Diabetic Diet Exchange List

The Diabetic Diet
Cookbooks
Basic Nutrition for People with Diabetes
Guidelines for Healthier Eating
Exchange Lists
Management Tips
Diet is a vital component in your overall diabetes control program. Your diabetes educator, dietician, and doctor will develop a personal meal plan to help you attain appropriate blood sugar (glucose) and blood fat (cholesterol and triglyceride) levels. If you have non-insulin dependent diabetes, sticking to your meal plan helps you achieve and maintain your correct weight, and balances the foods you eat with the insulin your body produces. If you have insulin dependent diabetes, you must stick to your meal plan to insure a balance between injected insulin and the foods you eat.

The Diabetic Diet

Your diabetic diet is a well-balanced meal plan tailored to your individual needs, tastes, activity level and life style. Meal times and types and amounts of foods are planned and adjusted just for you. You may need to learn more about foods, and you may have to make some changes in your eating habits. The better you understand your diet, the more flexibility you can enjoy. Your dietitian is there to get you started on your way to good nutrition and better health. He or she can help you tailor favorite recipes to fit your prescribed meal plan. Your dietary needs are not like anyone else's. That's why your dietitian's help is so important. Once you understand your dietary needs, you'll be able to design. your own menus and make safe judgments about your diet.

Attention Vegetarians:

Ask your dietitian about vegetarian options, and check your book store for Vegetarian Cooking for Diabetics by Patricia Mozzar (published by The Book Publishing Company.

Cookbooks

These cookbooks can help you plan healthy, varied meals that fit perfectly into your personal diabetes diet. Most are available at your local bookstore.

• ADA Family Cookbook, Vol. III
• ADA Family Cookbook, Vol. IV (The American Tradition)
• The UCSD Healthy Diet for Diabetes
• The Art of Cooking for the Diabetic
• The Calculating Cook
• Exchanges for All Occasions
• The International Menu Diabetic Cookbook
• Oriental Cooking for the Diabetic
• Sugar Free Kid's Cookery

Basic Nutrition for People with Diabetes

Although foods contain many nutrients, it is easiest to categorize them in three groups: carbohydrates, proteins, and fats.

• Carbohydrate foods include bread, potatoes, rice, crackers, cookies, sugar, fruit, vegetables, and pasta. When digested, carbohydrates provide fuel for energy.
  
• Protein foods include meat, poultry, fish, eggs, cheese, dried beans, and legumes. When digested, protein is used to build and repair your body. Some protein may also be used as fuel for energy.
  
• Fat foods include butter, margarine, cooking oil, cream, bacon, and nuts. When digested, fats are stored as fat cells or later used as fuel for energy.
  

Your meal plan will include carbohydrates, proteins and fats in amounts that will promote good diabetes control while providing adequate fuel for energy and building and repairing your body.

Calories

A calorie is a unit of heat used to express the energy-producing content of foods. Your dietitian will determine how many calories you need every day, and how they should be divided among types of food, by considering your height, weight, age, activity level, growth needs, metabolism, and general life style. For example, an active young person of normal weight needs more calories than an inactive older person or an overweight person. Remember, if you eat more calories than you need to produce energy, the excess calories are stored as body fat.

Obesity

If you are overweight, losing weight is your primary goal. You can lose weight by eating fewer calories than your body needs for your usual activity level and by increasing your exercise. A pound of fat is equal to 3,500 calories. To lose a pound in a week, you'd have to cut your calorie intake by 500 calories a day (500 calories x 7 days = 3,500 calories, or one pound). If that sounds like a lot of dieting for very little weight loss, remember a pound a week is 52 pounds a year. But you have to stick with it. To achieve your ideal weight you have to develop good eating habits, and to maintain that weight you must continue those habits.

Be realistic. Making a big change in your life takes time. It might help to keep a record of your weight each week, so you know when you're making progress, and when you're not. And don't worry about occasional relapses. Don't be harsh with yourself if you overeat once or twice, or regain a pound or two you thought you'd lost forever. But do try to identify the causes of your relapses, so that you can avoid them in the future.

Guidelines for Healthier Eating

There are some very simple things you can do every day to make sticking to your diet easier:

• Plan your meals so that you eat healthy food, not just whatever is easiest
  
• Think before you eat instead of raiding the refrigerator every time you feel hungry.
  
• Use a smaller plate, so that you can't heap on much more than you really want or need
  
• Chew slowly and completely, savoring every mouthful, instead of packing in as much as you can as quickly as you can.
  

