The Best Alternative Sweeteners for Diabetics

April 9, 2025

Blood sugar and insulin, Health concerns

To maintain balanced blood glucose levels, many diabetics are using sugar substitutes to sweeten foods and beverages.

However, not all alternative sweeteners are created equal, as some may have harmful effects on health and could even disrupt blood sugar control and metabolic functions.

Let’s look at the best and worst alternative sweeteners for diabetics and learn why it’s crucial to avoid artificial sugar substitutes.

What are alternative sweeteners?

Alternative sweeteners are sugar substitutes that offer sweetness without the same calorie content or glycemic impact as regular sugar.

These low-calorie sweeteners, also called non-nutritive sweeteners, are popular among individuals looking to reduce calorie intake, manage blood sugar levels, and minimize the health risks linked to sugar toxicity.

Depending on how these sugar substitutes are produced, they’re broadly grouped into three categories:

Artificial sweeteners
Alternative sweeteners
Sugar alcohols

Let’s look at the differences between these different types of sugar substitutes.

Artificial sweeteners

Artificial sweeteners are a group of synthetically manufactured sugar substitutes that mimic the sweetness of table sugar without containing any calories.

These sweeteners are commonly found in various processed foods and beverages, such as diet sodas, sugar-free fruit juices, packaged snacks, and low-calorie desserts.

The most widely used artificial sweeteners include sucralose, aspartame, saccharin, acesulfame potassium, and neotame.

Despite their widespread use, there is evidence that these synthetic sugar substitutes are linked to various health risks and may, in fact, counteract the intended benefits for blood sugar control and weight management.

Research published in Obesity investigated the effects of artificial low-calorie sweeteners and found that sucralose, the primary sweetener in Splenda products, has been linked to poor metabolic health and disruption in the gut microbiome.¹

In addition, the authors highlighted “Positive associations between nonnutritive sweeteners, body weight, and health conditions, including type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease.”

This suggests that reliance on artificial sweeteners may not be a safe or effective strategy for managing weight or diabetes and raises questions about their long-term impact on overall health.

Alternative sweeteners

Alternative sweeteners provide a natural source of compounds that offer sweetness without the negative impacts of regular table sugar on blood glucose levels and insulin balance.

Stevia and monk fruit extract are amongst the most popular alternative sweeteners and a staple for many diabetics and those following a ketogenic diet.

In addition to being natural sugar alternatives, stevia and monk fruit are also rich sources of health-promoting antioxidants and have anti-inflammatory properties. These sweeteners can help reduce oxidative stress and support overall health while satisfying sweet cravings.

Both stevia and monk fruit extracts are widely available but aren’t commonly found in many processed foods due to their higher production cost than synthetically manufactured artificial sweeteners.

Raw honey, maple syrup, and agave syrups are also classified as alternative sweeteners.

However, compared to low-glycemic options such as stevia and monk fruit, these options contain natural sugars that are processed and metabolized similarly to regular sugar. This means that they raise blood glucose levels and stimulate an insulin response, making them unsuitable for those managing diabetes.

Sugar alcohols

Sugar alcohols are a type of carbohydrate that occurs naturally in various fruits, vegetables, and plants and can also be created through the hydrogenation of sugars and starches.

The term alcohol refers to their chemical structure rather than any presence of ethanol or potential for intoxication.

These sweeteners have a flavor profile similar to regular sugar but provide fewer calories and have a much lower effect on blood sugar levels.

However, the impact of sugar alcohol on glycemic balance varies depending on the specific type, as the body’s ability to absorb these compounds differs.

Certain sugar alcohols, such as erythritol, are poorly absorbed and have little to no impact on blood sugar levels. In contrast, maltitol and isomalt are more readily digested and can lead to significant blood sugar and insulin spikes.

One downside of sugar alcohols is that they can cause gastrointestinal discomfort, including bloating, gas, and diarrhea, particularly when consumed in large quantities. This is due to their incomplete absorption in the intestines, which can lead to microbial fermentation by gut bacteria.

Watch the video below to learn more about artificial and natural sweeteners.

Can people with diabetes use alternative sweeteners?

According to guidelines published by the American Diabetes Association (ADA), individuals with diabetes can use alternative sweeteners to manage blood glucose levels and reduce overall sugar intake.²

However, it’s recommended to use natural sweeteners and sugar alcohols with minimal impact on blood sugar and insulin balance over artificial sweeteners, which are linked to potential health risks.

Evidence published in Current Diabetes Reports suggests that natural low-glycemic alternative sweeteners help improve blood sugar control and lipid metabolism in diabetic individuals without showing evidence of the adverse health effects associated with artificial sweeteners.³

Therefore, choosing sugar substitutes found on the keto diet food list is an excellent option for individuals with diabetes. These ingredients have minimal impact on blood glucose, making them ideal for managing diabetes and other metabolic imbalances.

The best alternative sweeteners for diabetics

To effectively manage and stabilize blood sugar levels, diabetics should opt for alternative sweeteners that won’t trigger insulin spikes, which can exacerbate metabolic imbalances and worsen diabetes-related complications.

Here are four of the best alternative sweeteners for diabetics.

1. Stevia

Stevia is a natural sweetener derived from the stevia plant that’s much sweeter than sugar but has zero calories and a negligible impact on blood sugar.

It’s a popular sugar substitute widely used by diabetics and those following a ketogenic diet as it doesn’t raise insulin levels, making it a safe, low-carb choice.

