Diabetic Exchange Diet

exchange dietThe diabetic exchange diet is the American Diabetes Association’s gold standard for diabetic eating. What is it really all about? Where can I find a food list or chart for the diabetic exchange diet? How does it work? Let’s take a look.

Curiously, many of the resources describing the diet on the American Diabetes Association and National Institute of Health websites don’t even refer to the diet by name. They simply “jump into” describing how you should eat. This can lead to a lot of confusion.

As with all diabetic diets, you should consult your doctor or nutritionist to determine what is right for you.


The diet is simply a way of categorizing or grouping food into a healthy way of eating. Food that has approximately the same nutritional content (calories, carbohydrates, fats, and protein) is grouped together and can be “exchanged” for one another. The key to the system is based on specific portion or serving sizes for any given food’s nutritional content.

Each serving is meant to approximately reflect the effect that a particular food has on your blood sugar. For example, one piece of bread has the same effect on your blood sugar as approximately 6 saltine crackers.

The number of servings from each category you can eat will depend upon a number of factors including:

  • Weight
  • Height
  • Overall Health (such as blood sugar levels)
  • Exercise Plan
  • Medications
  • Weight Loss Goals (if any)

This point is more fully discussed below and is also the basis for diets such as the 1600 Calorie or 1800 calorie diabetic diet, etc.

While the diet is designed to provide you with a balanced way of eating, it also seeks to be flexible based on personal tastes. Depending upon your diet plan, you can often “exchange” or substitute different foods based on the food’s exchange value.

For example, 3/4 of an ounce (one exchange) of pretzels is equal to 1 cup of raw vegetables.

If you were planning on eating vegetables for a snack, but decided you wanted some pretzels, you can easily “exchange” one for the other.

Categorizing food and paying attention to portion sizes is very foreign for most people, so it takes some getting used to. The main keys to the diet are:

  1. Understanding the nutritional value of foods (carbohydrates, protein, fat, etc.)
  2. Portion Control
  3. Developing a consistent pattern of eating (meals and snacks)

    The exchange diet categorizes food into six main categories: starches, meat and meat substitutes, vegetables, fruits, dairy and fat. While not always the case, based on individual circumstances a typical breakdown of nutritional value will be 50% carbohydrates, 30% fat and 20% protein.

    The Diabetes Food pyramid was created to illustrate these category and apportionment of food:

    food pyramid

    There are also foods that are considered “Free” in that they have little or no calories (under 2 per serving), such as coffee, tea, water, etc.

    Sometimes you may also see foods referred to as “combination foods”. These foods combine a number of different ingredients, such as casseroles, stews, pizza, and soups.

    2011 UPDATE: Please be aware that the diabetes pyramid is no longer used as a stand alone tool for meal planning. In 2011, the Plate Method was instituted instead, because it is easier to follow for most people.

    HOWEVER, the diabetic food exchange method still seems to utilize the food pyramid to group foods. This is a bit confusing, but remember. The ADA admits that no one method of eating or dieting is right for everyone. The Food pyramid on its own (not using any exchange method or carb counting) was way to confusing to most people, thus as a stand alone meal planning method they got rid of it. They still use it in some respects for the exchange diet in terms of grouping foods.

    Exchange Lists

    Popular terms you may hear are diabetic food exchange lists or simply exchange lists. These terms refer to lists of foods and what the portion size is for 1 exchange value. These lists are great for simplifying your eating and menu planning.

    For example, if your dinner calls for 3 starches, 3 meats, 2 vegetables, 1 fruit and 2 fats. The list allows you to pick the foods you want to eat and determine appropriate portion size. If the portion size for 1 exchange value of mashed potatoes is 1/2 of a cup. then you could have the 1/2 cup and 2 other starches or you could simply have all 3 of your starches as mashed potatoes (1.5 cups).


    As discussed above, each person will typically have a different exchange diet plan. Most likely the diet plan will be based on the number of calories the person is to consume in any given day. The number of calories will be determined by your doctor or nutritionist based on factors including overall health, weight loss goals, height, weight, etc.

    Take a look at our diabetic exchange chart to get a better idea of how your caloric plan would look based on your individual characteristics. You can also look at a sample meal plan using exchanges based on calorie amounts (see the above two links at the beginning of the article). Hopefully, this brief overview on the diabetic food exchange diet was helpful. Happy eating!


    What I Need to Know About Eating and Diabetes, NIH Publication No. 08-5043 (October 2007), NIH.com (accessed August 2012).