The following guidelines are a little more complicated, but well worth the effort:

EAT LESS FAT

• Cut down on meat. Eat more fish and poultry instead. When you do eat red meat, choose the leanest cuts.
• Roast, bake, or broil instead of frying. Trim the fat off meat and the skin off poultry, and avoid adding fat in cooking. Beware of sauces and gravies. They often contain lots of fat.
• Eliminate or cut down on high-fat foods like cold cuts, bacon, sausage, hot dogs, butter, margarine, nuts, salad dressings, lard, and shortening.
• Eat less ice cream, cheese, sour cream, cream, and other high-fat dairy products. Check for low-fat versions; they're increasingly available in grocery stores. And drink skim or low-fat milk instead of whole milk.

Know Your Fats

---

• Cholesterol is a fatty substance found in animal foods (meat, poultry, egg yolks, whole milk, cheese, ice cream, butter). Have your cholesterol level tested; your goal is a level under 200 mg/dl.
  
• High-density lipoprotein (HDL) is a type of cholesterol that may protect against heart disease (good cholesterol).
  
• Low-density lipoprotein (LDL) is a harmful type of cholesterol that deposits on artery walls and increases the risk of heart disease (bad cholesterol).
  
• Monounsaturated fat is a type of unsaturated fat that lowers blood cholesterol. It is found in olive oil and peanut oil.
  
• Polyunsaturated fat is a vegetable fat that lowers total blood cholesterol. It is found in cottonseed, soybean, sunflower, and safflower oils.
  
• Saturated fat is an animal fat that raises total blood cholesterol. It is found in hydrogenated vegetable fats, coconut and palm oils, cocoa butter, meat fat, whole milk, butter cream, and fatty cheeses.
  
• Triglycerides are fats in the blood that may increase the risk of heart disease.
  

  ---

INCREASE FIBER

• Switch to whole-grain breads, cereals and crackers.
• Eat more vegetables -- raw and cooked. Instead of fruit juice, eat fresh, whole fruit.
• Sample high-fiber foods that may be new to you, like bran, barley, bulgur, brown and wild rice, and dried beans, peas, and lentils.

What is Fiber?

Also known as roughage, fiber is the part of plant food your body cannot digest. Fiber relieves constipation, lowers blood cholesterol levels, and apparently slows down the rate of carbohydrate digestion, reducing carbohydrate-induced elevations of blood sugar. Fiber also causes gas if you eat too much too soon.

REDUCE SODIUM

• Don't add salt in cooking, and try not to put salt on your food at the table.
• Cut down on high-salt foods like canned soups, ham, sauerkraut, hot dogs, and pickles. Food that tastes salty probably is salty.
• Eat fewer convenience foods and try to avoid fast-food restaurants. Even when they don't taste salty, these foods are often loaded with sodium.

REDUCE SUGAR

• Don't eat table sugar. If you're used to adding sugar to food beverage, substitute an artificial sweetener that has no calories, like saccharin or aspartame (Nutrasweet).
• Avoid honey, syrup, jam, jelly, candy, sweet rolls, regular gelatin, cake with icing, and pie. Instead of fruit canned in syrup, choose fresh fruit, or fruit canned in natural juice or water.
• Drink diet soft drinks. One twelve-ounce can of regular cola contains nine teaspoons of sugar!

Exchange Lists

Your dietitian may use exchange lists to help you plan meals and snacks. Exchange lists are groups of foods that contain roughly the same mix of carbohydrates, protein, fat, and calories. There are six exchange lists: 1) Starches and Breads, 2) Meats and Meat Substitutes, 3) Vegetables, 4) Fruits, 5) Milk, and 6) Fats.

You need foods from all six lists for complete nutrition. Foods on the exchange lists are familiar, everyday items you can buy at the supermarket. For more information on cooking and eating with exchange lists. See Exchanges for All Occasions.

The Exchange Lists are the basis of a meal planning system designed by a committee of the American Diabetes Association and the American Dietetic Association. While designed primarily for people with diabetes and others who must follow special diets, the Exchange Lists are based on principles of good nutrition that apply to everyone. © 1989 by American Diabetes Association, Inc., and by the American Dietetic Association.

Exchange Lists and Nutrition

This chart shows the amounts of carbohydrate, protein, fat, and calories in one serving from each exchange list.

---

                Carbohydrate       Protein          Fat                       
                   (grams)         (grams)         (grams)        Calories    
Starch/Bread         15               3             trace            80       

Meat                                                                          
  Lean               --               7               3              55       
  Medium fat         --               7               5              75       
  High fat           --               7               8             100     

Vegetable             5               2              --              25       

Fruit                15              --              --              60       

Milk                                                                          
  Skim               12               8             Trace            90       
  Low fat            12               8               5             120       
  Whole              12               8               8             150       

Fat                  --              --               5              45       

As you read the exchange lists, you will notice that serving sizes vary for different choices on each list. Because foods are so different, portions are adjusted so that each choice on a list contains the same amount of carbohydrate, protein, fat, and calories.

