Medical Basis: American Diabetes Association Standards of Care in Diabetes—2026, FDA Food Sweetener Information
Updated: August 2026

Many people, upon discovering elevated blood sugar levels, or being diagnosed with diabetes or prediabetes, first react with:

"Does this mean I can never eat anything sweet again?"

The answer is not a simple "yes" or "no."

For blood sugar management, what truly matters is not whether a food tastes sweet, but rather:

• How many carbohydrates it contains

• How much added sugar it contains

• How much is eaten at one time

• Whether it also contains protein, fat, and dietary fiber

• The total caloric intake for the entire day

• Weight and insulin sensitivity

• Which blood sugar-lowering medications are being used

Therefore:

High blood sugar does not mean you can never eat sweet foods again.

However, this also doesn't mean that "if it says sugar-free, you can eat it without limit."

---

1. Why do diabetics need to focus on "carbohydrates" rather than just "sugar"?

Many people directly equate:

Sugar = Blood Sugar

In reality, it's not just white sugar that affects blood sugar when consumed.

The carbohydrates in foods like rice, noodles, bread, porridge, potatoes, cookies, fruits, and desserts can all be converted into glucose during digestion and affect post-meal blood sugar levels.

So, if a person completely avoids candy but eats large amounts of:

• White rice

• White porridge

• Noodles

• Bread

• Refined pastries

Their blood sugar may still not be well-controlled.

One of the core principles of diabetic dietary management is to look at:

Total Carbohydrate

Instead of just checking if the packaging says "Sugar."

---

2. Do diabetics have to completely cut out sweets?

Generally, not all diabetics are required to permanently and completely ban all sweets.

More importantly:

Control portion sizes and frequency.

For example, occasionally eating a small dessert is completely different from drinking large sugary beverages daily.

The American Diabetes Association's 2026 nutrition recommendations emphasize minimizing:

• Added sugar

• Sugar-sweetened beverages

• Highly processed sugary foods

While prioritizing:

• Water

• Low-calorie or zero-calorie beverages

• High-fiber carbohydrate sources

• Nutrient-dense, less processed foods

So the focus isn't on establishing a rule of "never eating anything sweet again," but rather on reducing chronic, repeated, high-dose intake of added sugars and highly refined carbohydrates.

---

3. Why do sugary drinks particularly warrant attention?

For blood sugar management, sugary drinks usually deserve priority reduction more than many solid sweets.

For example:

• Sodas

• Milk tea

• Sugared coffee

• Fruit juice beverages

• Sweet tea

• Energy drinks

The problem with them is that:

The sugar enters the system quickly, and they often lack sufficient fiber, protein, and satiety.

ADA 2026 explicitly recommends that people with diabetes and those at high risk prioritize water over sugary drinks and reduce added sugar foods to help manage blood sugar and lower cardiometabolic risk.

---

4. Are "sugar-free foods" necessarily suitable for diabetics?

Not necessarily.

This is one of the most common misconceptions.

The label on food packaging:

Sugar Free

Only indicates that the product's sugar content meets the regulatory definition of "sugar-free."

But it does not mean:

• No carbohydrates

• No calories

• Does not raise blood sugar

• Can be eaten without limit

For example, some sugar-free cookies, sugar-free chocolates, and sugar-free cakes may still contain:

• Flour

• Starch

• Sugar alcohols

• Fats

• High total calories

So, when diabetics buy "sugar-free foods," they should not only look at the "Sugar Free" on the front.

They should also look at:

Nutrition Facts

Specifically paying attention to:

• Total Carbohydrate

• Added Sugars

• Dietary Fiber

• Serving Size

• Calories

---

5. What are artificial sweeteners?

Artificial sweeteners generally refer to sweeteners used to provide sweetness as an alternative to sucrose, glucose, or fructose.

A portion of these belong to:

Nonnutritive Sweeteners

They are usually very sweet, requiring only a small amount, and therefore provide very few or almost no calories.

Common ones include:

• Monk Fruit / Luo Han Guo extract

• Stevia (steviol glycosides)

• Sucralose

• Aspartame

• Saccharin

• Acesulfame potassium

The FDA also lists monk fruit extract as a plant-derived high-intensity sweetener.

---

6. Can diabetics use artificial sweeteners?

Yes, but with a very important prerequisite:

It should be used to "replace sugar," not to add extra sweets on top of an existing diet.

