I have clients with diabetes who worry that using sweeteners will cause them to have other health problems down the road. They’ve heard rumors that sweeteners are related to weight gain or even cancer. I don’t blame them a bit for wanting to be cautious, but I do want to help them (and you) make an informed decision about whether to use sugar or sweetener if you have diabetes.

The truth is, alternative and artificial sweeteners can add a whole lot of enjoyment to an eating plan that might not otherwise be so sweet. If you have diabetes, it’s perfectly OK to use alternative sweeteners to add a little sweetness to your diet and your life.

Sweeteners used as sugar alternatives

Each of these sweeteners has very few or no calories, and can be used to replace sugar.

  • Aspartame
  • Acesulfame K
  • Advantame
  • Monk Fruit
  • Neotame
  • Saccharine
  • Stevia
  • Sucralose

What research says about alternative sweeteners

What if I told you that eating margarine is associated with getting a divorce in Maine?  Would you believe that eating margarine causes divorce?  No…that would be silly.  It’s true that between the years 2000-2009, margarine consumption and divorce rates in the state of Maine were correlated by more than 99%, but that doesn’t mean that one caused the other.

Research tells us that people who regularly use alternative sweeteners are heavier than people who don’t.  Sometimes, people who hear this draw the conclusion that sweeteners cause weight gain.  That’s not necessarily true.  Just like with margarine and Maine divorces, sweetener consumption is associated with higher weight, but that doesn’t mean sweetener consumption is the cause of higher weight.  It could be that people who are already heavier tend to choose alternative sweeteners because they are trying to manage their weight.

Believing that sweeteners cause weight gain is like believing that margarine causes divorce.  We just don’t have any proof of that, and it’s silly.

Do sugar-sweetened drinks cause health problems?

A high intake of sweetened drinks is associated with heart disease, but they may not be the cause of that heart disease.  People who drink sugary beverages are more likely to have other not-so-healthy habits, like smoking or choosing not to exercise. Just because sugary drinks are associated with heart disease doesn’t mean that sugary drinks cause heart disease.

What we know for sure is that sugar is a form of carbohydrate, and that all carbohydrates, especially simple carbs like sugar, will raise your blood sugar.  If you have diabetes, you probably don’t want to raise your blood sugar unless you’re experiencing hypoglycemia (low blood sugar.)  So…alternavie sweeteners are the best choice for most people with type 2 diabetes.

Is it safe to use artificial sweeteners?

Some people worry that artificial sweeteners are going to cause them problems down the road. At this time, we don’t have any evidence to say that artificially sweetened drinks are associated with poor outcomes like heart disease or cancer. We do know that the consumption of artificial sweeteners is associated with higher weight. So, we can only make the best choice that we can make today. For me, as a person without diabetes, that comes down to drinking my tea completely unsweetened and my coffee chock full of stevia. Let’s face it, I’m addicted to my morning caffeine, but I really don’t like the taste of black coffee. I choose stevia because it is found in nature. Several other alternative sweeteners such as sucralose, aspartame, & saccharine are man-made. That doesn’t make them necessarily bad, but it does make me choose stevia instead.

Choosing sweetener vs. sugar if you have diabetes

If you have diabetes, we know that sugar raises your blood sugar right away. The only time we want to see a spike in your blood sugar is if you are experiencing a low. So, the only time that’s a good time to have a high-sugar food or drink is when you’re trying to treat a low blood sugar. Even then, the recommended amount is 15 grams of carbohydrate, or about 4 ounces of juice or real soda.

Since routine consumption of regular sugar is out, people with diabetes who want something sweet should definitely go with the artificially sweetened version. I’m not endorsing the idea of drinking diet soda all day long…I’m just saying that the diet soda is the lesser of two evils if you are a person with diabetes, and everyone needs some “pleasure foods” in their life. So, having said all of that, it’s time for my coffee break…and I’m going to put some stevia in it!

Action Items Day 9:

  1. If you’re already using an alternative sweetener that you like, you’re doing great! 
  2. If you’re regularly using real sugar, consider using an alternative sweetener.  Go back up to the list of alternatives at the top of this article and choose the one you’d like to try.
  3. Physical Activity Goal:  Walk at an easy pace for 10 minutes, stretch for 2 minutes, and walk at a brisk pace for 5 minutes.  

This post is part of a series, Tame Type 2 Diabetes in 30 Days. Click here to go to Day 1.


I believe that people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

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Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.