If one of your favorite foods is not included on any exchange list, ask your dietician about it. You can probably work that food into your meal plan, at least now and then.

My Meal Plan in Exchanges

Carbohydrate _________ grams   Protein _____ grams   Fat ________ grams   Calories _____        

                 1           2          3           4           5         6    

           Starch/Bread    Meat     Vegetable     Fruit       Milk       Fat   

Breakfast                                                                      

Time____________________________________________________________________________________

Snack Time____________________________________________________________________________________

Lunch Time____________________________________________________________________________________

Dinner Time____________________________________________________________________________________

Snack Time____________________________________________________________________________________

STARCH / BREAD LIST

Choose your starch exchanges from this list. Each item is 1 exchange and contains about 80 calories. If you want to eat a starch food that is not on this list, the general rule is:

• 1/2 cup of cereal, grain, or pasta is one serving
• 1 ounce of a bread product is one serving

Your dietitian can help you be more exact.

CEREALS / GRAINS / PASTA

• Bran cereals, concentrated 1/3 Cup
• Bran cereals, flaked ½ cup
• (Bran Buds®, All Bran®)
• Bulgur, cooked 2 cup
• Cooked cereals 2 cup
• Cornmeal, dry 1½ tbsp
• Grapenuts 3 tbsp
• Grits, cooked 2 cup
• Pasta, cooked 2 cup
• Rice (white or brown), cooked 2 cup
• Shredded Wheat ½ cup
• Unsweetened cereals ¾ Cup
• Wheat germ 3 tbsp

DRIED BEANS/PEAS/LENTILS

• Beans and peas, cooked 1/3 Cup (kidney, white, split, blackeye)
• Lentils, cooked 1/3 Cup
• Baked beans 1/4 Cup

STARCHY VEGETABLES

• Corn 1/2 cup
• Corn on cob, 6" 1
• Lima beans 1/2 cup
• Peas, green (canned or frozen) 1/2 cup
• Plantain 1/2 cup
• Potato,baked 1 small (3 oz)
• Potato, mashed 1/2 cup
• Squash, winter (acorn, butternut) 3/4 cup
• Yam, sweet potato, plain 1/3 cup

BREAD

• Bagel 1/2 (1 oz.)
• Bread sticks, crisp, 4" x l/2'' 2 (2/3 oz.)
• Croutons, low fat 1 Cup
• English muffin 1/2
• Frankfurter or hamburger bun 1/2 (1 oz.)
• Pita, 6" 1/2
• Plain roll, small 1 (1 oz.)
• Raisin bread, unfrosted 1 Slice (1 oz.)
• Rye, pumpernickel 1 Slice (1 oz.)
• Tortilla, 6" 1
• White bread (including French or 1 Slice (1 oz.) Italian) 1 Slice (1 oz.)
• Whole wheat bread

CRACKERS/SNACKS

• Animal crackers 8
• Graham crackers, 1.5" square 3
• Matzo 3/4 oz.
• Melba toast 5 slices
• Oyster crackers 24
• Popcorn (popped, no fat added) 3 cups
• Pretzels 3/4 oz.
• Rye crisp 2" x 3.5" 4
• Saltine-type crackers 6
• Whole wheat crackers, no fat added 2-4 slices (3/4 (crisp breads, such as Finn®, Kavli®, oz.) Wasa®)

STARCH FOODS PREPARED WITH FAT

(Count as 1 starch/bread serving, plus 1 fat serving)

• Biscuit, 2.5 in. across 1
• Chow mein noodles 1/2 cup
• Corn Bread, 2 inch cube 1 (2 oz)
• Carcker, round butyter type 6
• Frennch fried potatoes, 2 to 3.5 inch 10 (1.5 oz)
• Muffin, plain, small 1
• Pancake, 4 inch 2
• Stuffing, bread, (prepared) 1/4 cup
• Taco shell, 6 inch 2
• Waffle, 4.5 inch square 1
• Whole wqheat chrakers, fat added (Triscuits) 4-6 (1oz)

MEAT LISTS

Choose meat and meat substitute exchanges from the lean, medium-fat, and high-fat lists. Each item is 1 exchange (usually 1 ounce of meat) and contains from 3 to 8 grams of fat and from 55 to 100 calories. Include mostly lean and medium-fat meats, poultry, fish, and meat substitutes in your meal plan. By decreasing your fat intake, you can decrease your risk for heart disease. Items from the high-fat list are high in saturated fat, cholesterol, and calories, so limit your high-fat choices to 3 times per week. Remember that meat and meat substitutes contribute no fiber to your meal plan.

TIPS FOR CUTTING DOWN FAT:

• Bake, roast, broil, grill, or boil meats and substitutes rather than frying with added fat. When pan-frying, use a pan spray or non-stick pan.
  
• Do not add flour, bread crumbs, or coating mixes when preparing meats and substitutes.
  
• Trim off visible fat before and after cooking.
  
• Weigh meat after removing bones and fat, and after cooking. Three ounces of cooked meat is equal to about 4 ounces of raw meat. Sample meat portions are:
  

2 ounces meat (2 meat exchanges) = 1 small chicken leg or thigh
l/2 cup cottage cheese or tuna
3 ounces meat (3 meat exchanges) = 1 medium pork chop
1 small hamburger
1/2 of a whole chicken breast
1 unbreaded fish fillet
any cooked meat about the size of a deck of cards

LEAN MEAT AND MEAT SUBSTITUTES

• Beef USDA Good or Choice grades of lean 1 oz. beef: steaks (round, sirloin, or flank), tenderloin, chipped beef
• Pork Lean pork: ham (fresh, canned, cured, 1 oz. or boiled), Canadian bacon, tenderloin
• Veal All cuts are lean, except for veal 1 oz. cutlets(ground or cubed). Examples of lean veal include chops and roasts .
• Poultry Chicken, turkey, Cornish hen (without 1 oz. skin)
• Fish All fresh and frozen fish 1 oz. Crab, lobster, scallops, shrimp, clams 2 oz. (fresh or canned in water) Oysters 6 medium Tuna (canned in water) 1/4 cup Herring (uncreamed or smoked) 1 oz. Sardines (canned) 2 medium
• Game Venison, rabbit, squirrel, pheasant, 1 oz. duck goose (without skin)
• Cheese Any cottage cheese 1/2 Cup Grated parmesan 2 tbsp Diet cheeses (less than 55 calories per 1 oz. oz.
• Other 95% fat-free luncheon meat 1 oz. Egg whites 3 whites Egg substitutes (less than 55 calories 1/4 cup per ¼ Cup)

MEDIUM-FAT MEAT AND MEAT SUBSTITUTES

• Beef Most beef products: ground beef (all 1 oz. types), roast (rib, chuck, rump), steaks (cubed, Porterhouse, T-bone), meat loaf
• Pork Most pork products: chops, loin roast, 1 oz. Boston butt, cutlets
• Lamb Lamb: Most lamb products: chops, leg, 1 oz. roast
• Veal Veal: Cutlets (ground or cubed, unbreaded) 1 oz.
• Poultry Poultry: Chicken (with skin), domestic 1 oz. duck or goose 1 oz. (well-drained of fat), ground turkey
• Fish Tuna (canned in oil and drained), 1/4 Cup salmon (canned)
• Cheese Cheese: Skim or part-skim milk cheeses: Ricotta 1/4 Cup Mozzarella 1 oz. Diet cheeses (56-80 calories per oz.) 1 oz.
• Other 86% fat-free luncheon meat 1 oz. Eggs (high in cholesterol; limit to 3 per 1 week) 1/4 Cup Egg substitutes (56-80 calories per ¼ Cup) 4 oz. 1/ 1 oz. Tofu (2.5" x 2.75" x 1") Liver, heart, kidney, sweetbreads (all high in cholesterol

HIGH-FAT MEAT AND MEAT SUBSTITUTES

(Use only 3 times per week)

• Beef Most USDA Prime cuts: ribs, corned beef 1 oz.
• Pork Spareribs, ground pork, pork sausage 1 oz. (patty or link)
• Lamb Patties (ground) 1 oz.
• Fish Fried fish (any kind) 1 oz.
• Cheese All regular cheeses: American, blue, 1 oz. cheddar 1 oz. Monteray jack, Swiss
• Other Luncheon meats: bologna, salami, pimento 1 oz. loaf 1 oz. Sausage (Polish, Italian) 1 oz. Knockwurst (smoked 1 oz. Bratwurst 1 frank Frankfurter (turkey or chicken, 10 per 1 tbsp pound) 1 Peanut butter (contains unsaturated fat Counts as one high-fat meat plus one fat 1 frank exchange: Frankfurter(beef, pork, or combination, 10 per pound

VEGETABLE LIST

Choose vegetable exchanges from this list. Unless otherwise noted, serving size is ½ cup for cooked vegetables and vegetable juices or 1 cup for raw vegetables. A serving of any item is one exchange and contains about 25 calories and 2-3 grams of dietary fiber. See the Starch/Bread list for starchy vegetables (corn, peas, and potatoes). See the Free Food list for free vegetables.

Vegetables are a good source of vitamins and minerals. Fresh and frozen vegetables contain more vitamins than canned, and have less salt. Rinsing canned vegetables removes much of the added salt.

FRUIT LIST

Choose fruit exchanges from this list. Each item is one exchange and contains about 60 calories. Fresh, frozen, and dried fruits contain about 2 grams of fiber per serving; fruit juices add very little dietary fiber. Whole fruit is more filling than fruit juice, so it may be a better choice for those who are trying to lose weight. Use fresh fruits or fruits frozen without added sugar.