The ADA 2026 recommendations are clear:

For people with diabetes or those at high risk of diabetes, nonnutritive sweeteners can be used in moderation and for short periods to replace sugary foods, thereby helping to reduce overall calorie and carbohydrate intake.

The key is:

replace, not add.

For example, if someone previously drank a sugary beverage daily:

Sugary soda → Sugar-free beverage

This might help reduce sugar and calorie intake.

However:

Normal diet + large amounts of sugar-free desserts daily

May not necessarily improve overall metabolic health.

So the goal of using artificial sweeteners should be:

To reduce sugar, not to maintain the habit of eating unlimited sweets.

---

7. What is Monk Fruit?

Monk fruit is usually called:

Monk Fruit

Scientific name:

Siraitia grosvenorii

It is a plant native to southern China.

Its main source of sweetness is:

Mogrosides

FDA data shows that different concentrations of monk fruit extract can be approximately:

100–250 times sweeter than sucrose

Some higher purity extracts can be even sweeter.

Therefore, only a very small amount of monk fruit extract is needed to produce a noticeable sweetness.

---

8. What is the FDA's view on Monk Fruit?

In the United States, monk fruit extract is widely used in:

• Tabletop sweeteners

• Beverages

• Baked goods

• Sugar-free foods

• Low-calorie foods

The FDA has evaluated multiple GRAS notices regarding monk fruit extract.

For the intended conditions of use described in these submissions, the FDA states:

No objection was raised to the notifier's GRAS conclusion of safety.

This is why monk fruit sweeteners are now widely and legally available in the US market.

It is important to note:

This does not mean "the FDA has approved monk fruit for the treatment of diabetes."

Monk fruit's role here is as a:

Food Sweetener

Not a blood sugar-lowering medication.

---

9. Does Monk Fruit raise blood sugar?

Pure, high-intensity monk fruit sweetener itself typically contains very little or almost no available carbohydrates, so it generally does not significantly raise blood sugar like an equivalent amount of sucrose.

This is also an important reason why it is used in low-sugar and sugar-free foods.

However:

"Products using monk fruit" does not mean "the entire product will not raise blood sugar."

This is one of the most easily overlooked points when purchasing.

For example, a:

Monk Fruit Cookies

Even if the sweetness comes from monk fruit, it may still contain large amounts of:

• Flour

• Starch

• Chocolate

• Other carbohydrate sources

So, you should still look at:

Total Carbohydrate

Instead of just seeing:

Sweetened with Monk Fruit

And assuming you can eat it without limit.

---

10. Why is monk fruit not the first ingredient on many monk fruit sweetener packages?

This is a very practical shopping tip.

Because monk fruit extract is extremely sweet, the actual amount needed is very small.

If manufacturers packed pure monk fruit extract directly into a bag like regular sugar, consumers would find it difficult to measure correctly.

Therefore, many commercial monk fruit sweeteners contain:

• Erythritol

• Allulose

• Other bulking agents

To make its volume and usage more similar to regular sugar.

So, when buying, don't just look at the front that says:

MONK FRUIT

Turn to the back to see the:

Ingredients

To check the actual formula of the product.

This is more important than the brand name itself.

---

11. Are Monk Fruit and Erythritol the same thing?

No.

This is one of the most common misconceptions on the market.

Monk Fruit is monk fruit extract.

Erythritol is a sugar alcohol.

Many products use a blend of both:

Monk Fruit + Erythritol

Hence, consumers often mistake them for the same thing.

In reality, they are different sweetening components.

If you need to avoid a certain ingredient due to digestive sensitivity, personal dietary needs, or doctor's advice, always check the ingredients list, not just the "Monk Fruit" on the front of the package.

---

12. How to choose between Monk Fruit and Stevia?

Both are plant-derived high-intensity sweeteners, commonly found in the US market.

Monk Fruit

Sweetness primarily comes from mogrosides.

Stevia

Sweetness primarily comes from steviol glycosides.

The FDA has relevant information regarding GRAS use for high-purity monk fruit extract and certain high-purity steviol glycosides that meet specific conditions.

As for which one is "better," there isn't a one-size-fits-all answer.

The actual choice often depends on:

• Taste preference

• Product formulation

• Whether it contains other fillers

• Digestive tolerance

• Price

• Baking applications

Some people prefer the taste of monk fruit, while others are more accustomed to Stevia.

