Exchange meals for diabetics

  1. diabetes-menu1-jpg
  2. Hello everyone! Is there anyone out there familiar with diabetes mellitus type II, and knows what an exchange diet is? Mario is having the hardest time understanding this concept. I have attached the simple menu to this message in a .jpg format.

    This assignment is killing me. I totally understand what diabetes is, and I know how insulin works, and where its from, what it does, how the lack of it can reek havok on a person's metabolism, what carbohydrates are, how they are digested and metabolised, ketoacidosis,etc.

    I am drawing a blank when it comes to understanding what an "exchange food" is. Now I know a persons diet must have variety, and that a person with diabetes is no exception. Diabetics can't just eat anything; They hafta watch closely their intakes of fats, carbs and proteins. It's kicking my arse, and I need help.

    I hafta make a one day diet for a diabetic (please see attached file, which is a scan of the menu, which includes the dietary parameters I must stay in). My job is to create a new menu for a day, different than this one (variety). It's knocking me out. Now I can appreciate what a diabetic goes through because there is so much to consider, yet it clicks with some folks right away. With me, the numbers are blowing me, and my understanding of this concept.

    I would gladly do a barter exchange for knowledge with anyone if they could help me make a one day exchange menu. This seems so simple, but I need someone to talk about it with. Looking at appendixes in the back of the book are not helping me. And i am panicing.

    Using the attached form, I have to fill in the menu portion for another day, but i hafta use different foods and drinks, and stay in the parameters. Is there a diabetic out there, or a super-power nutritionalist who can look at this and say, "oh yeah, this is what you gatta do." I would seriously be in your debt if you can shed light on this for me. Thank you.
  3. Visit mario_ragucci profile page

    About mario_ragucci

    Joined: Jan '02; Posts: 1,614; Likes: 2


  4. by   NurseDennie
    Mario -

    I'm afraid I don't understand what your question is. You have a menu on the attachment???


  5. by   hoolahan

    Exchange simply means you can fill in any food of equal nutritional value.

    Ex in an 1800 ADA diet, a person can have one fruit veg/exchange
    at breakfast, so a fruit exchange is
    1/2 banana
    4 oz OJ
    1/2 grapefruit
    1 small apple

    A milk exchange could be 1 cup 1% milk, or 8 oz non sweetened yogurt or x oz cheese.

    OK, my figures may not be exact, but you get the general idea.

    Looked at your menu, have to ask 2 things
    1. How many calories per day are you shooting for a day?
    2. When was the last time you ever ate 1 oz of chicken at a sitting? Usually 3 oz of meat per exchange is more realistic, unless it is a pediatric diet.

    OK Dude? Try this site for more details

    Beyond that, I can't help you any better. In practice, in my home health job, I take a pre-printed sheet of a 1800 ADA diet which gives a pt a 7 day sample diet. For pt's who have a very hard time with calcs, giving them this recipe, helps them get started, once BS is under control, then we worry about what can be exchanged for what. Good luck.
  6. by   mario_ragucci
    I'm starting to come out of the haze, thanks to being able to bounce this off the board :-)
    Dennie, the question is, given the attached menu, come up with a "day two" menu like the attached one, but with different foods.

    Is this where the concept of exchange comes in? exchanging one food for another? Like, exchanging one normal carbohydrate food for 2 lesser carbohydrate foods?

    Okay, so is it like a "deal a meal" type set up? Why is this so hard to understand for me :-(

    1500 kcals is the diet restrictions: 824 from carbs, 308 from protein and 369 from fat. But then, on the attached menu it says "exchange plan" which is where I get bugged out. What do those numbers mean?

    I am sorry to bug yall with this technical stuff. Menu planning is not like it is for me, where I can eat anything, and don't hafta count C, P and F, but for special folks, it must be rigorous. Unless there is a computer program. Let me check out the web site HotLips put down. I hafta have this understood by Thursday, and I am sweating it. Any comments are welcome, and I thank you again

    Mario the nutritional dunce :-(
  7. by   mario_ragucci
    This concludes my haze. I went to the website (which I shoulda did before shooting off another confused post), then read about exchanges and other diabetes related information.

