Diabetes Exchange Lists

The objective of the exchange lists is to maintain the proper balance of carbohydrates, proteins, and fats throughout the day. The exchange lists can be obtained by calling or writing to the American Diabetes Association. [See Where Else Can Help Be Obtained for Diabetes Diet?]

In developing a menu, patients must first establish with a doctor or dietitian their individual dietary requirements, particularly the optimal number of daily calories and the proportion of carbohydrates, fats, and protein. The exchange lists should then be used to set up menus for each day that fulfill these requirements.

The following are some general rules:

  • The diabetic exchanges are six different lists of foods grouped according to similar calorie, carbohydrate, protein, and fat content; these are starch/bread, meat, vegetables, fruit, milk, and fat. A person is allowed a certain number of exchange choices from each food list per day.
  • The amount and type of these exchanges are based on a number of factors, including the daily exercise program, timing of insulin injections, and whether or not an individual needs to lose weight or reduce cholesterol or blood pressure levels.
  • Foods can be substituted for each other within an exchange list but not between lists even if they have the same calorie count.
  • In all lists (except in the fruit list) choices can be doubled or tripled to supply a serving of certain foods. (For example 3 starch choices equal 1.5 cups of hot cereal or 3 meat choices equal a 3-ounce hamburger.)
  • On the exchange lists, some foods are “free.” These contain less than 20 calories per serving and can be eaten in any amount spread throughout the day unless a serving size is specified.

Exchange List Categories

The following are the categories given on the exchange lists:

Starches and Bread. Each exchange under starches and bread contains about 15 grams of carbohydrates, 3 grams of protein, and a trace of fat for a total of 80 calories. A general rule is that a half-cup of cooked cereal, grain, or pasta equals one exchange and one ounce of a bread product is one serving.

Meat and Cheese. The exchange groups for meat and cheese are categorized by lean meat and low fat substitutes, medium-fat meat and substitutes, and high-fat meat and substitutes. High fat exchanges should be used at a maximum of 3 times a week. Fat should be removed before cooking. Exchange sizes on the meat list are generally one ounce and based on cooked meats (three oz of cooked meat equals 4 oz of raw meat).

Vegetables. Exchanges for vegetables are 1/2 cup cooked, 1 cup raw, and 1/2 cup juice. Each group contains 5 grams of carbohydrates, 2 grams of protein, and between 2 to 3 grams of fiber. Vegetables can be fresh or frozen; canned vegetables are less desirable because they are often high in sodium. They should be steamed or microwaved without added fat.

Fruits and Sugar. Sugars are now included within the total carbohydrate count in the exchange lists. Sugars still should not be more than 10% of daily carbohydrates. Each exchange contains about 15 grams of carbohydrates for a total of 60 calories.

Milk and Substitutes. The milk and substitutes list is categorized by fat content similar to the meat list. A milk exchange is usually one cup or 8 oz. For those who are on weight-loss or low-cholesterol diets, the skim and very low-fat milk lists should be followed, and the whole milk group avoided. Others should use the whole milk list very sparingly. All people with diabetes should avoid artificially sweetened milks.

Fats. A fat exchange is usually 1 teaspoon but it may vary. People, of course, should avoid saturated and trans fatty acids and choose polyunsaturated or monounsaturated fats instead.

Number of Exchanges per Day for Various Calories Levels

Calories

1,200

1,500

1,800

2,000

2,200

Starch/Bread

5

8

10

11

13

Meat

4

5

7

8

8

Vegetable

2

3

3

4

4

Fruit

3

3

3

3

3

Milk

2

2

2

2

2

Fat

3

3

3

4

5