Can People with Diabetes Consume Sugar?
Sugar is often considered a four-letter word when it comes to diabetes prevention and management. That, of course, makes sense, given that elevated blood sugar is the main marker for diabetes.
Yet what about the sugar that you eat? While many people believe that it causes diabetes, others think they need to eschew sugar from their diets completely. Fortunately, neither is true, and if you have diabetes, the good news is that you can fit a little sugar in your diet. Here's how to do it safely.
How sugar impacts diabetes
As a reminder, there are two types of diabetes—type 1 and type 2—and while type 1 means your pancreas can't produce insulin, type 2 is where your body simply doesn't produce enough insulin. "Not only that, but the amount of insulin your body does produce doesn't always work as it should to help bring sugar, or glucose, into your cells to reduce overall blood sugar, something often called insulin resistance," says Christa Brown, M.S., RD, LDN, a registered dietitian in Woodbridge, New Jersey.
Numerous factors play into the development of type 2 diabetes, including age, family history and other medical conditions like high blood pressure and low HDL (AKA good) cholesterol, but the sugar in your diet isn't one of them. "Eating too much added sugar doesn't directly cause diabetes," says Lauren Harris-Pincus, M.S., RDN, a registered dietitian in Green Brook, New Jersey who's the founder of NutritionStarringYou.com and author of the Everything Easy Pre-Diabetes Cookbook.
Yet added sugar can contribute to issues that lead to diabetes. Take weight gain, for instance. "Extra weight can play a role in the development of insulin resistance and ultimately lead to a diabetes diagnosis," Harris-Pincus says.
It's important to note, though, that Harris-Pincus is referring to added sugar. There are also naturally occurring sugars like those in fruits, vegetables and plain yogurt, but the difference is that these are nutrient-dense foods, meaning that they provide a significant amount of nutrition for the amount of calories they contain. Plus, fruits and vegetables contain fiber, which helps delay the absorption of carbohydrates and temper any rise in blood pressure, she says.
Added sugar, on the other hand, is the problematic type. "Added sugar, which is added during the manufacturing process or at home, contributes calories without beneficial nutrients," Harris-Pincus says. Examples of added sugar include granulated sugar, honey, brown sugar, maple syrup, agave, coconut sugar and sucrose, to name a few. You can find these in everything from cakes and ice cream to breakfast cereal bars, yogurts, coffee drinks and soda.
Why people with diabetes think they can't eat sugar
Whenever you eat carbohydrates, your body breaks them down into their simple forms of sugar (glucose, fructose and galactose), which is why carbohydrate-rich foods are considered sources of sugar. As a result, your blood sugar level will naturally rise, especially if you're eating these foods by themselves. "Because carbohydrates are the easiest macronutrient to digest (compared to protein and fat), your blood sugar will rise within 15 to 20 minutes of eating that food," says Brown, stressing, though, that sugar and carbohydrates should not be considered "bad."
Although this is a normal response to eating carbohydrates, people who want to prevent or manage diabetes often assume they can't eat these foods and try to lop them out of their diet. It doesn't help that this philosophy is embedded in the diet culture, as certain diets like the keto diet advocate for eliminating all carbohydrate-containing foods.
The problem? By eliminating carb-containing foods like fruits, starchy vegetables, beans and whole grains, you're removing important food groups that your body needs. Not only do they contain valuable nutrients, but also the glucose from carbohydrates provides fuel for your body and brain.
So, can people with diabetes eat added sugar?
The good news is that even if you have diabetes, you can enjoy small amounts of higher-added-sugar foods like cakes, cookies and ice cream. "It's rare to find a person who can't tolerate any sugary foods once in a while," Harris-Pincus says. This applies whether you have type 1 or type 2 diabetes, although note that if you have type 1 diabetes, you'll fare better consuming sugar if you're appropriately dosing insulin in response to your carbohydrate intake, she adds.
The one caveat? Individuals who have chronically high blood sugar values of 300 mg/dL or more. "In that case, I would advise against eating sugary foods and drinks," Brown says
This doesn't mean, though, that you have carte blanche to eat sweets in excess, as you still need to be mindful and enjoy them in moderation. For starters, plan accordingly for when you'll be having higher-added-sugar foods. If you know you're going to have a sugary treat in the day, eat a smaller-than-normal portion of carbohydrate-containing foods and a larger amount of nonstarchy vegetables, like dark leafy greens, asparagus and zucchini, for dinner. "The nonstarchy vegetables are full of fiber that helps slow digestion and ultimately reduces a blood sugar spike, allowing room for a small slice of cake, a little bowl of ice cream or two cookies for a dessert," Brown says.
Plate your meals so that they contain a balance of protein, carbohydrates, healthy fats and fiber. "Eating a high-sugar food with protein, fiber and fat will help slow the absorption of that sugar," Harris-Pincus says.
How much added sugar you can eat will then depend on how your body responds to the higher-sugar foods. That's why it's important to monitor your blood sugar. If you're not used to regularly checking your blood sugar levels or foods, keep track of the foods and drinks you eat for two to three consecutive days, including a weekend day, noting how much you've eaten, what your blood sugar readings are and what time you're recording this information, Brown says. Include your medication, too. Each day, track your blood sugar once upon waking (from a fasted state) and two hours after any meal.
Also, don't get duped into thinking that all foods labeled "sugar-free" or "no added sugar" are carbohydrate-free. "Sugar-free foods, snack foods and desserts are tricky because they can still have a decent amount of carbs even if there is no added sugar," Harris-Pincus says. "You often see net carbs used as a marketing tool for these processed foods, but it's not a recognized term by the American Diabetes Association or the FDA because sugar alcohols and fibers are absorbed differently and may affect blood sugar in different ways." She recommends using these foods sparingly and chatting with a dietitian about how to track them in your diet.
And a quick note about non-nutritive sweeteners, both artificial (think sucralose and aspartame) and naturally derived, like stevia, monk fruit, allulose and erythritol: "Not only do they not count as sugar in the diet, they don't increase your blood sugar," Harris-Pincus says. Yet because they are so sweet, use as little as possible, knowing that a diet soda or a sugar-free snack is OK as long as you eat them only occasionally, she adds.
The bottom line
In the end, know that added sugar isn't necessarily healthy for anybody, even if you don't have diabetes, which is why the Dietary Guidelines for Americans recommends that you limit your intake to no more than 10% of your total daily calories. One way to help keep the percentage down? Follow Brown's lead by checking the nutrition label and choosing foods that have less than 5% of added sugar per serving in the Daily Value column, or as close to 0 grams as possible.