    Then I went to the TOOL BOX, then to the carbohydrate counter, then followed the 4 steps, and now I am handling a dietary tool.

    I still don't know what that "exchange plan" is on my assignment (attached at beginning post) but now I can get started.

    Thank you hot lips :kiss
  8. by   Squirrel

    I am not sure if this is what you are looking for, but I can give you a brief overview of what dietitians use when they counsel diabetic patients.

    The idea of the exchange list is to group similar foods into categories so the diabetic patient can have more of a selection and more control over his diet. The categories include the starch list, fruit list, milk list, vegetable list, meat list, and fat list.

    One serving from each list contains a certain amount of CHO, protein, fat, and calories. The serving size for each food is also listed so the patient will know how much of a certain food is considered a serving. Be careful because the serving sizes stated for the exchange lists may not be the same for the food guide pyramid. For example, one serving of fruit juice in the exchange list is 1/2 cup but the serving of fruit juice in the food guide pyramid is 3/4 cup.

    Each serving of food in the starch list contains 15 gm CHO, 3 gm protein, 1 gm fat, and 80 calories.

    Each serving in the fruit group has 15 gm CHO, no protein or fat, and 60 calories.

    If you need information from the other lists, I can post it for you.

    When you recommend a diet based on the exchange list, you first find out the Cal/day the patient needs such as 1800, then you figure out what percentage of Calories will come from protein, fat, and CHO. This will eventually lead you to how many grams of protein, fat, and CHO the patient will need each day. Then you work with the patient to figure out how these nutrients will be distributed during the day, and how many foods from the different lists will be included.

    For example, if a patient needs 60 gm of protein a day and does not like to eat meat to get the amount, he can choose more foods in the CHO or milk group. This can take alot of time to do and requires several calculations. If a patient likes to eat alot of fruit, then you should include more foods from the fruit list. If the patient will not drink milk, this needs to be considered before you recommend 2 servings from the milk list. I am not sure if this answers your question, as I am not sure how much information you need.
  9. by   Squirrel

    I am just now looking at your menu you uploaded (by the way how did you do that?) This looks like something right out of my dietetic textbook!

    What it is saying is that the number of servings from each food list has already been determined for that patient: 3 servings from milk list, 3 from meat list, 8 from bread list, 2 from fruit list, 4 from vegetable list, and 5 from fat list.

    Where it says exchange plan is how the foods from the exchange lists are distributed during the day. For example, the patient will get a total of 3 servings of milk a day. These 3 servings are distributed as follows: 1 for breakfast, 1 for lunch, 1/2 for dinner, and 1/2 at bedtime. Does that make sense? This is what you need to know to plan the menu for the next day. Look at each meal and see how many servings of each exchange list you need.

    Breakfast: you need 1 serving from the milk list, none for meat, 2 from bread, 1 from fruit, no vegetable, and 1 from fat.

    The sample menu just gives you an example of a menu planned from the information stated above.

    For you to do this your instructor should have given you a list of what foods are included in each food list and what the serving sizes are. Again, be careful because the serving sizes are different for the exchange list and the food guide pyramid.

    Hope this helps!
  10. by   Squirrel

    I forgot to mention a few things in my last post. At the bottom of the menu you will see foods listed as "free" (sugar free jello, iceburg lettuce). A free food has less than 20 Calories and less than 5 gm of CHO per serving, and patients usually can have up to 3 free food servings a day in addition to the servings from the food lists.

    After the number of servings from the exchange lists are figured out and distributed during the day (as was done on your menu), the patient can then choose from a variety of foods using the serving sizes from an exchange list. The patient needs to know what a serving size is and how to measure it, but does not need to worry about counting CHO, fat, and protein grams because this was already done by the dietitian when figuring out how many servings of each food list per day. No Calorie counting either! The exchange plan gives the patient more control over his diet with more variety. For example, 1 glazed doughnut counts as 2 CHO and 2 fat exchanges and the patient can eat a doughnut as long as it counts for 2 CHO and 2 fat exchanges in the daily menu.
  11. by   prn nurse
    You all are really first rate ! I read every word of your explanations for Mario. It is nurses like you who make this board a first rate site for all of us come to when we need information. You all are to be commended for your professional, conscientious, comprehensive responses.

