Exchange Lists, Counting Systems, and Sample Menus

Diabetic individuals need intensive education to effectively self-manage nutrition therapy. Information that individuals and their families need include the following topics:

Meal planning involves several strategies, including:

An exchange system is a meal planning method that groups similar types of foods into 6 categories:
When a specific number of each exchange is eaten, a constant amount of calories and nutrients is supplied. The foods within each category are interchangeable in the prescribed amounts.
For example:
The exchange system is easy to learn and provides a nutritious, well-balanced diet. A complete lists of foods and explanations for how to use the exchange system can be found in Exchange Lists for Meal Planning, available from the American Diabetic Association.

INSTANT FEEDBACK:
When using a food exchange system, foods within a category are interchanged within prescribed amounts.
True
 False

In the past, the patient’s physician ordered a nutrition prescription in the form of an "ADA" diet. The term "ADA" diet is no longer used, as the American Diabetes Association doesn’t endorse any specific meal plan or specified percentages of protein, carbohydrates, and fats in the diet.

The recommended meal planning method is to implement a diet that provides a consistent daily amount of carbohydrates. This method uses meal plans that incorporate consistent carbohydrate intake at meals and snacks, appropriate fat modifications, and consistent timing of meals and snacks.

Carbohydrate counting is now the preferred method for food and meal planning for persons with both type 1 and type 2 diabetes.

The article by Dr. Hirsch (editor, Clinical Diabetes) "The Death of the "1800-Calorie ADA Diet" helps explain clinical diabetes management, especially in our familiar hospital settings.

Please read the article, and be prepared to answer the following question, about one of several key points.

According to Dr. Hirsch, what is more important than the source or type of carbohydrate consumed in meals and snacks?

INSTANT FEEDBACK:
An "ADA diet" is the preferred method for food and meal planning for people with diabetes.
True
 False

An emphasis is placed on the total amount of carbohydrate in a meal or snack rather than whether the source of carbohydrate is a sugar or a starch. The person needs to know how many carbohydrate choices are allowed for meals and snacks. A typical meal plan for a woman with type 2 diabetes might begin with 3 to 4 carbohydrate choices (45-60 grams) per meal. A man with type 2 diabetes might start with 4 to 5 carbohydrate choices.

The diabetic person and a dietitian plan carbohydrate target ranges for meals and snacks based on the person’s usual carbohydrate intake, food and nutrition goals, and the person’s level of physical activity. When starting a carbohydrate counting system, the diabetic person needs to know some important basics:

Diabetics should be taught how to first determine the portion size on a food label, as all the information on the label is based on portion size. Next, the individual is taught to determine the total amount of carbohydrate in a specific food serving and to assess how many carbohydrate choices are provided. Although protein and fat content of foods have a minimal effect on blood glucose, the amounts of protein and fat must be evaluated as they contribute calories to the meal.

INSTANT FEEDBACK:
The first step in carbohydrate counting is to determine the portion size on food labels.
True
 False

As the individual gains more experience with the basics of carbohydrate counting, he or she can begin to more effectively manage diabetes by balancing the relationships between food, activity, and blood glucose levels. Individuals who use intensive insulin therapy or insulin pumps learn how to use carbohydrate-to-insulin ratios to determine how much rapid acting or short acting insulin to use to cover the amount of carbohydrate that will be consumed in the meal. As a guideline, one unit of insulin is usually taken for each 12-15 gm of carbohydrate contained in the meal.

The American Dietetic Association and the American Diabetes Association have recently published expanded and updated meal planning exchange lists. The lists have been re-grouped to provide patients more flexibility in choosing foods and some new lists have been added. Many foods have been added, including information about reduced fat food products, vegetarian food products, and fast foods.

Some of the new meal planning tools feature "exchange" information for very lean meat and meat substitutes, such as poultry, fish, shellfish, game, and cheese and other meats and meat substitutes that contain less than 1 gram of fat and 35 calories per ounce. New carbohydrate groupings allow more convenient exchanges. The fat group contains a wider variety of fats.

Patients who wish to lose weight may wish to use a calorie counting plan. With this method, a baseline calorie level is determined and a list of foods with specific caloric values is used to develop the meal plan. Another type of counting system uses "points" for counting the daily intake of calories for each meal and each snack.

People who find the exchange system too complicated, who have difficulty making food choices and who don’t have a high preference for food variety, may use individualized sample menus that can be rotated by the patient.

The American Diabetes Association (www.diabetes.org) or 800-232-6733 has a variety of excellent resources for diabetic meal planning, including books such as Exchange Lists for Weight Management, and the American Diabetes Association Complete Guide to Diabetes. The website also has a feature called the "virtual grocery store" that provides information about products useful for people with diabetes, and advice about eating out, recipes, and portion control. By calling the American Dietetic Association Hot Line at 800-366-1655, individuals can be referred to a registered dietitian in their area.

Some individuals may benefit from keeping food diaries to assess how much carbohydrate is being eaten, portion sizes, eating or snacking patterns, meals skipped, food choices, and the level of exercise. People who might benefit from keeping a food diary include individuals: