The Exchange System Doesn’t Work!


By: Beverly Mack

For the past 10 years, I have been telling people with diabetes to drink fruit juice only if they are having a hypoglycemic reaction. My feelings on this issue have now been backed up in a recent study published in the Diabetes Educator (volume 17, number 4). Marilyn Sullivan, MS, RD, CDE and Robert Scott, MD found that both fruit juice and decaffeinated cola raised patients blood sugar at a similar rate. They concluded by stating: “When it comes time to revise the Diabetic Exchange Lists for Meal Planning, the authors may want to reconsider listing fruit juices as acceptable choices from the fruit list to be used in routine meal planning.”

In order to follow the exchange system, one must eat the same amount of starches, proteins, fruits, and fats every morning. This same policy must be followed for lunch and dinner as well. Exchanges are based on how many calories an individual needs, as well as the type and amount of insulin or oral medication required. The exchange system is designed to work if glucose levels are always within a normal range (80-120mg/dl). But this is rarely the case. It is obvious that stress, exercise, hormones, and illness alter glucose levels. All of us need to be equipped to handle these unexpected blood sugar changes. It is inappropriate to eat the same amount of food on a 350 glucose level as on a 110 glucose level. A powerful tool at our disposal is the ability to alter what we eat.

Since both fruit and starch have an immediate effect on blood sugar, I suggest to cut out all fruit if your blood sugars are high. In addition, I recommend cutting back, not cutting out, on starch. If blood sugars are low before a certain meal, it makes sense to increase your starch and fruit intake.

Beverly Mack is a registered dietitian and Certified Diabetes Educator. She has been teaching for ten years and has had diabetes for 16 years. She is presently an educator at The Diabetes Center at Mount Zion Hospital and is also in private practice.



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