The diabetes exchange system can help you select the right amount of different types of foods to eat each day. Eating a well-balanced diet will help your blood sugar stay within a healthy range.
The Exchange Categories
The exchange system groups foods into one of six categories: starches, meat and meat substitutes, vegetables, fruits, milk, and fats. There are also some foods that are considered free foods because they contain such a low amount of calories and/or carbohydrates.
Serving for serving, foods in each of these categories have similar amounts of carbohydrate, protein, and fat. This means that each food in a particular category can be exchanged for another food in that same category.
Many foods are made up of more than one food category, so they will not fall nicely into just one of the diabetes exchange categories. These types of foods are known as combination foods.
Points to Consider
- The number of servings, or exchanges, from a category that you can consume each day depends on how many calories you need. A dietitian can help you determine your nutrition needs, including total calories and proportion of carbohydrates, fats, and protein that you should be consuming each day.
- The key to mastering the diabetes exchange system is becoming familiar with the serving sizes for each category, and also how much carbohydrate, protein, and fat the foods in each category typically contains.
- Distribute your exchanges over the course of a day and be consistent about following this pattern everyday. This will spread out the amount of carbohydrates that you are consuming, which will help regulate your blood sugar.
- The foods listed below in the starch, fruit, and milk categories contain the same amount of carbohydrates per serving, 15 grams. Since they have similar effects on your blood sugar, these foods can also be exchanged because they are generally considered carbohydrate servings. For example, you may trade 1 starch serving for 1 fruit or milk serving.
- A common misconception is that at any given meal, you are limited to eating only the serving sizes listed below, which many people consider small. The exchange system is not quite that restrictive. For example, cup mashed potato counts as 1 serving of starch, or 1 carbohydrate serving. But if you are allotted 3 servings of carbohydrate at dinner, you could skip other starches, fruits and milks, and choose to have all of your carbohydrate as potato. Thus you would eat 1 cups of mashed potato. Nonetheless, this is probably a restriction for most people, but perhaps not quite as restrictive as it first may appear.
- The exchange system is helpful not only in diabetes, but also for regulating weight.
The Exchange Lists
The below tables show each of the different exchange categories, the amount of carbohydrates, protein, fat, and calories one serving of a particular category provides, and examples of different foods and their portion sizes for each category.
Starches_____ servings per dayOne starch exchange = 15 grams carbohydrate, 3 grams protein, 0-1 grams fat, 80 caloriesTypeOne Exchange/ServingBagel (varies), 4 ounces of a bagel (1 ounce)Bread (white, pumpernickel, whole wheat, rye)1 sliceBread, reduced calorie or lite2 slicesBroth-based soup1 cupCooked beans, peas, or corn cupCooked cereal cupCrackers4-6English muffin, hot dog bun, or hamburger bunPasta, rice1/3 cupPopcorn, air popped, no fat added3 cupsPotato1 small (3 ounces) or cup mashedPretzels ounceSweet potato or yam cupTortilla1 smallUnsweetened, dry cereal cupFiber is what makes one carbohydrate better than another. Remember to choose higher fiber