From Fitchburg, Massachusetts, USA:
I was diagnosed with Type 2 about 2 months ago and I'm now following the exchanges diet. Can non-carbohydrate exchanges be moved around during the course of a day? For example, I have 3 meat exchanges for both lunch and dinner, if I only have 2 meats at lunch can I have 4 at dinner time?
Since most after-meal blood glucose comes from carbohydrate foods, moving non-carbohydrate foods around shouldn't affect your blood sugar. So, if eating less protein at lunch and more at supper makes more sense for you for any reason, enjoy! But I like the fact that you're planning on keeping some protein at both meals. That makes sense because, for one thing, it helps control appetite better than an all-carbohydrate meal would. Also, meals with some protein and fat in them tend to produce a slower after-meal rise in glucose than meals containing only carbohydrate. I think your plan should work well. You can check the result yourself by testing your blood sugar before and after eating. If your doctor hasn't given you specific glucose goals, you might consider the ones suggested by the American Diabetes Association: 80-120 before meals and less than 180 after meals. If you're not in that goal range most of the time following your meal plan, see your diabetes team. Either the food plan or your medicines need adjusting.
Moving carbohydrate foods, on the other hand, can be more touchy. Most people with Type 2 diabetes (the ones on no medicines or on diabetes pills only) have a limited amount of carbohydrate they can handle at one meal. At our center, we call this amount the carbohydrate "budget." With your financial budget, you can spend less than you've allowed but you might get into trouble if you spend more! In the same way, when it comes to your diabetes meal plan, if you're not very hungry or want to eat a low carbohydrate meal (say, broiled salmon and a big salad), you can probably eat less carbohydrate than is on your meal plan. But if you eat more, you blood sugar may go up because you don't have enough insulin to handle the load. People who take a set dose of injected insulin or have problems with low blood sugar need to ask their doctor or diabetes educator whether eating less than is on their meal plan is an option for them.
Virtually any meal plan needs "tailoring," just like you are doing now. If you're going to use a structured meal plan, keep working with your team to tailor it to fit your needs, lifestyle, appetite and so on. Otherwise, you are sure to quickly abandon it. Diabetes is forever -- so you need a nutrition approach that's both effective and comfortable for the long haul!
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