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How Sweet They Are: The Real Skinny on Eight Common Sugar Substitutes and Diabetes


Denise Mann, MS

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This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the HealthGrades advertising policy.


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There are so many sugar substitutes available today it can be hard to keep them all straight.  Making the healthiest choice possible is especially important for the millions of people who live with diabetes.

In general, sugar substitutes sweeten food and drinks with fewer calories and carbs than table sugar. People with diabetes need to limit the carbs in their diet to keep their blood sugar (glucose) levels under control.

Here’s the real skinny on eight of today’s artificial sweeteners and how they affect your blood sugar levels and sweet tooth.

Baked apples for dessert will satisfy your sweet tooth while keeping you healthy!

Medical Reviewer: William C. Lloyd, MD, FACS Last Review Date: Feb 16, 2015

2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.


What it is: Derived from the South American stevia plant, this sugar substitute is also known as Rebaudioside A, Reb-A, or rebiana. Brand names include PureVia, Truvia and SweetLeaf Sweetener. According to the US Food and Drug Administration (FDA), Stevia is a Generally Regarded As Safe (GRAS) ingredient. This ruling does not pertain to whole-leaf stevia or [other] non Reb-A  extracts.

Where it is: Stevia can be found in drinks, desserts, gum, baked goods, candy, yogurt, and in packets for use in beverages. Stevia can also be used when baking at home.

How sweet it is: Up to 300 times sweeter than sugar

Ok for diabetes? Yes. Stevia does not affect blood sugar levels.

Agave Nectar

What it is: Agave comes from the same Southwestern U.S plant that is used to make tequila. It has more calories than table sugar, 60 calories versus 30 calories respectively, which is rare for a sugar substitute. Some brand names may include Wholesome Sweeteners, Madhava, and Volcanic Nectar.

Where it is: Agave is a concentrated sugar syrup that looks and feels like honey. (Yes, it is that sticky!) It can be used to sweeten beverages and baked goods. Agave dissolves easily in cold drinks.

How sweet is: 1.5 times sweeter than table sugar

OK for diabetes? In moderation. It’s better than refined sugar, but the American Diabetes Association lists Agave as “a sweetener to limit.”


What it is:  Aspartame is produced by linking aspartic acid and phenylalanine, two amino acids (building blocks of proteins). Brand names are Equal and Nutrasweet.

Where it is: Aspartame can be found in soft drinks, yogurt and dairy, candy, fruit spreads and other foods. It is also available in packets to be added to coffee and tea according to taste.

How sweet it is: Up to 200 times sweeter than sugar

OK for diabetes? Yes. Aspartamehas no effect on blood glucose levels.

Sucralose (Splenda)

What it is: Sucralose or Splenda is a no-calorie sugar substitute.

Where it is:  Splenda is found in many processed foods, and is available as a tabletop and general purpose sweetener. Splenda can be found in small yellow packets wherever coffee and tea are served. It is considered the most heat-stable of all the sugar substitutes, which makes it ideal for your baking needs.

How sweet it is: As much as 600 times as sweet as sugar

Ok for diabetes?  Maybe not, research suggests. Splenda contains about 1 gram of carbs per teaspoon, which means it could affect blood sugar if it’s not consumed in moderation.


What it is: Discovered in 1879, saccharin is an artificial sweetener. Brand names include Sweet and Low®, Sweet Twin®, Sweet'N Low®, and Necta Sweet.

Where it is: Saccharin may be found in drinks, and other food bases or mixes if it’s prepared in accordance with directions and stringent guidelines. It is also used as a sweetener for coffee and teas. 

How sweet it is: From 300 to 500 times as sweet as sugar

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Dec 20, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. American Academy of Family Physicians. Acesulfame K: What You Need To Know.
  2. American Academy of Family Physicians. Stevia Sweeteners.
  3. American Academy of Family Physicians. Sugar Alcohols.
  4. American Diabetes Association. Low Calorie Sweeteners.
  5. American Diabetes Association. Size Up Your Sweetener Options.
  6. Food and Drug Administration. Saccharin.
  7. Pepino ML, et al. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013 Sep;36(9):2530-5.
  8. National Institutes of Health. Sweeteners-Sugars.

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