breads and bread products for a better effect on your blood sugar. Non-Starchy Vegetables_____ servings per dayOne vegetable exchange = 5 grams carbohydrate, 2 grams protein, 0 grams fat, and 25 caloriesTypeOne Exchange/ServingCooked vegetables cupRaw vegetables1 cupTomato or vegetable juice cupThree servings of non-starchy vegetables add up to one serving of carbohydrate, meaning a bread, fruit, or milk exchange. For example, if you eat a large salad with 3 cups of vegetables, you should count that as 1 serving of carbohydrate. Fruits_____ servings per dayOne fruit exchange = 15 grams carbohydrate, 0 grams protein, 0 grams fat, and 60 caloriesType
One Exchange/ServingCanned fruit cupDried fruit cupFresh fruit1 small or 1 cup (eg, cut up or berries)Fruit juice cupAlthough whole fruits and fruit juices have the same amount of carbohydrate (in the servings listed above), its usually better to choose the whole fruit more often because it has fiber. Milk_____ servings per dayOne milk exchange = 12 grams carbohydrate and 8 grams protein (Fat and calories vary as listed below.)TypeOne Exchange/Serving0-3 grams fat and 90 calories per servingNonfat or low-fat milk1 cupPlain, nonfat yogurt cupNonfat or low-fat soy milk1 cup5 grams fat and 120 calories per serving2% Milk1 cupSoy milk1 cupYogurt, plain, low-fat cup8 grams fat and 150 calories per servingWhole milk1 cupYogurt, plain (made from whole milk) cupKeep in mind that only the milk products that are in fluid form, such as milk and yogurt, typically have carbohydrate. Cheese, on the other hand, is considered a high-fat meat substitute. You can remember this because when cheese is made, the curd (solid) is separated from the whey (liquid). Meat and Meat Substitutes_____ servings per dayOne very lean meat exchange = 0 grams carbohydrate, 7 grams protein, 0-1 grams fat, and 35 caloriesOne lean meat exchange = 0 grams carbohydrate, 7 grams protein, 3 grams fat, and 55 caloriesOne medium-fat meat exchange = 0 grams carbohydrate, 7 grams protein, 5 grams fat, and 75 caloriesOne high-fat meat exchange = 0 grams carbohydrate, 7 grams protein, 8 grams fat, and 100 caloriesType
One Exchange/ServingVery lean meats and substitutesEgg substitutes, plain cupEgg whites2Fish: fresh or frozen cod, flounder, haddock, halibut, trout, tuna1 ounceNonfat or low-fat cottage cheese cupPoultry: chicken or turkey, white meat, no skin1 ounceShellfish1 ounceLean meat and substitutesBeef: round, sirloin, flank, tenderloin, roast, steak, ground round (trimmed of fat)1 ounceFish: herring, salmon, catfish, tuna (canned in oil, drained)1 ounceParmesan cheese2 tablespoonsPork: lean pork, such as fresh ham, Canadian bacon, tenderloin, center loin chop1 ouncePoultry: Chicken or turkey (dark meat, no skin); chicken (white meat with skin)1 ounceTofu, light cup or 4 ouncesVeal: lean chop, roast1 ounceMedium-fat meat and substitutesBeef: most beef products (ground beef, meatloaf, corned beef, short ribs, prime rib)1 ounceCheese with 5 grams or less of fat per ounce: feta, mozzarella1 ounce (ricotta 2 ounces)Egg1Lamb: rib roast, ground1 ouncePork: top loin, chop, cutlet1 ouncePoultry: chicken (dark meat with skin), ground turkey or ground chicken, fried chicken (with skin)1 ounceSausage with 5 grams or less of fat per ounce1 ounceTofu cup or 4 ouncesHigh-fat meat and substitutesCheeses: all regular cheese (eg, American, cheddar, Monterey Jack, Swiss