    And last, but not least, for caring....that the next generation of nurses "gets' it right."
  12. by   hoolahan
    Mario, the concept is just like deal-a-meal! I was oging to use that analogy, but figured by your trim-looking picture, you would not be familiar with it

    You are right, this is a tough assignment. But it is one of those that you MUST just do and get past. In the real world, there is always a dietary consult for doing these calcs, and cheat sheets for those of us who don't. I have never in 20 years taught a diabetic to calc how many CHO grams versus protein grams, etc. I am just happy if they understand the basic ideas of exchange lists and if they are able to keep their Blood sugar controlled, I don't care what they eat!
  13. by   mario_ragucci
    These explanations are what I needed, and I am in the debt of (((((***Squirrel***)))), **Hoolahan**, and *Dennie*and *prn*. It took guts to respond.

    I was lucky to have wandered into the forest, sad and blue over this diabetic diet assignment, when out popped a squirrel from a beautiful tree's branch, that explained it to me like the instructor wishes he/she could have. I'll print this thread today, and read and re-read the responses before I get to class, and with your help to guide me, can hold my own and complete this assignment. Now I understand what an "exchange food" and an "exchange list" are. Diabetics are like anyone else in that they want to eat delicious foods. That can be where this "exchange" concept can be a tool for them, enabling them to assign a "exchange value" to foods like a donut, or a chocolate milk shake. They can eat this stuff, but not exceed the CHO put into their bodies their insulin can handle. Just because they eat a rich meal DOES NOT mean they hafta starve for the rest of the day. They hafta keep eating, like everyone else, but must take into consideration the dilution of that insulin, via other less dense foods. I hope I said that right,


    (Yeah i know about Richard Simmons. I used to wtch TV years ago, and his infomercial saturated everything. I had to quit watching TV years ago because I would remember everything I saw on it, making my brain a warehouse of useless information, supposed to fire my imagination, I can't get no, no no no no, hey hey hey, thats what I say (Satisfaction):roll
  14. by   mario_ragucci
    Squirrel - In answer to your querry about the's easy.

    Several year ago a bought a cheapo scanner (<$100.00) and it came with generic photo manipulation software called "photoplus!"

    In photo plus, you can do basic things to a picture or scan, like add text, change background colors, paint over stuff, or ADJUST SIZE. So, I just open a picture, choose adjust size, choose by pixel (and not percent or inches) and I shrink the picture to 100x100 pixels. Then I just load it into my profile, and you see it.
    It's super easy. You just need that generic photo software. mine came with the scanner I bought.

    What I will do is create a .gif. Thats where an image will change and give the appearance of animation. this is a little more complicated, because you need PhotoShop software and a more powerful computer, which I can't afford. Also, I could do it in a snap if I had a digital camera set up with my PC (I don't)

    But, on the campus, you can check out a digital camera, but they don't have a workstation set up to do this stuff.

    BUT I FIGURED IT OUT. I WILL TAKE 4-5 STILL, SELF-DIRECTED PICTURES OF MYSELF with my disposable camera, SCAN THEM INTO .jpg on my scanner, then go to Kinkos, pay them the $10.00 minimum, and have the folks help me turn the 4-5 still .jpg pictures into a .gif that is <100kb. I will.

    then you can see an animated Mario blowing a kiss perhaps, or doing something with my arms. i haven't decided.
  15. by   hoolahan
    My scanner software is adobe photo, and my friend and I scanned a pic of us from work, and we darn near peed our pants laughing at the way I removed my double chin, and took away her bra strap from showing in the picture, gave her bigger boobs too!

    Sorry, I digress!! :roll