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Diabetes: Exchange Meal Plan

What is the exchange meal plan?

The exchange meal plan is a food program that balances the amount of carbohydrate your child eats each day. Carbohydrates (carbs) affect your child's blood sugar more than any other kind of nutrient. Insulin works with carbs to supply energy for the body. It is important to keep insulin and carbs in balance.

This plan helps your child decide what type of food to eat, how much food to eat, and when to eat it. As your child gets more comfortable with his eating, he may want to change to a more flexible meal plan such as the constant carbohydrate or the counting carbohydrate meal plan.

How does the exchange meal plan work?

In the exchange meal plan, foods are divided into food lists (starch, fruit, milk, fat, vegetable, and meat). The foods on each list have a similar number of calories, protein, carbs, and fat in them. Foods from each list can be traded or "exchanged" for any other food on the same list because they all have a similar nutritional value. For example, you could exchange a piece of toast for one waffle because they are both on the starch list.

Your child's dietitian will tell you the number and type of exchanges your child should eat at each meal. To do this, your dietitian will need to figure out the number of calories your child needs each day. Most children under age 14 need 1000 calories per day plus 100 calories for each year of age.

1000 calories + (# of years x 100 calories) = # of calories needed per day

For example, a 5-year-old would need 1500 calories.

1000 calories + (5 years x 100 calories) = 1500 calories/day

After calculating the number of calories your child needs each day, the dietitian will make a meal plan. Your child needs a consistent amount of carbohydrate at each meal. Carbohydrates come from the starch, milk, and fruit lists. The meal plan helps your child eat the correct amount of carbs as well as eat a variety of other healthy foods.

For example, if your daughter needs 1500 calories a day, her exchange meal plan might look like this.


           Breakfast   Snack   Lunch   Snack   Dinner  Snack 
Meat                              1               2      1 
Vegetable                                         1 
Fat                               1               1 
Starch        1          1        1       1       2      1 
Fruit         1          1        1       0       0 
Milk          1                   1               1 

The numbers tell you how many items your child can pick from each food list. Notice that the carbs (starch, fruit, milk) are equal for breakfast, lunch, and dinner and that they are also included in snacks.

Your daughter might choose the following menu based on the above plan.

Breakfast: 3/4 cup of cereal (1 starch), 1 cup skim of milk (1 milk), 1/2 banana (1 fruit), grapefruit juice (1 fruit)

Morning snack: small apple (1 fruit)

Lunch: Hot dog bun (2 starch), hot dog (1 meat, 1 fat), 1 cup milk (1 milk), orange (1 fruit)

Afternoon snack: fruit roll-up (1 fruit), 1 1/2 graham crackers (1 starch)

Dinner: 2 ounces of chicken breast (2 meat), 1/2 cup pasta (1 starch), green beans (1 vegetable), bread with butter (1 starch, 1 fat), glass of skim milk (1 milk).

Bedtime snack: 1 string cheese (1 meat) and 6 saltine crackers (1 starch)

The next day, your child could choose a completely different menu using the exchange lists. For example, instead of having cereal, she could choose toast from the starch list.

Sugary foods (brownies, sugar, ice cream, cookies, and honey) do not fit into any of the normal exchange lists. These foods are on a list called the "other carbohydrates" list. If your child chooses to eat a food from the "other carbohydrates" list, he must exchange it for a starch, fruit, or milk exchange. For example, your son plans to eat cereal, milk, a banana, and grapefruit juice for breakfast. Then he decides he wants to add sugar to his cereal. Because sugar is an "other carbohydrate," he would have to give up one of the carbohydrate items from his breakfast, such as the banana, and trade it for the sugar. Because foods on the "other carbohydrates" list are not healthy foods, they are not typically part of a meal plan and need to be exchanged sparingly into your child's diet.

What foods are on the exchange food lists?

The exchange food lists provide lists of food options. In addition to working with the dietitian, you may want to buy the Exchange Lists for Meal Planning from The American Diabetes Association and the American Dietetic Association (1-800-342-2383).

Examples of types of food in each exchange list are as follows:


  • Starch List: One starch exchange contains about 15 grams of carbohydrate and 3 grams of protein (80 calories). Examples of items on this list include bread, cereals, grains, starchy vegetables, crackers, and beans.
  • Fruit List: One fruit exchange contains about 15 grams of carbohydrate (60 calories) and has essentially no fat or protein. Items on the fruit list include fruits and fruit juice.
  • Milk List: One milk exchange contains about 8 grams of protein, 12 grams of carbohydrate with a trace of fat (90 calories). Items on the milk list include different varieties of milk and yogurt.
  • Other Carbohydrates List: One "other carbohydrate" exchange has 15 grams of carbs Many of these foods count as a carb exchange and one or more fat exchanges. This list contains cakes, cookies, ice cream, potato chips, and other foods with carbohydrates.
  • Vegetable List: Vegetables have such a small amount of carbohydrate and protein that it is usually not necessary to count them as an exchange. However, they are important for good nutrition. Your child should eat vegetables every day.

Meats and Meat Substitutes

Meats are divided into very lean, lean, medium fat, and high fat meats. People with diabetes should try to eat more lean and medium fat meats and stay away from the high fat choices.

  • Very Lean List: One exchange equals 7 grams of protein and 0 to 1 gram of fat (35 calories). Examples include skinless chicken or turkey, fresh fish, fat-free cheese, and egg whites.
  • Lean List: One exchange equals 7 grams of protein and 3 grams of fat (55 calories). Examples include lean pork, lean beef, and cottage cheese.
  • Medium Fat List: One exchange equals 7 grams of protein and 5 grams of fat (75 calories). Examples include ground beef, eggs, and tofu.
  • High Fat List: One exchange equals 7 grams of protein and 8 grams of fat (100 calories). This group includes items such as fried fish, hot dogs, spare ribs, peanut butter, and most cheeses.


Fats include oils, butter, nuts, bacon, cream cheese, and other fatty foods. A fat exchange is equal to 5 grams of fat and 45 calories. Fats are divided into three lists: monounsaturated fats, polyunsaturated fats, and saturated fats. Saturated fats are the "bad" fats that are linked with heart disease.

Free Foods

A free food contains less than 20 calories or less than 5 grams of carbs per serving. If the food has a serving size listed on its package, it should be limited to 3 servings spread throughout the day. Examples of free foods include fat-free margarine, sugar-free gelatin, diet soft drinks, catsup, soy sauce, and spices.

Combination Foods

Many foods, such as casseroles, are mixed together. Your dietitian can help you figure out how many exchanges to count for combination foods. For example, a cup of lasagna would equal 2 carb exchanges and 2 medium-fat meat exchanges.

Abstracted from the book, "Understanding Diabetes," 10th Edition, by H. Peter Chase, MD (available by calling 1-800-695-2873).
Published by McKesson Provider Technologies.
Last modified: 2005-04-14
Last reviewed: 2005-12-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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