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Sugar provides most of the energy the body needs to function. It is a simple carbohydrate made up of carbon, hydrogen and oxygen.
Dietary sugar comes in many forms and from many sources, including table sugar, candy, cakes, fruits, milk and other foods. Many processed items ranging from tomato sauce to salad dressings to frozen dinners have high amounts of sugar. Some medications, such as cough and cold remedies, also contain sugar.
After they are consumed, these sugars are converted into the simple sugar glucose (blood sugar). Insulin, a hormone, helps move glucose into the cells, where they are turned into energy to fuel the body’s activities.
Some sugar is vital to good health, but many people eat far more than they need. For example, glucose is normally the only source of energy for brain cells. Yet eating a lot of sugar triggers the pancreas to release insulin, which causes the level of glucose in the bloodstream to drop. This hypoglycemia then deprives the brain of fuel and can result in symptoms such as confusion.
In people with diabetes, severe acute episodes of insufficient glucose or excessive glucose (hyperglycemia) can lead to a diabetic coma, and chronic hyperglycemia can cause complications ranging from heart disease to diabetic neuropathy. People with diabetes must monitor their intake of sugar to ensure they do not consume too many or too few carbohydrates. Patients may be advised by their physician to eat modest amounts of sugary foods at certain times, such as before, during or after exercise.
Sugar in forms such as glucose tablets, nonfatty candies, nondiet soft drinks or cake icing is generally a part of a physician-recommended treatment plan for episodes of hypoglycemia. A typical protocol is to consume 10 to 15 grams of carbohydrates (e.g., six jellybeans or half a cup of fruit juice), wait 15 to 20 minutes, perform glucose monitoring again and repeat the treatment if necessary. Patients are advised to consult their physician about what source of sugar to carry, when to consume it and how much. Severe hypoglycemia may need to be treated with other methods, such as a glucagon injection or intravenous glucose at a hospital.
Most humans are born with a natural preference for sweet–tasting foods and substances such as sugar. It is believed that sweetness is a sensory cue in humans to obtain the energy needed to fuel metabolic needs and physical activity. Substances taste sweet to people based on how they interact with taste receptors in the mouth and throat. The preference for sugar varies among individuals.
Sugars belong to one of two classes:
Starches are made up of many sugar molecules linked to form a complex carbohydrate. Examples include grains and potatoes. These foods do not taste sweet.
For many years, people with diabetes were encouraged to avoid sugars as much as possible. At the time, experts believed that sugar was the main culprit in elevating blood glucose levels. However, recent research has shown that carbohydrates in general, not just sugar, affect blood glucose levels. Sugary foods remain a potential source of problems for people with diabetes, because foods that are high in sugar content are also high in carbohydrates and calories.
People with diabetes need to consider the following information regarding sugary foods in their diet:
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Sugary foods tend to have higher carbohydrate counts than starchy foods. Candy, cakes and sodas can thus cause a greater and faster rise in blood glucose than potatoes or pastas. Also, sugary items such as pastries are usually made from refined sugar and white flour and can cause blood glucose levels to surge. In contrast, starchy foods made of slower–acting carbohydrates, such as a baked sweet potato, raise blood glucose levels more gradually.
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Sugary foods tend to be less nutritious. Though some sugary foods – including fruits and milk – do contain vitamins and minerals, most are loaded with “empty calories” that provide energy but have little or no nutritional value. Even less-refined sugars such as honey, cane juice crystals and maple syrup do not contain meaningful amounts of nutrients.
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Except for fruit, most sugary foods lack fiber, which helps moderate levels of glucose and cholesterol.
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Sugary foods can promote tooth decay and gum disease. Dental conditions pose additional challenges to people with diabetes.
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Diabetes mellitus is sometimes called sugar diabetes, but organizations such as the American Diabetes Association (ADA) state that, contrary to popular belief, sugar does not cause diabetes. The exact cause of diabetes is unknown. Type 1 diabetes is an autoimmune disorder in which the body mistakenly destroys the insulin-making cells of the pancreas. However, an excess of calories can cause obesity, a major risk factor for prediabetes, type 2 diabetes (by far the most common form of diabetes), gestational diabetes and double diabetes, which is the development of insulin resistance in someone with type 1 diabetes.
Furthermore, some research has suggested that excess consumption of sugar can damage the beta cells of the pancreas, foster insulin resistance and be a risk factor for diabetes. Research has also linked heavy consumption of sugar to other conditions including pancreatic cancer.
The glycemic index is a controversial measure of how fast a food affects blood glucose. Some studies have indicated that spikes in glucose caused by high-GI foods such as sugary pastries can contribute to obesity, diabetes and heart disease. Other studies, however, have questioned the value of this tool.
One belief that science has proven to be untrue is that some natural sweeteners, such as honey, have a nutritional advantage over others, such as table sugar. Honey has more calories and carbohydrates than granulated sugar, although it is also usually used in lower amounts.
The average American consumes almost 20 teaspoons of added sugars a day. Most of the added sugars in the typical American diet come from soft drinks, baked goods, sweetened fruit drinks, candy, breakfast cereals, table sugar (added to coffee, tea etc.) and dairy desserts.
The U.S. government’s latest Dietary Guidelines for Americans recommend choosing and preparing foods with little added sugars or other caloric sweeteners, as these added sugars provide calories with few vitamins and minerals. Though people with diabetes need to limit sugar much more than the average person, the ADA has a Diabetes Food Guide Pyramid that can be used for balancing meals and limiting added sugars. The Diabetes Food Guide Pyramid separates food groups by carbohydrate and protein content. For instance, potatoes, a starchy vegetable, can be found with the grains. The U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) also has guidelines for diabetes. Although these recommendations are close in numbers of servings per day, they are stricter on allowing sugary foods into the diet.
People with diabetes may not need to eliminate all sugary foods from their diets. Many experts suggest that the occasional ice cream sundae or candy bar is fine as long as it is substituted for an equivalent amount of starchy carbohydrate in the patient’s meal plan and is within a reasonable portion. Sharing desserts is one way to limit portions. However, medical professionals who treat people with diabetes often remind their patients that eating such “empty calories” wastes some of their daily carbohydrate allotment. It is better to consume carbohydrates in nutritious foods that provide the body with essential vitamins and minerals.
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