Counting Carbs vs. Carb Exchanges

I’m a T2 dx several months ago. Since I am also trying to lose weight I count carbs, fats (amount & type), fiber, protein, etc. I’ve read several posts where people follow the food exchange system.

Started me wondering about the differences and similarities and if one might be better than the other. It appears to me that the two systems would likely provide similar overall counts at the end of the day with the possibility of vastly different results for specific meals. I don’t know, just a guess…

What do you do and why?

Good morning Gerriann,

I count carbs because the individual gram of a carbohydrate is an integral part of the insulin doseage with my pump. The bolus wizard calculates the amount of insulin I need based upon my BG reading, insulin on board, and grams of carbohydrate, NOT number of exchanges.

Exchanges are less precise than counting carbs (because grams are rounded up or down to equal one exchange), but using exchanges may ensure a more well-balanced eating plan that includes foods from all the nutrient groups–starch, veg, fruit, dairy, meat, fat. The first four exchange categories contain carbs.

Exchanges are also helpful in teaching people exactly what a serving size should look like. The amount of starch with a typical restaurant meal (picture a Mexican dinner: tortilla chips [carbs], refried beans [carbs and fat], tortillas [carbs] and rice [carbs] is WAAAAAY over what most people should eat–diabetes or no).

Much depends on what type of diabetes you have and what meds you take. People with type 2 who so far use diet and exercise to control blood sugars often find the exchange system works just fine. People with type 1 or those with type 2 who use insulin need to more closely match the specific number of carb grams to their doses.

In the end, however, the best system is the one that helps you hit blood sugar and weight targets. During my 36 years with type 1, I’ve used exchanges, I’ve used no method (those were bad blood sugar years :-), I’ve used Weight Watchers points, and I’ve counted carbs. Now, I use my own custom blend of carb counting and exchanges while making sure I try not to eat beyond my daily calorie target. I’m eager to hear what works for others.

Thanks George, I can see why taking insulin would really complicate things. I don’t take insulin yet so my management is still really simple. My question must really seem silly to those on insulin.

There are no silly questions when it comes to controlling diabetes–honest. Feel free to ask, and ask often!

Wow Kelly…this put’s a lot of things into perspective. Your first sentence is why I choose to count carbs as opposed to the food exchange system. Maybe I made an incorrect assumption about the exchange system…It reminds me of the weight watchers exchange system where you are allowed a certain number of exchanges in each group per day and maybe diabetics who use it would apply the system per meal, not necessarily per day totals. Again I am guessing.

I couldn’t agree more with your statement, “the best system is the one that helps you hit blood sugar and weight targets.”

I am also eager to hear what works for others.

When I was first diagnosed, we used carb exchanges. I have found for myself, carb counting gives me far better control and my occurrences of lows are few and far between. Your treatment may vary are you trained in both systems?

When my mother (gone since 1996) was first dealing with type 2, in the 70s, she was taught the exchange system, and she was expected to eat certain exchanges each meal, and I believe that is still what exchanges are about. She, for example, for lunch, was to have one fruit exchange, one vegetable exchange, one or was it two starch exchanges, one meat exchange, etc. So it’s not like WW’s point system.

I still can do both - take a look at my meal plan - It is a thread A1C and diet. It shows both ways and how I alternate back and forth

if you have any questions let me know I can further explain it if needed.

I have one that I need to scan that shows both meal systems. When I can make it up the stairs to my office I will scan it.

No offical training in either, self taught in carb counting. I saw a dietitian after dx who got me started and I have a couple of books. The dietitian was really a life saver. She showed me that I can eat whatever I want if I am willing to pay the price.

I looked at the meal plan you posted on a1c and diet. Very helpful…thanks. I am interested in the second one whenever you have time to scan it.

Thank you again!

I’ve been officially trained in both, and personally, I found the exchange system to be MUCH more complicated than just carb counting.

It may simplify things for some T2’s who really need to stick to a regular diet and not vary much from meal to meal with what they’re eating (since the exchange system considers more than just carb exchanges), but as a T1 on MDI it just seemed extraordinarily stupid to be “stuck” eating the same amount all the time… there’s no need to do that, especially if you can adjust your insulin to match your food.

It may be a day or so, I had surgery Tuesday. :slight_smile: When I can get someone to help me up the stairs I’ll be glad to post it :slight_smile:

I’m a T2 and I carb count to control my blood sugar. Not all T2’s can safely eat many carbs because diet, exercise, and metformin only go so far . . .

Oh my…no rush…I hope you recover quickly!

To me, the exchange system is like carb counting for dummies. The whole reason it was created was because “they” didn’t think people were intelligent enough to do simple math and if they only had to add or subtract using 1 they would be able to do it easier. Plus I don’t think the nutritional labeling or access to nutrition was anywhere near what it is today. The downside of that is it’s stupidly inaccurate and causes more issues than it solves. With nutrition labels, web sites like,,, etc and some basic math skills there is no reason why you can’t count nutrition with a greater degree of accuracy. If you are dosing insulin based on what you eat then it’s essential to count rather than use the exchange system.

I count carbs and kind of know what the healthy carbs are. I try to keep it to 50-75 carbs a day more or less. I try not to eat any processed carb. By doing that it elimates most of the bad stuff. The only bread I eat is sprouted bread. (5 carbs per slice) I try to avoid rice, potatoes and pasta. By doing that it is much easier to control carbs.

I’m sorry it took so long

Here it is
7393-mealplan09.doc (69.5 KB)

Thank you Cynthia…how are you feeling?

Still sore but thank you for asking. Each day the pain gets better