Sugar Substitutes and Diabetes

For people living with Diabetes, sugar is often seen as the enemy, but with proper management it doesn’t have to be the villain. There are many misconceptions centered around sugar. A popular one is that eating too much sugar can actually cause Diabetes. Another misconception is that once someone is diagnosed with Diabetes, they can never eat sugar again.

It’s important first to understand how sugar affects someone with Diabetes so let’s get started by clearing up some of these misconceptions. First, eating too much sugar does not cause Diabetes. Sugar is simply a component of diet. Eating too much sugar does, however, cause people to gain weight. Being overweight can lead to a Type 2 Diabetes diagnosis. Here’s a quick lesson on the difference between Type 1 and Type 2 Diabetes.

  • ❖ Type 1 or Type 2 Diabetes means having too much glucose (a type of sugar) in the blood.
  • ❖ Type 1 Diabetes is an autoimmune condition which means the body has attacked and destroyed cells that make a hormone called insulin. Type 1 patients can’t produce insulin.
  • ❖ Type 2 Diabetes means that the body doesn’t make enough insulin or the insulin it does make doesn’t work properly.
  • ❖ Insulin is needed by everyone because it helps to take the glucose (sugar) from the blood which is then used for energy.
  • ❖ Without insulin blood glucose levels get too high.
  • ❖ Consuming sugar increases blood glucose levels even further.


“A sugar substitute is basically a food additive that provides a sweet taste while containing significantly less food energy than sugar-based sweeteners, making it a zero-calorie or low-calorie alternative.”2 Sugar is not the healthiest choice for most people because it can cause obesity, heart disease, cancer, and oral health issues, like tooth decay. But, it can complicate matters even further for those living with Diabetes. Because of this, it’s worth taking a look at the myriad of sugar substitutes that are on the market today, both natural and artificial. These alternatives can help patients living with Diabetes make substitutions in their daily diet that can help to control blood sugar levels and keep things in balance.


Natural sweeteners provide other health benefits so we will focus on these healthier options first. These sugars include coconut sugar, honey, maple syrup and molasses. Many of these are still high in fructose which means they still need to be monitored. Because of their many other health benefits they are worth mentioning, especially for those patients that are health conscious3.

  • ❖ Coconut Sugar is extracted from the sap of the coconut palm and contains nutrients like zinc, iron, calcium, potassium and other antioxidants. It also has a lower glycemic index than sugar due to its insulin content which helps to slow digestion, increase fullness and feed healthy bacteria in the stomach. Coconut sugar is high in fructose so it should be used as a substitute in moderation.
  • ❖ Honey contains trace amounts of vitamins, minerals and antioxidants which can help prevent Diabetes, inflammation, heart disease and cancer. It also contains fructose and should be consumed in moderation.
  • ❖ Maple syrup contains calcium, potassium, zinc, iron, manganese and more antioxidants than honey and has been found to have a lower glycemic index than sugar.
  • ❖ Molasses contains vitamins and minerals and has a high concentration of iron, potassium and calcium, but it’s still high in sugars and consumption should be limited.
  • ❖ Stevia may not sound natural, but it falls under this category because it’s derived and extracted from the leaves of a South American shrub known as stevia rebaudiana. “It’s 100% natural, contains zero calories, and has been known to lower blood sugar and blood pressure levels.”5
  • ❖ Luo han guo or Monk Fruit sweetener is extracted from the monk fruit. “Monk fruit contains natural sugars like fructose and glucose, but it gets its sweetness from antioxidants called mogrosides. During processing, mogrosides are separated from the fresh-pressed juice, removing fructose and glucose from monk fruit sweetener.

Two other alternatives that fall under the natural category that should be monitored closely are:

  • ❖ Agave Nectar, produced by the agave plant, which contains a much higher fructose concentration than sugar.
  • ❖ High Fructose Corn Syrup made from the starch of corn which may sound healthy, but it’s extremely high in harmful fructose and should be monitored closely.


The US Food and Drug Administration has approved several sugar substitutes for patients living with Diabetes over the years.4

  • ❖ Saccharin is most commonly known as Sweet’N Low. There were issues with saccharin in the 70s and it was linked to cancer, but it is now widely available as a viable sugar substitute.
  • ❖ Neotame is sold under the brand name Newtame and can tolerate high temperatures which makes it ideal for baking.
  • ❖ Acesulfame K is available under the brand names Sunett and Sweet One.
  • ❖ Aspartame is often found in diet sodas and is found under the brand names Nutrasweet, Equal, and Sugar Twin.
  • ❖ Sucralose also known as Splenda is one of the most popular sugar substitutes and is also a good choice for sugar-free baking.

Sugar substitutes are not sugar and may take some getting used to in terms of taste and can be more costly, but they are viable solutions for people living with Diabetes.


Sugar alcohols are sweeteners that can occur naturally, but they can also be man-made and added to processed foods to make them taste better. Sugar alcohols are often found in lower-calorie and sugar-free foods and typically end in the letters OL:

  • ❖ Erythritol
  • ❖ Maltitol
  • ❖ Mannitol
  • ❖ Sorbitol
  • ❖ Xylitol


Calculating sugar intake, whether it’s natural or a substitute, can be challenging. Reading labels, monitoring levels, and calculating next steps can seem like a hassle, especially for those new to the diagnosis. Thanks to the creation of Continuous Glucose Monitors (CGMs), like the FreeStyle Libre, much of that guesswork has been eliminated. Continuous Glucose Monitors can help to keep an eye on those foods that can make blood glucose rise quickly and keep levels in check. A Continuous Glucose Monitor helps to create a customizable food plan and takes the mystery out of food spikes caused by too much sugar.

Diabetes does not mean that you can never have sugar again. With the help of a Continuous Glucose Monitor, food education and a support network, Diabetes is a completely controllable disease. Quest Health Solutions is here to support you during this food journey and always. We are committed to providing Diabetes education to our patients and healthcare providers. To learn more about how Continuous Glucose Monitors can help control sugar intake, contact us at 1-877-888-7050 Option 3, Ext. 1011 or email or schedule an appointment today.

1. (2020) Diabetes UK. Differences Between Type 1 and Type 2 Diabetes available at Click Here accessed on 19 December 2020.

2. (2020) Wikipedia. Sugar Substitutes available at Click Here accessed on 19 December 2020.

3. (2020) Healthline. 9 Natural Substitutes for Sugar available at Click Here accessed on 20 December 2020.

4. (2020) American Diabetes Association. Get to Know Carbs available at Click Here accessed on 20 December 2020.