The no-sugar myth is probably one of the biggest misconceptions about diabetes. The reality is that it isn't sugar specifically that raises blood glucose levels — it's any food containing carbohydrates, including honey, fruit, milk, and vegetables, to name a few.

So whether it's a spoonful of sugar, a bagel, or a banana, it will cause blood sugar levels to rise. However, some foods may cause a faster or more pronounced blood sugar spike; this is described in more detail in the glycemic index section.

So sugar isn't, in itself, completely off-limits in a diabetes meal plan. However, moderation in sugar intake is important. The reason some people with diabetes prefer to use sugar substitutes such as artificial sweeteners or sugar alcohols is because they contain few or no carbohydrates or calories.

Sugar Alcohols

A sugar alcohol is, quite simply, a monosaccharide that has been chemically transformed into its alcohol form. There are a number of naturally occurring sugar alcohols (also called polyols), including sorbitol, mannitol, xylitol, lactitol, maltitol, isomalt, erythritol, and hydrogenated starch hydrolysates. Because they are not completely absorbed in the gastrointestinal tract, they don't cause much of a rise in blood glucose levels, which is why people with diabetes may find them desirable. Polyols are frequently used as sweeteners and bulking agents in processed foods marketed as sugar-free.

Some people find that sugar alcohols have a laxative effect, causing diarrhea and/or gas. The U.S. Food and Drug Administration requires that foods containing significant amounts of sorbitol or mannitol (those products where daily consumption may result in over 50 grams of sorbitol or 20 grams of mannitol) must be labeled with the statement: “Excess consumption may have a laxative effect.”

When calculating carbohydrates in foods that contain sugar alcohols, you should subtract half of the sugar alcohol grams (located on the nutrition label) from the total carbohydrate count.

Artificial Sweeteners

As opposed to naturally derived sugar alcohols, artificial sweeteners include the following synthetically manufactured sugar substitutes:

• Aspartame (NutraSweet or Equal): This FDA-approved sweetener is 180 times sweeter than table sugar. Aspartame has been the subject of much controversy regarding potential health effects, but there is currently no clinical research indicating that the sweetener is unsafe for most people (except for individuals with advanced liver disease, pregnant women, and those with a rare genetic condition known as phenylketonuria, or PKU).

• Neotame: This sweetener is derived from aspartic acid and phenylalanine (both are amino acids). Neotame is considered safe for use in people with diabetes, children, pregnant and lactating women, and individuals with PKU. It is primarily used in food manufacturing.

• Saccharin (Sweet 'n Low): The oldest artificial sweetener, saccharin was discovered in 1879 and has been used as a sweetener in foods and beverages for over a century. Saccharin has been linked to bladder cancer in rats, but there is no hard data establishing that normal amounts of the sweetener are dangerous for humans.

  In 2000, based on a newer and more relevant body of human studies, the National Toxicology Program of the National Institutes of Health took saccharin off their ninth edition of the Report of Carcinogens list and President Clinton signed legislation removing the carcinogenic warning label from saccharin-containing products. Saccharin is considered GRAS (or generally recognized as safe) by the FDA, and is about 300 times sweeter than table sugar.

• Acesulfame potassium (Sunett): Acesulfame potassium, also called acesulfame K, is FDA-approved for use as a sweetener in processed foods and beverages. It is an estimated 200 times sweeter than table sugar, and studies have confirmed its safe use in people with diabetes, pregnant and nursing women, children, and the general population.

• Sucralose (Splenda): Sucralose is unique in that it is derived (through a chemical process of chlorination) from table sugar. However, unlike table sugar, it has no carbohydrates, no calories, and it passes through the body almost entirely undigested. The sugar substitute, which is 600 times sweeter than table sugar, was cleared by the FDA for use as a food additive and a sweetener in the late 1990s. Because it is very stable and withstands temperature changes well, it can be used in cooking and baking. Extensive clinical studies have uncovered no safety risks for people with diabetes and the general population.

Some artificial sweeteners are available in special blends that combine the sweetener with sugar. These are marketed for use in baking and cooking to add texture and color. When using a sweetener blend, be sure to check the nutrition facts label carefully for the total carbohydrate count per serving.

A Few Words on Stevia

Stevia is a dietary supplement derived from the herb Stevia rebaudiana, a wild shrub that is grown in South America and the Pacific Rim. Although used extensively as a sweetener for food products throughout South America and Asia, stevia is not approved for use in the United States, Canada, or the European Union. The FDA initially banned the import of the herb in 1991, following a study that raised questions about its toxicity as a food additive, but subsequently allowed it to be sold as a dietary supplement. However, the FDA has refused to add it to its GRAS list, citing a lack of substantial, controlled data on the safety of the herb.

Because stevia does not affect blood glucose levels, it is often touted as a sweetener alternative for people with diabetes. The extract of the herb (called steviosides) is said to be 200 to 300 times sweeter than table sugar and is used in cooking and baking outside the United States. Extracts are available in powder, tablet, liquid, and capsule form. Stevia is also available in a green herbal powder formula that is less intense than the extract. Both types of stevia are available in health food stores, marketed as dietary supplements.

If you're considering using stevia, talk with your doctor and dietitian before incorporating it into your food plan. A dietitian familiar with the herb can also provide information on sugar-to-stevia conversion for cooking.