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Should I Count Calories or Use Exchanges for My Meal Planning Approach?

Counting calories alone is not a very effective way to manage your diabetes, because calories that come from carbohydrate will have a larger and quicker effect raising your blood glucose than calories that come from protein or fat. So if you eat an average-sized meal, but it is all carbohydrate, your blood glucose may rise to an unhealthy level. On the other hand, for many people with diabetes — particularly older people with type 2 diabetes — weight loss is a very important goal to help keep their blood sugars under control. So calories do matter.

Both exchange meal planning and newer meal planning tools like carbohydrate counting and fat gram counting can help you monitor calories while controlling blood glucose.

Many people who have had diabetes for a decade or longer were taught exchange meal planning to manage their diabetes. This system divides all food into six categories — starch, fruit, milk, vegetable, meat, and fat groups. A defined serving or "exchange" of each food item in one of these categories has the same calories, grams of fat, protein, and carbohydrate in it as every other food item in that category. So, under the "fruit choices" in the exchange system, for example, ½ cup of applesauce and a small banana each equals one "fruit exchange" that has 60 calories, 15 grams of carbohydrate, and no protein or fat.

In the exchange meal planning system, your healthcare team works with you to develop a meal plan that distributes a number of exchanges from each of the six food categories through each of three meals and two or three snacks each day. The meal plan is developed based on the patient's diabetes treatment plan and goals. If weight loss is a goal, for example, the patient will have fewer exchanges to spend at each meal, so that total calories are kept at a level to enable the patient to lose weight. Patients then use food lists to figure out how to "spend" those exchanges at each meal.

This system has been fairly complicated for many patients to use successfully, though many people who have used this system for years are very happy with it.

More recently — and particularly with the growing use of prepackaged foods — the focus has shifted to carbohydrate counting and fat gram counting for meal planning. Because carbohydrate has the biggest effect on blood glucose, clinicians believe that if the patient is allocated a number of grams of carbohydrate to eat at each meal, they can keep their blood glucose under control with much less mathematical gymnastics. Similarly, some patients who need to lose weight may focus on counting grams of fat, because each gram of fat in a food has 9 calories in it (versus carbohydrate or protein, which have only 4 calories per gram). Because fat grams and carbohydrate grams per serving are listed on all packaged foods, this becomes a much easier way for people to manage their meals for good blood glucose control.

The bottom line: talk with your healthcare team about what your diabetes treatment goals are, and with a dietitian who has experience in diabetes about what type of meal planning methods are available that will be easiest for you to use to achieve those treatment goals.

See our latest cookbooks and nutrition books at the Joslin Store.

Page last updated: July 23, 2014