FRESH, FROZEN, AND UNSWEETENED CANNED FRUIT

Apple (raw, 2" diameter)             1 apple                               
Applesauce (unsweetened)             ½ cup                                 
Apricot (medium, raw)                4 apricots                            
Apricot (canned)                     halves                                
Banana (9" long)                     ½ banana                              
Blackberries (raw)                   3/4 Cup                               
Blueberries (raw)                    3/4 Cup                               
Cantaloupe (5" diameter)             1/3 melon                             
Cantaloupe (cubes)                   1 cup                                 
Cherries (large, raw)                12 cherries                           
Cherries (canned)                    ½ cup                                 
Figs (2", raw)                       2 figs                                
Fruit cocktail (canned)              ½ cup                                 
Grapefruit (medium)                  ½ grapefruit                          
Grapefruit (segments)                ¾ Cup                                 
Grapes (small)                       15 grapes                             
Honeydew (medium                     1/8 melon                             
Honeydew (cubes)                     1 Cup                                 
Kiwi (large)                         1 kiwi                                
Mandarin oranges                     ¾ Cup                                 
Mango (small)                        ½ mango                               
Nectarine (1.5" diameter)            1 nectarine                           
Orange (2.5" diameter)               1 orange                              
Papaya                               1 Cup                                 
Peach (2.75" diameter)               1 peach or ¾ Cup                      
Peaches (canned)                     2 halves or ½ cup                     
Pear                                 ½ large or 1 small                    
Pears (canned)                       2 halves or ½ cup                     
Persimmon (medium, native)           2 persimmons                          
Pineapple (raw)                      ¾ Cup                                 
Pineapple (canned)                   1/3 Cup                               
Plum (raw, 2" diameter)              2 plums                               
Pomegranate                          ½ pomegranate                         
Raspberries (raw)                    1 Cup                                 
Strawberries (raw, whole)            1 1/4 Cup                             
Tangerine (2.5" diameter)            2 tangerines                          
Watermelon (cubes                    l l/4 cup 

DRIED FRUIT

Apples     4 rings              Apricots   7 halves

Dates      2½ medium            Figs       1 ½

Prunes     3 medium             Raisins    2 tbsp 

FRUIT JUICE

Apple juice/cider  ½ Cup        Cranberry juice cocktail  1/3 Cup

Grapefruit juice   ½ Cup        Grape juice               1/3 Cup

Orange juice       ½ Cup        Pineapple juice           ½ Cup

Prune juice        1/3 Cup 

MILK LIST

Choose milk exchanges from the skim and very low-fat, low-fat, and whole-milk lists. Each item is one exchange and contains trace amounts to 8 grams of fat and from 90 to 150 calories. The amount of fat in milk is measured as the percent of butterfat. Items on the whole-milk list contain much more fat than those on the skim and low-fat lists. Limit your choices from the whole-milk list as much as possible.

Milk is the body's main source of calcium, needed for growth and the repair of bones. Yogurt is also a good calcium source. Yogurt and dry or powdered milk products have different amounts of fat. Check labels for fat and calorie content.

Milk is good to drink and can be added to cereal and other foods. You can make tasty dishes like sugar-free pudding from milk (see the Combination Foods list). Add flavor to plain yogurt by mixing in one of your fruit exchanges.

SKIM AND VERY LOW-FAT MILK

Skim milk, ½% milk, 1% milk, low-fat buttermilk   1 cup

Evaporated skim milk                              ½ cup

Dry non-fat milk                                  1/3 Cup

Plain non-fat yogurt                              8 oz.

LOW-FAT MILK

2% Milk      1 Cup 

Plain low-fat yogurt (with added 8 oz. non-fat milk solids) 

WHOLE MILK

Whole milk              1 Cup

Evaporated whole milk   ½ oz.

Whole plain yogurt      8 oz. 

FAT LIST

Choose fat exchanges from these lists. Each item is 1 exchange and contains about 45 calories. These foods are mostly fat, although some contain a small amount of protein. All fats are high in calories, so measure them carefully, and modify your fat intake by eating unsaturated fats instead of saturated fats. Sodium content of these foods varies widely; check labels for sodium information.