1 ounceHot dog (beef, pork, or combination)count as 1 high-fat meat plus 1 fat exchange1 ouncePeanut butter1 tablespoonPork: spareribs, ground pork, pork sausage1 ounceProcessed sandwich meats: bologna, salami1 ounceSausage (eg, Italian, bratwurst)1 ounceIt is best to choose meats that are lean and very lean more often than medium-fat or high-fat meats. Fats_____ servings per dayOne fat exchange = 0 grams carbohydrate, 0 grams protein, 5 grams fat, and 45 caloriesTypeOne Exchange/ServingMonounsaturatedAvocado2 tablespoons (1 ounce)Oil (canola, olive, peanut)1 teaspoonOlives9-10 largePeanut butter2 teaspoonsTahini paste2 teaspoonsPolyunsaturatedMargarine1 teaspoonMayonnaise, regular1 teaspoonMayonnaise, low-fat1 tablespoonSalad dressing, regular1 tablespoonSaturatedBacon, cooked1 sliceButter, stick1 teaspoonCoconut, sweetened, shredded2 tablespoonsCream cheese, reduced fat1 tablespoonsCream cheese, regular1 tablespoonCream, half and half2 tablespoonsShortening or lard1 teaspoonSour cream, reduced fat3 tablespoonsSour cream, regular2 tablespoonsTry to limit the amount of saturated fat you eat, since it is the bad fat that will raise your bad LDL cholesterol. Free FoodsOne free food exchange contains less than 20 calories or 5 grams of carbohydrate per servingNote: If a serving size is given, limit to three servings per day.Type
One Exchange/ServingBouillon, broth or consommN/ACandy, hard, sugar free1 candyCarbonated or mineral waterN/ACoffeeN/ACream cheese, fat-free1 tablespoonCreamers, nondairy1 tablespoonDiet soft drinks, sugar-freeN/ADrink mixes, sugar-freeN/AGarlicN/AGelatin dessert, sugar-freeN/AHerbs, fresh or driedN/AHorseradishN/AJam or jelly, light2 teaspoonsKetchup1 tablespoonLemon or lime juiceN/AMargarine spread, fat-free4 tablespoonsMayonnaise, fat-free1 tablespoonMustardN/ANonstick cooking sprayN/APickles, dill1 largeSalad dressing, fat-free or low-fat1 tablespoonSalsa cupSoy sauceN/ASpicesN/ATabasco or hot pepper sauceN/ATeaN/AVinegarN/AWhipped topping, light or fat-free2 tablespoonsWine, used in cookingN/AWorcestershire sauceN/A Sweets, Desserts, and Other CarbohydratesOne exchange on this list = 15 grams carbohydrate, or 1 starch, or 1 starch, or 1 fruit, or 1 milkTypeServing SizeExchanges per ServingAngel food cake, unfrosted1/12 cake (2 ounces)2 carbsBrownie, small, unfrosted2 inch square (about 1 ounce)1 carb, 1 fatCake, frosted2 inch square (about 2 ounces)2 carbs, 1 fatDoughnut, plain1 medium (1 ounce)1 carbs, 2 fatsGingersnaps31 carbHoney1 tablespoon1 carbIce cream cup1 carb, 2 fatsIce cream, low-fat cup1 carbsMilk, chocolate, whole
1 cup2 carbs, 1 fatPudding, sugar-free (made with low-fat milk) cup1 carbSports drink8 ounces1 carbSugar1 tablespoon1 carbSyrup, regular1 tablespoon1 carbYogurt, frozen, low-fat1/3 cup1 carb, 0-1 fat Combination FoodsTypeServing SizeExchanges per ServingChili with beans1 cup (8 ounces)1 carb, 2 medium fat meatsCream soup (made with water)1 cup (8 ounces)1 carb, 1 fatLasagna1 cup (8 ounces)1 carb, 2 medium fat meatsPizza, cheese, thin crust of 10 inch (5 ounces) pizza2 carbs, 2 medium-fat meats, 1 fatVeggie burger (soy based)3 ounces1 carb, 1 lean meat RESOURCES: American Diabetes Associationhttp://www.diabetes.org National Institute of Diabetes & Digestive & Kidney Diseaseshttp://diabetes.niddk.nih.gov/ CANADIAN RESOURCES: Canadian Diabetes Associationhttp://www.diabetes.ca/ Dietitians of Canadahttp://www.dietitians.ca/ References: American Diabetes Association website. Available at: http://www.diabetes.org . Accessed January 31, 2006. Powers M. American Dietetic Association Guide to Eating Right When You Have Diabetes. John Wiley & Sons, Inc: Hoboken, NJ; 2003. Last reviewed May 2008 by Dianne Scheinberg, MS, RD, LDNPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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