Using the Exchange System
A tool to help you plan your daily meals and control glucose.
Diabetes is a disorder of how your body processes food: after you eat something, the level of glucose in your blood rises, but your body is unable to produce enough (or any) of the hormone insulin, necessary to help clear glucose from the blood. So, every choice you make about what to eat or drink is important.
Eating to manage diabetes, then, means eating with your eyes open—knowing what’s going into your body and when. That means planning for, and keeping track of, your meals. Ideally, you’ll work with a dietitian or diabetes educator to determine an eating plan that works with your schedule and your needs, one that takes into account how and what you like to eat. One system you might opt to use is the Exchange System—a classic method that has helped people with diabetes select foods for over 50 years.
The Exchange System groups together foods that have roughly the same amounts of calories, carbohydrate, fat and protein into “Exchange” groups, so that one may be exchanged for another. There are six main categories of foods: Starch/Bread, Meat and Meat Substitutes, Vegetables, Fruit, Milk and Fat. Each exchange corresponds to a fixed serving size: one exchange in the “Starch/Bread” group, for instance, could be a 6-inch corn tortilla or 1/2 cup of green peas or 1/3 cup of pasta; an exchange in the “Lean Meats” group could be an ounce of tuna or lean pork.
If you’re following the Exchange System, you’ll work with a dietitian to plan out your daily meal pattern: which exchanges to include in each meal from each food group and how many. For example, at breakfast you might aim for one Starch exchange, one Fruit, one Fat and one Milk. Within that general pattern, you’ll have plenty of room to be creative: on one day you might choose a slice of whole-grain toast with peanut butter and sliced banana with a glass of fat-free milk; on another day, you might opt for a bowl of oatmeal made with milk and sprinkled with nuts and raisins. These two very different meals will give you a similar nutritional profile that can help you keep your blood-glucose levels consistent from day to day.
While it takes some time in the beginning to become familiar with which foods belong on which lists—and to recognize their portion sizes—it becomes easier over time and eventually becomes almost instinctive for most people. Keeping a food diary and checking in with a dietitian regularly can help.
Since the simpler Carbohydrate Counting System was introduced in the 1990s, the Exchange System has lost some of its popularity—but it’s still a useful way for many people with diabetes to keep track of what they eat.