Managing Sugar Consumption for Diabetics
People with diabetes should avoid sugar-sweetened beverages (including fruit juices) and minimize foods with added sugars to control glycemia, weight, and reduce risk for cardiovascular disease and fatty liver. 1
Understanding Sugar in the Diabetic Diet
Carbohydrate Considerations
- The total amount of carbohydrate in meals or snacks is more important than the source or type when considering glycemic effects 1
- Carbohydrate intake should emphasize nutrient-dense sources that are high in fiber and minimally processed, focusing on vegetables, fruits, legumes, whole grains, and dairy products 1
- For individuals using flexible insulin therapy, education on carbohydrate counting is essential for determining mealtime insulin dosing 1
- For those on fixed insulin doses, maintaining a consistent pattern of carbohydrate intake regarding time and amount is recommended to improve glycemic control and reduce hypoglycemia risk 1
Added Sugars vs. Natural Sugars
- Naturally occurring sugars in whole foods (like fruits) are different from added sugars in terms of their health impact 1
- Free fructose (naturally occurring in foods such as fruit) consumption is not more harmful than other forms of sugar unless intake exceeds approximately 12% of total caloric intake 1
- Added sugars in processed foods and beverages can displace healthier, more nutrient-dense food choices 1
Specific Recommendations for Sugar Management
Sugar-Sweetened Beverages
- Replace sugar-sweetened beverages (including fruit juices) with water as much as possible 1
- Consuming high levels of fructose-containing beverages may have particularly adverse effects on fat deposition, lipid metabolism, blood pressure, and insulin sensitivity 1
Added Sugars in Foods
- Minimize consumption of foods with added sugars that can displace healthier, more nutrient-dense food choices 1
- When consuming carbohydrates, prioritize those from vegetables, fruits, legumes, whole grains, and dairy products, with emphasis on foods higher in fiber and lower in glycemic load 1
Sugar Alcohols and Non-nutritive Sweeteners
- Non-nutritive sweeteners may help reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources 1
- However, people are encouraged to decrease both sweetened and non-nutritive-sweetened beverages overall, with an emphasis on water intake 1
Important Considerations for Hypoglycemia Management
- In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations 1
- Therefore, carbohydrate sources high in protein should be avoided when trying to treat or prevent hypoglycemia 1
- For treating hypoglycemia, sucrose or glucose in the form of tablets, liquid, or gel may be preferred over fruit juice 1
Dietary Pattern Recommendations
- There is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes 1
- A Mediterranean-style eating pattern rich in monounsaturated and polyunsaturated fats may improve glucose metabolism and lower cardiovascular disease risk 1, 2
- Weight loss of ≥5% through reduction of calorie intake and lifestyle modification benefits overweight or obese adults with type 2 diabetes 1, 2
Common Pitfalls to Avoid
- Avoiding all sugars completely is unnecessary and may reduce dietary adherence 3
- Some studies show that teaching individuals with type 2 diabetes how to incorporate modest amounts of sugar into their meal plans does not worsen metabolic profile 3
- Many foods marketed to people with diabetes may contain large amounts of alternative sweeteners (such as agave nectar); these should not be consumed in large amounts to avoid excess caloric and fructose intake 1
- Relying on herbal supplements like berberine instead of evidence-based dietary approaches is not recommended by current diabetes guidelines 2
By following these guidelines and working with healthcare providers, people with diabetes can effectively manage their sugar consumption while maintaining a balanced, nutritious diet that supports their overall health goals.