Pile of white sugar cubes next to a spoon heaped with granulated sugar

Artificial Sweeteners and Blood Sugar: What the Research Shows

Key Takeaways

  • The FDA says sweeteners contribute few or no calories and generally will not raise blood sugar levels.[1]
  • A Cochrane review of 9 trials in 979 people with diabetes found no clear HbA1c difference. Against placebo the difference was 0% (0 mmol/mol) in 4 trials with 360 people. Certainty was very low.[2]
  • In 210 adults with type 2 diabetes, swapping sugar for sucralose in tea or coffee for 12 weeks did not change HbA1c.[3]
  • A short test in 21 people without diabetes found a 30% larger glucose area after swallowed sucralose than after water.[4]
  • A meta-analysis of stevia in 1,439 people found no significant effect on HbA1c.[5]
  • The American Diabetes Association (ADA) says sweeteners can be used in place of sugar-sweetened products in moderation and for the short term.[6]

Artificial sweeteners and blood sugar usually do not clash. These sweeteners add little or no carbohydrate. The FDA says they generally will not raise blood sugar the way sugar does.[1] The detail is messier. Some short tests show bigger glucose responses after sucralose, and trials in people with diabetes are small. This guide is general education. If you use insulin or other glucose medicines, follow the plan your diabetes team gave you.

Do artificial sweeteners raise blood sugar?

Mostly no, at least in the short term. A 2023 network meta-analysis pooled 36 trials with 472 mostly healthy people. It found that drinks with nonnutritive sweeteners had no effect on glucose after drinking, much like water, while sugar-sweetened drinks raised it.[7] The review was funded by an industry body, the Institute for the Advancement of Food and Nutrition Sciences. Its senior author also reports support from Tate and Lyle and two sweetener trade groups.[7] Funding does not make results wrong. Still, read them next to independent trials.

What about people who already have diabetes? A Cochrane review pooled 9 trials with 979 people with type 1 or type 2 diabetes, lasting 4 to 10 months. For HbA1c, sweeteners differed from placebo by 0% (0 mmol/mol) in 4 trials with 360 people. Against sugar, HbA1c was 0.4% (about 4 mmol/mol) higher with sweeteners in 3 small trials with 72 people, and the range crossed zero. The certainty was very low.[2] The authors called the evidence inconclusive. In plain terms, no harm and no gain has been shown.

You may have seen the 2023 WHO advice against using non-sugar sweeteners to control weight. It applies to all people except those who already have diabetes, and it is a conditional recommendation.[8] The WHO review also noted possible long-term concerns in adults, such as a higher risk of type 2 diabetes. Those are associations, not cause and effect.[8]

What does the ADA say about artificial sweeteners and blood sugar?

The ADA says people with diabetes can use nonnutritive sweeteners in place of sugar-sweetened products if they consume them in moderation and for the short term. The aim is to reduce overall calorie and carbohydrate intake. This is recommendation 5.22 in the 2026 Standards of Care.[6]

The words "in place of" matter. The advice is to swap sugar out, not to add sweetness on top of it. A second recommendation, 5.25, tells people with diabetes to replace sugar-sweetened beverages, including any juices, with water or low-calorie or no-calorie drinks.[6] For the wider picture, see our guides to smart nutrition choices and carbs and blood sugar. In the UK, Diabetes UK says artificial sweeteners contain little or no calories or carbohydrate and do not affect blood glucose levels. It also reminds shoppers that products labelled "sugar-free" are not always low in calories, so labels still matter.[9]

Does stevia raise blood sugar?

Not in the trials so far. A 2024 meta-analysis pooled 26 studies and 1,439 people. It reported a small difference in blood glucose with stevia, but the abstract does not state the units. It found no significant effect on insulin or HbA1c. Certainty was low to very low.[5]

A separate review pooled 9 trials with 462 people and looked at steviol glycosides, the sweet compounds in stevia. It found no significant effect on HbA1c, and the authors declared no conflicts.[10] Both pool small trials. Read them as a reassuring signal, not a promise. The FDA has also not questioned the notifiers' safety conclusions for high-purity stevia sweeteners.[1]

Is monk fruit safe for people with diabetes?