UNSATURATED FATS

Avocado 1/8 medium Margarine 1 tsp Margarine, diet 1 tbsp Mayonnaise 1 tsp Mayonnaise, reduced calorie 1 tbsp Nuts and seeds: Almonds (dry roasted) 6 whole Cashews (dry roasted) 1 tbsp Pecans 2 whole Peanuts 20 sm or 10 lrg Walnuts 2 whole Other nuts 1 tbsp Seeds, pine nuts, sunflower (no 1 tbsp shells) 2 tbsp Pumpkin seeds 1 tsp Oil (corn, cottonseed, safflower, soybean, sunflower, olive, peanut) Olives 10 small or 5 large Salad dressing, mayonnaise-type 2 tsp Salad dressing, mayonnaise-type, reduced-calorie 1 tbsp Salad dressing (all varieties) 1 tbsp Salad dressing, reduced-calorie 2 tbsp (Two tablespoons of low-calorie salad dressing is a free food.)

SATURATED FATS

Butter 1 tsp Bacon 1 slice Chitterlings ½ oz. Coconut (shredded) 2 tbsp Coffee whitener, liquid 2 tbsp Coffee whitener, powder 4 tsp Cream (light, coffee, table) 2 tbsp Cream, sour 2 tbsp Cream (heavy, whipping) 1 tbsp Cream cheese 1 tbsp Salt pork ¼ oz.

FREE FOODS

Free foods are foods and drinks that have less than 20 calories per serving. When no serving size is specified, you can eat as much of the item as you want. You can eat 2 or 3 servings of those items that have specific serving sizes each day; be sure to spread them out through the day.

DRINKS

Bouillon or broth without fat
Bouillon, low sodium
Carbonated drinks, sugar-free
Carbonated water
Club soda
Cocoa powder, unsweetened (1 tbsp)
Coffee/Tea
Drink mixes, sugar-free
Tonic water, sugar-free


NONSTICK PAN SPRAY

FRUIT

Cranberries, unsweetened (1/2 cup)
Rhubarb, unsweetened (1/2 cup)

RAW VEGETABLES (1 CUP)

Cabbage
Celery
Chinese cabbage
Cucumber
Green onion
Hot peppers
Mushrooms
Radishes
Zucchini

SALAD GREENS

Endive
Escarole
Lettuce
Romaine
Spinach

SWEET SUBSTITUTES

Candy, hard, sugar-free
Gelatin, sugar-free
Gum, sugar-free
Jam/Jelly sugar-free (1-2 tbsp)
Sugar substitutes: saccharin, aspartame
Whipped topping (2 tbsp)

CONDIMENTS

Catsup (1 tbsp)
Horseradish
Mustard
Pickles, dill, unsweetened
Salad dressing, low-calorie (2 tbsp)
Taco sauce (1 tbsp)
Vinegar

SEASONINGS

Seasonings can be helpful in making food taste better. Check labels for sodium content, and choose seasonings that do not contain "sodium" or "salt."


Basil
Celery seed
Cinnamon
Chili powder
Chives
Curry
Dill
Flavoring extracts (vanilla, almond, walnut, peppermint, butter, lemon, etc.)
Garlic
Garlic powder
Herbs
Hot pepper sauce
Lemon
Lemon juice
Lime
Lime juice
Mint
Onion powder
Oregano
Paprika
Pepper
Pimento
Soy sauce
Soy sauce, low sodium ("lite")
Spices
Wine, for cooking (1/4 Cup)
Worcestershire sauce

COMBINATION FOODS

Much of what we eat is mixed together in combination foods t do not fit into any one exchange list. Sometimes it's difficult to know the ingredients in a casserole or baked food item. This exchange list will help you fit combination foods into your meal plan. You can always check with your dietitian for information about any other foods you'd like to eat. The American Diabetes Association/American Dietetic Association Family Cookbooks and the American Diabetes Association Holiday Cookbook contain many recipes and further information about many foods, including combination foods. Check your library or your local bookstore.

COMBINATION FOOD         SERVING                   EXCHANGES                

Casserole, homemade      1 cup (8 oz.)             2 starch, 2 medium-fat   
                                                    meat, 1 fat              

Cheese pizza, thin       ¼ of 15" pie              2 starch, 1 medium-fat   
crust                                                meat, 1 fat              

Chili with beans         1 cup (8 oz.)             2 starch, 1 medium-fat   
(commercial)                                         meat, 1 fat              

Chow mein (without       2 cup (16 oz.)            1 starch, 2 vegetable,   
noodles or rice)                                   2 lean meat              

Macaroni and cheese      1 cup (8 oz.)             2 starch, 1 medium-fat   
                                                     meat, 2 fat              

Bean soup                1 cup (8 oz.)             1 starch, 1 vegetable,   
                                                   1 lean meat              
                                                     (cooked)  meat           

Chunky soup (all         10 3/4 oz. can            1 starch, 1 vegetable,   
varieties)                                         1 medium-fat meat        

Cream soup               1 cup (8 oz.) lean        1 starch, 1 fat          

Vegetable soup or broth  1 cup (8 oz.)             1 starch                 

Spaghetti and meatballs  1 cup (8 oz.)             1 starch, 1 medium-fat   
                                                     meat, 1 fat              

Sugar-free pudding       1/2 cup                   1 starch                 
(made with skim milk)                                                       

Beans used as a meat substitute:                                           

Dried beans, peas, or    1 cup                     2 starch, 2 lean meat    
lentils                                                                     

FOODS FOR OCCASIONAL USE

The foods on this list can be included in your meal plan, despite their sugar or fat content, provided you maintain blood-glucose control. Average exchange values are listed for each item; because these foods are concentrated sources of carbohydrates, the serving are small. Check with your dietitian for advice on how often and when you can enjoy these foods.

