S. H. Short, Ph.D.,Ed.D.,R.D. Prof of Nutrition, Syracuse U.
DIABETES AND EXCHANGE LISTS
‘Six million Americans have diabetes and don’t know it” “ A weight gain
of 1118 pounds can double your risk of developing diabetes”
1. Usually, food that you eat is digested and much of it is changed into
glucose which the body uses for fuel. The glucose is carried by the
bloodstream to the individual cells of the body. The body produces
insulin (a hormone)that helps the glucose enter the cells. Normally,
enough insulin is produced to allow the amount of glucose in the blood to
be absorbed by the cells, where it is used for energy. Insulin also helps
the body to store extra glucose and fat for later use.
2. When you have diabetes, your body does not make enough insulin or
does not use it properly. Without insulin, your body cannot use the food
you eat. Glucose builds up in the blood, cells can't get energy they
need, and glucose may spill over into the urine. People with diabetes
may also have high blood fat levels (cholesterol and triglycerides). Over
time all of these problems cause complications.
3. There are 2 major types of diabetes mellitus: insulin dependent (IDDM,
Type I, juvenile onset) and non insulin dependent (NIDDM, Type II,
4. People with INSULINDEPENDENT DIABETES do not make enough
insulin. When the body has little or no insulin and cannot use glucose for
energy, it begins to burn fat. When fat is burned for energy, acid wastes
called ketones are formed. The ketones build up in the blood and cause
a serious condition called ketoacidosis. People with insulin dependent
diabetes must take insulin injections to avoid this life threatening
5. People with NONINSULINDEPENDENT DIABETES make some insulin,
but either there is not enough insulin, or it is not working properly.
People often can control this type of diabetes by limiting the amount of
food they eat and by increasing their exercise. Oral hypoglycemic agents
(diabetes pills) help some people to make more insulin or to use their
own insulin better. Some people with non insulin dependent diabetes
may need insulin injections to regulate their blood glucose levels.
6. Those with diabetes must balance food, activity, and medication (if
needed). Food raises blood glucose and blood fat levels. Activity and
medications (insulin or oral hypoglycemic agents) lowers blood glucose
and blood fat.
7. There are three nutritional goals of diabetes management:
Appropriate blood glucose and blood fat levels, reasonable weight, and
8. Some principles of good nutrition are: eat less fat, sugar, salt, eat 2
more carbohydrates (starches and breads), especially those high in fiber,
and use alcohol in moderation.
9. The most important nutrition principle for people with insulin
dependent diabetes is consistency. Meals should be eaten at about the
same time each day, and the amounts and type of food each day should
be about the same.
10. Many people with non insulin dependent diabetes are
overweight. For them the most important nutrition principle is weight
1. The six exchange lists help to make the meal plan work. Foods are
grouped together on a list because they are alike contain about the
same amount of carbohydrate, protein, fat and calories. In the amounts
given, all the choices on the same list are equal. Any food on a list can
be exchanged (traded) for another food on the same list.
2. The six lists are: starch/bread, meat and substitutes, vegetables, fruit,
milk, and fat.
3. Using the exchange lists and following the meal plan provides a
variety of food choices, and will control the distribution of calories,
carbohydrate, protein, and fat throughout the day, so that food and
insulin will be balanced. This balance gives good blood glucose control.
4. The reason for dividing foods i