“In addition to serving as a sugar alternative, stevia has antioxidant and anti-inflammatory properties, which may offer added health benefits for diabetics and those managing metabolic health,” explains Dr. Berg.

Research published in Trends in Food Science & Technology highlights stevia’s potential benefits, showing promise in managing diabetes, obesity, and hypertension, as well as in protecting against cancer, oxidative stress, and microbial infections.⁴

2. Monk fruit

Monk fruit sweetener is derived from a small melon native to Southeast Asia and is naturally calorie-free and carb-free.

Similar to stevia, monk fruit provides a sweet taste without raising blood sugar levels, making it ideal for those managing diabetes.

Many find that monk fruit offers a more natural sweetness without the slightly bitter aftertaste of stevia, making it a preferred choice for sweetening beverages and desserts.

3. Erythritol

Erythritol is a type of sugar alcohol with a sweet taste similar to sugar but without the glycemic impact, so it won’t spike insulin or blood sugar levels.

Compared to other sugar alcohols that can trigger gastrointestinal discomfort, erythritol is generally well-tolerated and less likely to cause bloating or digestive upset.

4. Xylitol

Xylitol is a naturally occurring sugar alcohol derived from birch tree bark and certain fruits and vegetables.

It has a significantly lower glycemic index than sugar, making xylitol suitable for diabetics. However, it can raise blood sugar levels if consumed in excess, and it’s recommended to use xylitol in moderation to avoid blood sugar fluctuations and gastrointestinal issues.

A study published in Applied Microbiology and Biotechnology found that xylitol has dental health benefits as it helps reduce the risk of cavities and promotes oral hygiene by inhibiting the growth of harmful bacteria in the mouth.⁵

Alternative and artificial sweeteners to avoid

Artificial sweeteners may seem convenient and appealing for those looking to reduce added sugar intake, but they can carry potential health risks that outweigh their benefits.

A review study published in Nutrients linked the use of artificial and certain alternative sweeteners to alterations of microbial, neurological, and hormonal responses. This may contribute to metabolic disturbances and an increased risk of obesity and related health issues.⁶

Here are artificial and alternative sweeteners to avoid:

Sucralose
Aspartame
Saccharin
Acesulfame potassium (Ace-K)
Neotame
Splenda
Maltitol
Maltodextrin
Dextrose

While maltodextrin and dextrose aren’t classified as artificial sweeteners, they’re high-glycemic carbohydrates, meaning they can cause rapid blood sugar spikes, making them unsuitable for individuals with diabetes.

In addition, honey and agave nectar, while often perceived as healthier alternatives, are high in sugars and contribute to insulin spikes and weight gain. They should be avoided by diabetics.

It’s crucial to carefully read the product and nutrition labels of the alternative sweetener you plan to use.

In some cases, beneficial sugar substitutes such as stevia are bulked out with maltodextrin, which negates the health benefits of using stevia as an alternative sweetener, especially for those with poor metabolic health.

Key takeaways

Following a low-carb diet and avoiding sugar is critical for individuals with diabetes, prediabetes, and those with metabolic imbalances and insulin resistance.

Fortunately, there are various suitable sweeteners for diabetics, including stevia, monk fruit, erythritol, and xylitol, which provide sweetness without significantly impacting blood sugar balance.

However, it’s best to avoid artificial sweeteners, maltodextrin, and dextrose, as these sugar substitutes can disrupt gut health, contribute to metabolic imbalances, and may increase the risk of cardiovascular and liver diseases.

FAQ

1. What are the best alternative sweeteners for diabetics?

The best alternative sweeteners for diabetics include stevia, monk fruit, erythritol, and xylitol.

2. Is the use of artificial sweeteners beneficial for patients with diabetes?

Artificial sweeteners aren’t suitable for diabetics as they can disrupt metabolic processes, potentially complicating blood sugar management. In addition, artificial sweeteners have been linked to impaired gut health and an increased risk of heart, liver and kidney disease.

3. Are natural sweeteners okay for diabetics?

Natural sweeteners such as monk fruit and stevia don’t impact blood sugar balance and are suitable for diabetics.
However, natural sugar substitutes such as honey, date sugar, or agave syrup contain high levels of fructose or glucose, which trigger blood sugar fluctuations and should be avoided by those managing diabetes.

4. Is Splenda or stevia better for diabetics?

Stevia is considered the better option for diabetics because it’s a natural sweetener that doesn’t affect blood sugar levels.
In contrast, Splenda contains sucralose, an artificial sweetener that has been linked to adverse effects on gut health and metabolic balance, which can worsen blood sugar fluctuations and interfere with diabetes management.

5. Are sugar alcohols okay for diabetics?

Sugar alcohols such as erythritol and xylitol won’t interfere with blood sugar and insulin levels, making them suitable options for those with diabetes. However, certain sugar alcohols, such as maltitol, isomalt, and sorbitol, can raise blood sugar levels and should be avoided by those with diabetes.

6. Is honey okay for diabetics?

No, honey isn’t okay for diabetics as it contains naturally occurring sugar that can spike blood sugar and insulin levels, which can worsen diabetic complications and interfere with diabetes management.

7. Does stevia affect insulin?

No, stevia doesn’t affect insulin levels, making it a suitable alternative sweetener for individuals with diabetes, those following a ketogenic diet, and people seeking to support their metabolic balance.