                         SERVING                   EXCHANGES                

Angel food cake          1/12 cake                 2 starch,                

Cake (no icing)          1/12 cake or  3" square   2 starch, 2 fat          

Cookies                  2 small (1 3/4")          2 starch, 2 fat          

Frozen fruit yogurt      1/3 Cup                   1 starch                 

Gingersnaps              3                         1 starch                 

Granola                  ¼ Cup                     1 starch, 1 fat          

Granola bar              1 small                   1 starch, 1 fat          

Ice cream (any flavor)   ½ cup                     1 starch, 2 fat          

Ice milk (any flavor)    ½ cup                     1 starch, 1 fat          

Sherbet (any flavor)     ¼ cup                     1 starch                 

Snack chips (all         1 oz.                     2 starch, 2 fat          
varieties)                                                                  

Vanilla wafers           6 small                   1 starch, 1 fat 

MANAGEMENT TIPS

Here are some tips to help you manage the way you eat:

• Make changes gradually. Don't try to do everything at once. It may take longer to accomplish your goals, but the changes you make will be permanent.
• Set realistic, short-term goals. If weight loss is your goal, try to lose two pounds in two weeks, not 20 pounds in one. Walk two blocks at first, not two miles. Success will come more easily, and you'll feel good about yourself!
• Reward yourself. When you achieve a short-term goal, treat yourself to a movie, buy a new shirt, read a good book, or visit a friend.
• Measure foods. Be careful about serving sizes, and learn to estimate the amount of food you are served when dining out. Measuring all the food you eat for a week or so will help you do this. Measure liquids with a measuring cup. Some solid foods (tuna cottage cheese, canned fruits) can be measured with a measuring cup, too. Use measuring spoons for smaller amounts of foods like oil, salad dressing, or peanut butter. You can use a scale to measure almost anything -- especially meat, poultry, and fish.
  
• Measure all foods after cooking. Some foods you buy uncooked will weigh less after you cook it. This is true of most meats. Starches often swell in cooking, so a small amount of uncooked starch can become a much larger amount of cooked food. The following table illustrates these changes:

                         UNCOOKED                  COOKED                   
STARCH FOODS                                                                

Oatmeal                  3 level tbsp              1/2 cup                  

Cream of Wheat           2 level tbsp              1/2 cup                  

Grits                    3 level tbsp              1/2 cup                  

Rice                     3 level tbsp              1/3 cup                  

Spaghetti                1/4 cup                   1/2 cup                  

Noodles                  1/3 cup                   1/2 cup                  

Macaroni                 1/4 cup                   1/2 cup                  

Dried beans              3 tbsp                    1/3 cup                  

Dried peas               3 tbsp                    1/3 cup                  

Lentils                  2 tbsp                    1/3 cup                  

MEATS                                                                       

Hamburger                4 oz.                     3 oz.                    

Chicken                  small drumstick           1 oz.                    
                         half breast               3 oz. 

• Read food labels. Remember dietetic does not mean diabetic! "Dietetic" on a food label means that something has been changed or replaced. There may be less salt, less fat, or less sugar, but dietetic food is not necessarily sugar-free or calorie-free. Some dietetic foods may be useful. You can eat dietetic foods that contain up to 20 calories per serving three times a day as free foods.
  
• Know your sweeteners. There are two types of sweeteners on the marker: those that contain calories and those that do not. Sweeteners with calories, such as fructose, sorbitol, and mannitol, can cause cramping and diarrhea when used in large amounts. And these sweeteners have calories, which do add up. Sweeteners without calories include saccharin and aspartame (Equal,® Nutrasweet®) and may be used in moderation.

More Helpful Hints

Dietetic candy may satisfy your craving for sweets, but eat no more than 3 hard candies (usually 3 calories a piece) in a day. "Diet" chocolates contain many more calories in fat, Sorbitol, and milk solids. It is best to avoid these.
Here are a few more rules for keeping your insulin dependent diabetes in control:

• If a meal is unavoidably delayed, you may need to prevent an insulin reaction with fast-acting sugar (see Chapter 9). You may also have to eat a small snack, such as
• If you are planning a late-evening dinner, eat your usual bedtime snack at your regular dinner hour. Then enjoy your late dinner. Do not have another bedtime snack.
• If you eat extra food, you'll need to adjust your activity level or insulin to accommodate the added blood glucose.

