Diabetic Diet Guidelines

Diabetic Diet Guidelines

Your diet, exercise level and other factors, such as body weight, are important variables in the management of diabetes, particularly type II diabetes. Consuming a wide variety of healthy foods and spacing your meals evenly throughout the day helps keep your blood glucose levels under control. Using the diabetic exchange system for meal planning is one method for ensuring that you consume the proper balance of carbohydrates, fats and proteins.

Where do I start?

Meet with a registered dietitian (RD) and/or a certified diabetes educator (CDE) to calculate an appropriate calorie level for your particular needs. A professional will divide the calories, proportionally, into a balance of carbohydrate, protein and fat. Roughly 50% of your calories should come from carbohydrate-rich foods, particularly high-fiber grains, cereals and vegetables.

What are diabetic exchange food lists?

With the exchange system, the three macronutrients—carbohydrate, protein and fat—are categorized into six food groups. One serving from any group is referred to as a diabetic exchange. The food groups include starches/bread, milk, fruits, meat/cheese, non-starchy vegetables and fats. The number of exchanges you are allotted daily depends on factors such as your desired weight (fewer exchanges and a lower calorie level to lose weight), exercise level/frequency as well as the timing of medications.

Exchange list values for carbohydrate-rich foods

Carbohydrate is your body’s preferred source of energy and the nutrient that has the greatest influence on your blood glucose levels. Carbohydrate-rich diabetic exchange food groups include starches/breads, fruits and milk products. One starch exchange provides, on average, 15 g carbohydrate, 3 g protein, < 1 g fat and 80 calories. Examples of one starch exchange include a 1oz slice of bread, ½ cup of cooked cereal or ½ cup of cooked pasta or corn. A milk exchange is one 8 oz cup of milk or unsweetened/artificially sweetened yogurt. Choose skim or 1 % milk to control your fat, cholesterol and caloric intake. One milk exchange provides 12 g carbohydrate, 8 g protein, < 3 g fat and 80 to 100 calories.

Fruits, while healthy, are high in simple sugars, and can increase your blood glucose levels quickly. One fruit exchange provides 15 g carbohydrate and 60 calories. The serving size of one exchange varies depending upon type (whole/fresh or juice). One small apple or ½ cup of juice is the equivalent of one fruit exchange. Sugars are included within the total carbohydrate count for the exchange lists and should not exceed 10% of your daily carbohydrate intake.

Exchange list values for other foods

Non-starchy vegetables are lower in carbohydrates. One exchange provides, on average, 5 g carbohydrate, < 2 g protein and 25 calories. Examples of one exchange include ½ cup of cooked vegetables, one cup raw or 6 oz juice. Two cups of leafy green vegetables equals one exchange.

The meat/cheese and fat food groups may be carbohydrate-free but contain calories and fat, so you must monitor your portions on a diabetic meal plan. Meat and meat alternatives are categorized by fat content and include lean, medium-fat and high-fat options. Choose lean meats most often. Exchanges are 1oz and based on cooked meats (not raw weight). One egg and/or ½ cup of tofu are meat alternatives. A fat exchange is usually 1 tsp, but the portion size may vary. A fat exchange, such as oil, provides 45 calories and 5 g of fat.

What are the ‘rules’ and/or take home points for using diabetic exchange lists?

The ‘exchanges’ refer to trading options within a food group. You can swap one food item for another within an exchange group, however, to ensure a balanced diet, limit or avoid exchanging items between groups, even if they offer the same amount of calories. In all lists (except fruits) choices can be doubled/tripled to supply a common serving. For example, 1½ cups of oatmeal meets a breakfast allotment of three starches and a 3 oz hamburger meets a lunch allotment of three meat exchanges. With the exchange system, there is a “free” food list. These foods, such as sugar-free gelatin, provide < 5 g carbohydrate and 20 calories. You can choose these items as desired unless a specific serving size or limit is specified.

Does your calorie level determine the number of exchanges you are allowed daily?

Yes, the higher your calorie level, the more exchanges you are allowed daily. A standard 1,800-calorie diabetic diet typically includes ten starch exchanges; two milk exchanges (the equivalent of 16oz of milk); three fruit exchanges; seven meat exchanges or 7 oz of meat; three non-starchy vegetable exchanges and three fat exchanges. If your calorie level is lower, you will follow a plan with fewer exchanges and visa versa.


  • University of Maryland Medical Center. Diabetes Diet – Diabetic Exchange Lists.
  • American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. Jan 2009.

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