The “exchange system” diabetes meal plan was introduced in the 1950s. I didn’t come on the diabetes scene until 1975, so I can’t comment on the early exchange days. For the first two decades of my diabetes life; however, we were told to take a certain amount of insulin at a certain time, and then eat certain amounts of food at certain times. Some may (understandably) compare this with prison life.
The Diabetes Control and Complications Trial introduced us to carbohydrate counting, which was closely followed by the introduction of new, fancy types of insulin that work faster or longer than the types we had in the early days. Together, carbohydrate counting and fancy insulin have broken us out of prison, and given us the freedom to eat when we want. In addition, we are not limited to eating the same foods day in and day out.
The downside to carbohydrate counting, however, is that we often focus only on the carbs. This can lead to over (or under) eating protein and fat, overeating carbohydrate, undereating vegetables and weight gain. The nice things about the “exchange system” are 1) it is a great way to introduce someone to the different types of foods and the effect they have on blood glucose levels, 2) it is a good way to learn carbohydrate counting (once you learn what an “exchange” is, it’s easy to transfer that to a “carb serving”), and 3) it is a wonderful reminder to eat foods – in moderation – from all of the food groups.
I was surprised to learn how many people are still being taught to use exchanges in recent years. I truly thought this system had gone the way of the horse and buggy. But knowing it’s still out there, I think the most important thing is to use it to our advantage, and not as a way to frustrate or anger people.
What meal plan were you taught at diagnosis?