Alcohol

Alcohol can cause control problems for people with diabetes. It can lower blood sugar by blocking the release of glycogen (stored glucose), possibly leading to a severe insulin reaction. Never drink when insulin is at the peak of its action (see Chapter 9). If you have alcohol on your breath, people may think you're drunk when you're actually having a reaction.


USE ALCOHOL ONLY WITH MEALS AND SNACKS, AND ONLY IN MODERATION.

Ask your diabetes educator or doctor for advice and avoid alcohol when your diabetes is not in good control. If you're on a weight reduction diet, remember that alcohol contributes 7 calories per gram, and actually stimulates the appetite.
Alcohol is a depressant. It has an anesthetic effect that impairs the self-control and judgment you need to keep in good control. Try to limit your drinking to special occasions. A non-alcoholic beverage (mineral water or club soda with lemon or lime, diet soft drink, tomato or vegetable juice) is always a safer choice.

Alcohol Exchanges

Your body digests alcohol as a fat. A highball with water or soda water contains about 135 calories. Remove one fat exchange for every 45 calories in an alcoholic beverage.
WARNING: DO NOT ELIMINATE YOUR REGULAR MEAL TO BALANCE ALCOHOL CALORIES. You could have a severe insulin reaction.

Food Exchanges for Alcoholic Beverages

BEVERAGE                 EXCHANGES         APPROXIMATE CALORIES     

Gin, rum, scotch,        2-3 fat                80 proof: 96             

vodka, whisky (1.5 oz.)                         100 proof: 120           

Dry wine                 2 fat                  70                       
(unsweetened, 4 oz.)                                                        

Low cal beer (12 oz.)    2 fat                  90                       
                         1/2 fruit                                          

Beer, 4.5% alcohol       1 bread                160                      
(12 oz.)                 2 fat                                              

Manhattan (3.5 oz.)      1/2 bread              170                      
                         3 fat                                              

Martini (3.5 oz.)        3 fat                  135                      

Old Fashioned (4 oz.)    1/2 bread              190                      
                         3.5 fat                                            

Sherry, dry(3 oz.)       1/2 bread              125                      
                         2 fat 

Eating Out

Sticking to your meal plan doesn't mean you can't eat out in restaurants or accept friends' dinner invitations. But you do have to take precautions:

• Keep your meal plan with you until you know it well.
  
• Order plainly cooked, familiar foods. Avoid casseroles, fried foods, cream soups, gravies, sauces, stuffings, breaded meats, and desserts.
  
• Try ordering ala carte. Ask the server about any food you're not familiar with.
  
• Measure foods at home so you'll be able estimate portions when you go out. Restaurant portions tend to be generous, so plan to share your meal or bring part of it home.
  
• Call ahead for information about menu offerings so you can plan your meal. This applies to both restaurants and friends. Don't be afraid to explain your meal plan requirements. People will usually cooperate.
  
• Never eat unacceptable foods to please your hostess or the cook. Your health is more important.
  
• Try to eat within an hour of your regular meal time. If there is a delay, ask for some crackers or bread sticks.
  
• Always carry some form of fast-acting sugar (see Chapter 9).

Fast Food Restaurants

It can be difficult to meet nutritional requirements and maintain good balance with fast food meals. Fast foods typically contain little fiber, and their vitamin and mineral contents vary. Vegetables, fruits, whole grain breads, and dairy products are often missing from fast food menus. Remember, a fruit drink is not fruit juice. And fast food is typically high in sodium, saturated fats, and cholesterol. If you must eat fast food, choose the low-fat menu selections now available in many chain restaurants. Ask your diabetes educator or dietician for a copy of Becton Dickinson's Fast Food Guide. This foldout chart lists calories, nutritional content, and exchanges for many popular fast foods.

Sample 1500 Calorie ADA Diet

Breakfast                   Afternoon Snack          

1 Fruit (List 4)            1 Fruit (List 4)
    
2 Starch/Bread (List 1)     Dinner                   

1 Fat (List 6)              2 Meat (List 2)          

1 Milk (List 5)             2 Starch/Bread (List 1)  

*Free Foods (List 7)        1 Vegetable (List 3)     
                            1 Fruit (List 4)         
Lunch                       2 Fat (List 6)           

1 Meat (List 2)             *Free Foods (List 7)
 
2 Starch/Bread (List 1)     Evening Snack            

1 Vegetable (List 3)        1 Starch/Bread (List 1)  

1 Fruit (List 4)            1 Milk (List 5)          

1 Fat (List 6)              1 Fruit (List 4)         

*Free Foods (List 7)                                 

REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort.

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical Center. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management.

Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention!

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