---

13. Can monk fruit help with weight loss?

It should not be treated as a weight-loss product.

A more accurate statement is:

If:

You replace a large amount of sugar you previously consumed with monk fruit sweetener

thereby truly reducing daily calorie and refined carbohydrate intake, then it can be part of overall dietary management.

But if it becomes:

"Since this is monk fruit, I can eat twice as many desserts."

Then the advantages gained from reducing sugar might quickly be offset by the total caloric intake.

This is why the ADA emphasizes:

moderation

and:

replacement

Rather than unlimited use.

---

14. What should diabetics prioritize doing?

Instead of just debating "white sugar versus monk fruit," the overall dietary structure is more important.

ADA 2026 emphasizes:

Prioritize minimally processed, nutrient-dense, high-fiber carbohydrate sources

Which means:

• Less processed

• Higher nutrient density

• Rich in dietary fiber

Carbohydrate sources.

For example:

• Non-starchy vegetables

• Legumes

• Moderate amounts of whole fruits

• Whole grains

• Nuts

• Fiber-rich foods

While reducing:

• Sugary drinks

• Added sugars

• Highly refined foods

• Excessive refined carbohydrates

---

15. How should sweets be consumed after high blood sugar is detected?

You can remember a very practical principle:

It's not about "absolutely can't eat," but "knowing how much you've eaten."

If you absolutely want to eat sweet foods:

Step one: Check the portion size

Do not ignore the Serving Size just because it is sugar-free.

Step two: Check Total Carbohydrate

More important than "grams of sugar."

Step three: Check Added Sugar

Minimize long-term, high intake.

Step four: Check the ingredients list

Especially when buying monk fruit products, check for:

Erythritol, Allulose, or other ingredients.

Step five: Observe your blood sugar response

Different people may have different post-meal blood sugar responses to the same food.

For individuals using CGM or home blood glucose monitors, they can combine this with advice from their doctor or diabetes educator to more accurately understand their dietary reactions.

---

16. Who, in particular, should not rely solely on "eating less sugar"?

If there is already:

• Persistently elevated fasting blood sugar

• A1C reaching the diabetic range

• Significant post-meal hyperglycemia

• Gestational diabetes

• Insulin use

• Use of medications that may cause hypoglycemia

• Diabetes complicated by CKD

• Significant weight issues

Then treatment cannot be simplified to:

"From now on, just don't eat anything sweet."

Diabetes management may involve:

• Diet

• Exercise

• Weight management

• Medication

• Blood sugar monitoring

• Cardiovascular risk management

• Kidney protection

And other aspects.

---

17. Starside Drugs Pharmacist Summary

If you only remember these five points from this article:

1. High blood sugar does not mean you can never eat sweet foods again.

2. Blood sugar management should focus more on Total Carbohydrate, Added Sugar, portion size, and overall dietary patterns.

3. Monk Fruit can be used as one of the alternative sweeteners to sugar.

4. The FDA has not objected to the GRAS use of monk fruit extract under relevant conditions, but monk fruit is not a medication for treating diabetes.

5. "Monk Fruit food" does not mean "zero-carb food"; when buying, you still need to check the Nutrition Facts and Ingredients.

If you are taking diabetes medications, using insulin, or are unsure whether a "sugar-free" or "low-sugar" food is suitable for you, you can bring the food label or product ingredient list to your pharmacist or doctor for assessment.

---

References to Medical Literature

This article primarily refers to:

1. American Diabetes Association. Standards of Care in Diabetes—2026

2. U.S. Food and Drug Administration — Aspartame and Other Sweeteners in Food

3. U.S. Food and Drug Administration — High-Intensity Sweeteners

4. FDA GRAS Notice Inventory — Siraitia grosvenorii / Monk Fruit Extract

---

Medical and Nutrition Disclaimer

This article is provided by Starside Drugs Pharmacy for general health, nutrition, and food knowledge education only, and does not constitute individualized medical, nutritional, or diabetes treatment advice.

Dietary plans for people with diabetes may be affected by medication, insulin regimens, kidney function, weight, age, pregnancy status, and other medical conditions. For any adjustments to diet or diabetes treatment plans, please consult a doctor, registered dietitian, diabetes educator, or pharmacist.

Starside Drugs Pharmacy
www.starsidedrugs.com