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Sugar, sweeteners and diabetes


Sugars, sugar substitutes and sweeteners: natural and artificial

If you’re living with diabetes, or even if you’re not, you might think sweet foods are a barrier to your healthy, balanced diet. As a general rule, everyone should be eating less sugar – but sometimes, only something sweet will do.

If want to lose weight, or you’re trying to keep your blood glucose levels stable, you may want to know whether artificial sweeteners could help. If you browse around your local supermarket, you’ll see a huge range of sweeteners on offer, so it can be baffling to know which, if any, to go for.

So in this section we'll take you through:

What are sweeteners?

Sweeteners are ingredients that are added to food to enhance sweetness. They can be grouped in different ways: One way is to loosely group sweeteners as: sugar or sugar substitutes.Another way to group sweeteners is whether the sweetener is: natural or artificial. 

Types of sweeteners

One of the most useful ways of grouping sweeteners is to look at those that have nutritive value, ie nutritive sweeteners, and those without nutritive value, ie non-nutritive or ‘low-calorie’ sweeteners. 

Nutritive sweeteners

There are different types of nutritive sweeteners, but they all contain carbohydrate and provide calories. They are usually referred to as ‘sugars’ or ‘added sugar’, but they can also appear in the ingredient list of food packaging as:

  • glucose
  • fructose
  • sucrose
  • maltose
  • honey and syrup, etc.


One group of nutritive sweeteners is polyols, which are sugar alcohols, and include:

  • erythritol
  • isomalt
  • maltitol
  • mannitol
  • sorbitol
  • xylitol. 

They can be natural or artificially produced. Polyols contain carbohydrates and calories, but they have fewer calories and less of an effect on blood glucose levels than sucrose (sugar). 

Polyols and diabetes

It’s not exactly clear how the polyols should be ‘counted’ by people who are adjusting their insulin dose according to the carbohydrate they consume, as not all of the carbohydrate from polyols is absorbed. The amount of calories provided by polyols varies, as the amount of carbohydrate digested or absorbed by the body varies, depending on the type of polyol. People with diabetes should speak to their healthcare team for individual advice about this.  

Polyols and ‘diabetic’ foods

Polyols are usually used in products marketed as‘diabetic’ or ‘suitable for diabetics’and, as these products can be as high in fat and calories as standard products, Diabetes UK and the European Commission Regulations don’t recommend them. Consuming large amounts of polyols can have a laxative effect, causing bloating, flatulence and diarrhoea. 

Non-nutritive or artificial sweeteners 

Non-nutritive sweeteners can be one way of reducing your overall carbohydrate and calorie intake if you use it instead of sugar. These are sometimes called ‘artificial sweeteners’ and are usually found in:

  • ‘sugar-free’ or ‘diet’ foods and drinks
  • fizzy drinks
  • fruit juices
  • jellies
  • yogurts
  • chewing gums, etc.

The terms ‘non-nutritive’ and ‘artificial’ sweeteners are used interchangeably. 

Types of artificial sweeteners 

There are various artificial sweeteners licensed for use in the UK. These include: 

  • aspartame, used in Canderel, Hermesetas granulated  
  • saccharin, used in Hermesetas mini sweeteners 
  • sucralose, used in Splenda 
  • acesulfame potassium (acesulfame-K), used in Hermesetas Gold sweetener  
  • cyclamate, used in Hermesetas liquid.

Some products are made from a combination of two artificial sweeteners. For example, Hermesetas Gold sweetener is made from a blend of aspartame and acesulfame-K.

Sweeteners and cooking

Why use sweeteners in cooking?

They can give you a burst of sweetness, while reducing your sugar and calorie intake because they contain little or no calories or carbohydrates and don’t affect blood glucose levels.

Which sweeteners are best for cooking?

Artificial sweeteners come in granules, tablets or liquid form. Most of them can be used in cold and hot foods, but not all can be used for cooking: 

  • Aspartame (used in Canderel) loses some sweetness at a high temperature.
  • sucralose (used in Splenda) and acesulfame-K (used in Hermesetas Gold sweetener) can be used in cooking and baking. 

Only small amounts of artificial sweeteners are needed as they are intensely sweet.

Sweeteners from the stevia plant

A relatively new group of non-nutritive sweeteners include naturally sourced, calorie-free sweeteners made from the stevia plant, eg Truvia and Stevia. They are 200–300 times sweeter than sucrose (sugar) and are heat stable, so can be used in cooking and baking. 

Natural and artificial sweeteners

It can be confusing to group together sweeteners as the terminologies are open to interpretation. For instance, some products from the stevia plant are marketed as ‘natural’, even though they’re processed and refined. Yet, some of the other products marketed as artificial sweeteners may be derived from naturally occurring substances. For example, sucralose, which is used in Splenda, is derived from sugar (sucrose). Whatever the name, grouping or terminology, it’s important to ask what is in the particular sweetener and whether the sweetener or product has carbohydrate or calories, and how that fits into your individual goals for healthy eating.

Sweeteners and safety

A major question that often comes up is how safe sweeteners are. There has been, and continues to be, some bad publicity and controversies about certain artificial sweeteners. 

All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission.

Food ingredient manufacturers have to provide evidence from safety studies showing that the sweetener in question:

  • doesn’t cause any adverse effects, including cancer
  • doesn’t affect reproduction
  • doesn’t cause allergic reactions
  • isn’t stored within the body, or metabolised into other potentially unsafe products.

What amount of sweetener is safe to eat?

As part of the approval process for each non-nutritive sweetener, an Acceptable Daily Intake (ADI) level is set. The ADI is the estimated amount per kilogram of body weight that a person can consume, on average, every day, over a lifetime without risk. ADIs are set 100 times less than the smallest amount that may cause health concerns, so it’s extremely difficult for most people to reach the ADI. With these checks, the current levels of intake of artificial sweeteners in the UK are safe, although people with phenylketonuria (a rare metabolic disorder) are advised to avoid sweeteners containing aspartame.

Should I eat sweeteners?

It’s a personal choice whether you decide to use sweeteners or not. If you decide to use sweeteners, but you’re unsure, speak to your diabetes healthcare team for individual advice, and check labels and ingredients on food packaging, as this can help you to make informed choices.

Should I avoid sugar altogether?

We all know we need to eat a healthy, balanced diet that’s low in saturated fat, sugar and salt to keep our weight, cholesterol, blood glucose and blood pressure in check. Sugar is a type of carbohydrate and because all carbohydrates affect blood glucose levels, reducing your sugar intake can help to keep blood glucose levels under control. As sugar contributes no nutritive value, apart from carbohydrates and calories, it has ‘empty calories’ and so is not good for overall health.

This doesn’t mean that people with diabetes should have a sugar-free diet. In fact, it’s almost impossible to have a sugar-free diet in the long term. And, it’s also worth remembering that products labelled ‘sugar-free’ aren’t necessarily low-calorie.

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