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October 1999 Issue
Diet and Diabetes
by Ronda L. Halpin
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Before you start a diet based on the Exchange System, it is best to meet with a dietitian who can take a careful diet history and use the information to design a diet plan for you. You will need to learn how many servings from each food group you should have in a day, and how to develop a variety of meals with the plan. Always remember that timing is very important in an Exchange System plan. You need to distribute carbohydrates and calories throughout the day, especially when you take insulin or oral medications for diabetes. The purpose of your medication is to reduce your blood sugar after you have eaten, so it is very important to time your meals and snacks carefully.

To give you a better idea about how the Exchange System works, here is an example menu for a 1500 calorie diet:

  • Breakfast
    • 1/2 banana (1 fruit)
    • 4 oz. (1/2 cup) orange juice (1 fruit)
    • 3/4 cup Total flakes (1 starch)
    • 8 oz. (1 cup) skim milk (1 milk)

  • Lunch
    • 2 slices whole wheat bread (2 starch)
    • 1/2 cup water-packed tuna (2 meat)
    • 1 Tbsp. reduced-calorie mayonnaise (1 fruit)
    • lettuce and tomato (free)
    • 1 cup carrot sticks (1 vegetable)
    • 1 cup cantaloupe (1 fruit)
    • glass of diet soda

  • Snack
    • 8 oz. (1 cup) sugar-free yogurt (1 milk), combined with
    • 3 Tbsp. Grape nuts (1 starch)

  • Dinner
    • 1 1/2 cups cooked spaghetti (3 starch)
    • 3 one-oz. meatballs (3 meat and 1 fruit)
    • 4 oz. (1/2 cup) spaghetti sauce (1 vegetable)
    • tossed salad (1 vegetable)
    • 1 Tbsp. salad dressing (2 fats)
    • diet Jell-O

  • Evening Snack
    • 4 oz. (1/2 cup) apple juice (1 fruit)
    • 3 square graham crackers (1 starch)

Flexible Exchanges is a method based on the Exchange System, but it provides more choice and flexibility. For instance:

  • Foods from the starch/bread, fruit, and milk lists are interchangeable in this method.

  • The carbohydrate content in each of these three groups is similar (12-15 grams of carbohydrate per serving), so their effects on blood sugar tend to be similar, too.

This program works well for those who enjoy a more flexible approach, do not need strict glucose control, and can understand how to use the Exchange System.

The Total Average Glucose (TAG) diet system method is based on adjusting insulin to the total amount of glucose derived from foods. It is more complex, but does an excellent job of controlling glucose intake. Here are some facts about the TAG system:

  • The amount of glucose derived is equal to the sum of the glucose available from 100 percent of carbohydrate, 58 percent of protein and 10 percent of fat.

  • "Points" are calculated from each meal according to its content of fat, protein and carbohydrate.

  • People likely to do well with this system must be able to understand this advanced method well.

  • This approach is a good choice for very motivated people who need tight glucose control.
  • The diet requires that you weigh your food regularly.
Carbohydrate Counting focuses on the grams of carbohydrate eaten at meals and snacks, since carbohydrate has the greatest effect on blood sugar.
  • Carbohydrate Counting is more precise, yet simpler to apply, than the Exchange System;

  • Like the Exchange System, Carbohydrate Counting requires referring to a list of food.

  • Among those who do well with this approach are people who need something simpler than the Exchange System.

  • This is also a good plan for people who are very carbohydrate-sensitive and need tight glucose control.

The Importance of Timing

Regardless of which diet plan works best for you, it is extremely important to time your meals and snacks appropriately. If you are using insulin, you need to know the onset, or the period of time insulin takes to begin working, and the duration, or the length of time it is active and when it tapers off. For instance, an often used insulin called NPH is intermediate-acting. It begins to work within 1-3 hours of injection, reaches a peak in 6-12 hours, and then tapers for up to 18 more hours.

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