How to Make Food Swaps on a Diabetes Diet

by Heather Reese Patient Expert

Question: What is the best method for calculating diabetic exchanges of mixed foods such as chicken pot pie or vegetable beef soup?
Could you please share the steps to this process?

Heather: This can be quite challenging. In fact, many diabetes educators recommend carbohydrate counting over exchange lists because determining the number of exchanges in combination foods can be difficult. However, I think exchange lists can be a great method for monitoring intake when utilized properly.

The use of exchange lists is one method you can use to help you plan healthy meals that will support blood sugar control. This system divides the food groups into the following categories: carbohydrates, meats and fats. If you choose to use the exchange system for menu planning, your diabetes educator will give you a plan that tells you how many servings of each exchange category you should eat each day.
Combination Foods
While the exchange system is pretty straight-forward when it comes to plain foods, determining the number of exchanges for combination foods can be a barrier to staying on your menu planning. Let's be honest, we eat more than just pieces of fruit or bread and simple combination foods like pasta with marinara sauce or cereal with milk. In everyone's life a little casserole will fall, and when that happens it takes a little skill to determine what exchanges and how many of those exchanges you are eating.

This doesn't mean that if you are using the exchange system to plan your meals, you can't have combination foods. In fact, by using the nutrient information and a little math, you can figure it out. This is what you need to know:

One carbohydrate exchange, which includes starches, milk, fruit and vegetables, equals 15 grams of carbohydrate.

Once meat exchanges equals 7 grams of protein.

One fat exchange equals 9 grams of fat.

Doing the Math
Step One: Begin by looking at the total grams carbohydrate, protein and fat in one serving of the food you are eating. For example, one serving of chicken casserole may have 247 calories, 27 grams of protein, 5 grams of fat and 24 grams of carbohydrate.

Step Two: You divide the total grams of carbohydrate, protein and fat by the number of grams per exchange to determine the number of exchanges per serving. For this chicken casserole, one serving would provide 1.5 carbohydrate exchanges, 3 meat exchanges and
½ fat exchanges. This is how I figured it out:

24 grams of carbohydrate / 15 grams per exchange = 1.5 carbohydrate exchanges.

27 grams of protein / 7 grams per exchange = 3 meat exchanges.

5 grams of fat / 9 grams per exchange =
½ fat exchanges.
To determine whether the carbohydrate exchanges come from fruits, vegetables, milk or starches you will need to make an estimate based on the ingredients.

If you do not have the nutrient information, it can be very difficult to determine the number of exchanges you are eating. In this case, you need to estimate the number of exchanges based on the ingredients in the dish.

Heather Reese
Meet Our Writer
Heather Reese

Heather wrote for HealthCentral as a patient expert for Food & Nutrition.