by Christopher D. Saudek, M.D.
One of the most common questions in considering a nutritional plan for diabetes is, "Can I eat sugar?" Surprisingly, after all these years, the answer remains confusing and even controversial. Why is this the case? Because the academic, scientific answer may not match the practical, behavioral answer. So what are the facts, and what is a person to do? The fact is that when a person with type 1 or type 2 diabetes ingests concentrated sweets such as candy, pies, cakes and doughnuts, their blood glucose may rise a bit more quickly, but not necessarily any more, than if the person ate an equal number of grams of a complex carbohydrate such as potatoes or rice. Based on these sorts of observations on patients in a hospital research ward, both the American Diabetes Association and the Canadian Diabetes Association now state in their recommendations that people with diabetes may consume some of their total calories from sugar or sweets. So what's the problem with eating sweets? Simply, it is that most people just add sweets, they don't substitute them for exactly the same amount of complex carbohydrate. For example, if you have a doughnut at the office (approximately 45 grams of carbohydrate), do you eliminate three slices of bread from lunch? If you have a 3 1/2-inch piece of apple pie (estimated at 75 grams of carbohydrate), do you eliminate two medium baked potatoes from dinner? Another problem: do you really know how many carbohydrates were in that doughnut or piece of pie? For these reasons, I caution against sweets for people with diabetes. At best, they are empty calories, devoid of nutritional value; at worst, they can wreak havoc on your blood glucose control. It's not all doom and denial, though. If people with diabetes decide to incorporate a certain amount of sugar or sweets into their diet, they should do so carefully and with their eyes wide open. The best way to make it easy and predictable is to be consistent: Have a small dessert such as a scoop of ice cream or a cookie after your regular supper, take the right amount of insulin or oral medication, and then check your blood glucose several hours later. If your blood glucose is okay, you will know that you can tolerate a small dessert after supper. But remember, it is easy to ingest far too many calories when eating sweets. If you do eat sugar-containing foods, remember to eat fewer carbohydrates at your next meal and to get some exercise to burn off the extra calories. In addition, many sugar-containing foods, like ice cream and cookies, are high in fat. If you choose to eat a sugar-containing food, seek out low-fat sweets like graham crackers, fig bars or low-fat frozen yogurt. Keep in mind, however, that many low-fat versions of products like ice cream often replace fat with sugar! In the end, the most important thing is to work with an experienced dietitian to develop a meal plan that is satisfying and good for you as an individual. Last Updated: 7/7/2003
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
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