straightforward, and effective.

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