Copyright © 1998 American Diabetes Association

Sugars And Artificial Sweeteners
Table sugar used to be seen as a danger for people with diabetes.

The New Sugar Scoop
Sweet, salty, bitter, sour. As every child learns in grade school, these are the four aspects of taste. At one time, having diabetes meant a lifetime of meals that lacked the most pleasant of these elements: sweetness. Today, the rules for avoiding sugar have been relaxed. And new artificial sweeteners can give you sweetness that tastes as good as sugar without sugar's effect on your weight. As a result, people with diabetes today can eat meals well rounded in tastes as well as in nutrition.

The Sweet Life
Table sugar (sucrose) used to be seen as a danger for people with diabetes. Because it is a simple sugar, doctors and dietitians figured that table sugar must be more quickly digested and absorbed into the blood than complex carbohydrates, like the starch in potatoes and breads. They thought that table sugar would cause a larger rise in blood glucose.

They were wrong. At least 10 recent studies have shown that simple sugars don't spike blood glucose any higher or faster than other carbohydrates. The American Diabetes Association changed its nutritional recommendations in 1994. The new recommendations say, "scientific evidence has shown that the use of sucrose as part of the meal plan does not impair blood glucose control in individuals with insulin-dependent (type I) or non-insulin-dependent (type II) diabetes."

The picky guidelines that told you exactly how many teaspoons of sugar you could eat per week have been dropped. However, one important rule remains: you must must work sugar into the meal plan that you have set up with your dietitian. Sugar is not a "free food." It counts as a carbohydrate. You must substitute sugar for other foods containing carbohydrates.

What is a sugary food? The Nutrition Facts labels on almost all packaged foods will tell you how many grams of sugar are in a serving of that food, as well as how  many grams of total carbohydrate. Your registered dietitian can help you read the new food label. He or she will also do a nutrition assessment to tell you how much carbohydrate you should eat per day.

The Aftertaste
The new recommendations are good news. But there are still reasons to limit the amount of sugar you eat. Sugary foods are often foods without much nutrition. They have calories, but they lack the vitamins, minerals, and fiber that are important to your health. Foods made with a lot of sugar are often also high in fat. Look at the exchange values for foods such as ice cream, cake, and chocolate. One-half cup of ice cream equals 1 starch and 2 fat exchanges. Eating too many high-fat foods puts you at risk for heart and blood vessel disease.

Remember, too, that different people have different responses to food. It's a good idea to test your blood glucose after you eat a sugary food. You may be able to eat a serving of something with sugar without much change in your blood glucose levels. Or you may not be able to eat any sugar at all without your blood glucose level shooting up. If you take insulin, your doctor may be able to teach you how to increase your dose when you plan to eat something with sugar.

a.k.a. Sugar
There are many types of sugars in nature. You should be aware that the Nutrition Facts label groups all types of sugar together under the category "Sugars." Regular table sugar is called sucrose. You can recognize some other sugars because their chemical names also end in -ose. These include glucose (also called dextrose), fructose (also called levulose), lactose, and maltose. Other kinds of sugars are sugar alcohols: sorbitol, xylitol, and mannitol.

Fructose and the sugar alcohols may have a smaller effect on your blood glucose levels than sucrose or other carbohydrates. These sweeteners are fine to use in moderate amounts. But there is no reason to use large amounts of fructose or sugar alcohols in place of sucrose. Large amounts of fructose may increase blood fat levels. And it is hard to determine the number of calories in the sugar alcohols.

Sucrose is known by several names, depending on its form and how it was processed. Molasses, beet sugar, brown sugar, cane sugar, confectioner's sugar, powdered sugar, raw sugar, turbinado, maple syrup--all are basically just table sugar.

Other natural and processed foods are very high in sugars. These foods include carob powder, corn syrup, starch syrup, sugar cane syrup, honey, sweetened condensed milk, and chocolate. Some of these foods are also high in saturated fat, an ingredient to limit.

Artificial Sweeteners
Don't throw away your artificial sweeteners just because sugar is safer than you thought. Artificial sweeteners are "free foods". They make food taste sweet, but they have no calories and do not raise blood glucose levels. They do not count as a carbohydrate, a fat, or any other exchange. They can be added to your meal plan instead of substituted.

The American Diabetes Association approves the use of three artificial sweeteners in moderate amounts.

Saccharin. Saccharin can be used in both hot and cold foods to make them sweeter.

As you may know, large amounts of saccharin cause cancer in laboratory animals, such as rats. Evidence from studies done on people suggests that saccharin does not cause cancer in humans.

Saccharin may help people who have diabetes or are obese stick to a healthy, low-calorie meal plan. The American Diabetes Association recommends that pregnant women avoid heavy use of saccharin.

Only you can decide how to balance a small--or possibly even zero--risk of cancer against the large known risk of being overweight or not keeping your diabetes under control. Other artificial sweeteners are available if you do not want to use saccharin.

Aspartame. Aspartame (NutraSweet) is a newer artificial sweetener. Because it is 180 times as sweet as sugar, you need only a tiny amount to sweeten food. So even though it does have calories, it adds almost no calories to food because you use so little.

People who have the rare disease phenylketonuria (PKU) should not eat or drink anything with aspartame. Otherwise, aspartame appears to be safe. A few people have had mild reactions (headaches, dizziness) to it. But no effects have been common or severe.

One problem with aspartame is that it loses its sweetness when heated. As a result, you cannot use it in baked goods, such as cakes. You can use it in top-of-the-stove foods like pudding by adding it at the very end of cooking.

Acesulfame potassium. The newest artificial sweetener on the market is acesulfame potassium (Sweet One), also called acesulfame-K. This sweetener can be used in baking and cooking because it does not break down when heated. But the texture of baked goods is not the same with acesulfame-K as with sugar. To get a good texture, you might need to add some sugar.

For Dessert
Whether you choose to eat foods with sugar, artificial sweeteners, both, or neither, there are three helpful hints to a sweeter life with diabetes.

1. See a registered dietitian to develop a meal plan unique for you. A nutritional assessment will tell you how much carbohydrate you should aim for each day.

2. Learn to read the Nutrition Facts on food labels to know how much fat, protein, and carbohydrate you're getting. (You can order a copy of Reading Food Labels: A Handbook for People With Diabetes, by the American Diabetes Association, the American Heart Association, and the American Association of Diabetes Educators; see below.)

3. Avoid saturated fats, which often go hand in hand with sugar in sweet foods.

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Nutrition And Fitness Index

Additional Information:
Diabetes Diagnosis and Understanding Lab Tests
Diabetes Facts and Figures
Children with Diabetes -- Information for Teachers and Child-Care Providers
Medical Treatment Of Diabetes
Sex, Pregnancy And Parenting
Living With Diabetes
Diabetes Complications And Related Concerns