Regulators have raised no concern at intended use, but long-term data in people with diabetes are thin. The FDA has not questioned the notifiers' conclusions for monk fruit extract. It describes the extract as reported to be 100 to 250 times sweeter than sugar.[1]

On monk fruit and diabetes, a 2025 systematic review covered 5 randomized trials. Its authors reported glucose responses after meals 10 to 18% smaller and insulin responses 12 to 22% smaller with the extract. They declared no conflicts. Those are the authors' figures from five small trials. Take them as a hint only.[11]

What does sucralose do to blood sugar?

It depends on how you test it. Short tests in people without diabetes sometimes show bigger glucose responses.[12] Trials of 12 to 13 weeks in people with type 2 diabetes found no change in HbA1c.[3][13] This is why research on sucralose and blood sugar feels contradictory.

Short lab tests

A crossover trial gave sucralose before a glucose drink to 17 people with obesity who did not normally use sweeteners. The peak rise in glucose was 4.8 mmol/L (86 mg/dL) against 4.2 mmol/L (76 mg/dL) with water. Insulin area under the curve was also 20% larger.[12]

A second crossover trial of 21 people without diabetes found a 30% larger glucose area with swallowed sucralose than with water. Sucralose that was only tasted did not do this.[4] In 120 healthy adults, two weeks of saccharin or sucralose impaired glucose responses. Effects varied by person and linked to gut microbes.[14] Some authors co-founded DayTwo, a personalised nutrition company.

Longer trials in type 2 diabetes

In one trial, 128 adults with type 2 diabetes took 667 mg (0.024 oz) of sucralose a day for 13 weeks. HbA1c and fasting glucose did not differ from placebo.[13] Its first author worked for the maker of a sucralose brand, and the dose came in capsules.

A 12-week trial in India followed 210 adults with type 2 diabetes who replaced about 60 kcal of added sugar with sucralose in tea or coffee. HbA1c and fasting glucose did not change. Weight, BMI and waist size were slightly smaller.[3]

What about erythritol and aspartame?

Erythritol and aspartame raise the most questions. Erythritol is a sugar alcohol, and the FDA says sugar alcohols do not cause a sudden increase in blood glucose.[1] Yet an observational study of people having heart risk checks linked high blood erythritol to more heart events. Hazard ratios were 1.80 and 2.21 for the top quarter against the bottom quarter in two cohorts.[15] Blood erythritol also includes what the body makes itself. The study cannot show cause, and the authors called for long-term safety studies.

In July 2023 the IARC classed aspartame as possibly carcinogenic to humans (Group 2B), citing limited evidence. JECFA reaffirmed an acceptable daily intake of 40 mg/kg (2.2 lb) of body weight. IARC classes reflect the strength of evidence, not the risk at a given intake.[16] An adult weighing 70 kg (154 lb) would need more than 9 to 14 cans of diet soft drink a day to pass that limit.[16]

Which sweetener suits people with diabetes?

No study can say. We found no head-to-head trial of sweeteners in people with diabetes, and no source names one winner. People often search for a single top sweetener for diabetes. The table compares what each source found instead. Any pick fits the ADA advice only when it replaces sugar, in moderation.[6]

Sweeteners compared at a glance

Item. What the evidence says. Practical point.
Drinks with nonnutritive sweeteners.[7][6] No effect on glucose after drinking, similar to water, in 36 trials. Sugar-sweetened drinks raised it.[7] Industry bodies backed the work.[7] A swap for a sugary drink matches ADA advice.[6]
Sucralose.[4][13][3][14] Larger glucose responses in short tests.[4] No HbA1c change in trials of 12 to 13 weeks in type 2 diabetes.[13][3] Responses vary by person, so your own readings matter.[14]
Stevia.[5][10] No clear effect on HbA1c.[5][10] Reassuring, but the trials are small.[10]
Monk fruit.[11] Five small trials reported smaller glucose and insulin responses after meals.[11] Promising but thin.[11]
Erythritol.[15] An observational study linked high blood levels to more heart events.[15] The link is not proof of cause. Ask your GP or primary care team if you have heart risk.[15]
Aspartame.[16][1] The WHO limit is 40 mg/kg (2.2 lb) a day and the US limit is 50 mg/kg (2.2 lb).[16][1] A 70 kg (154 lb) adult needs more than 9 to 14 cans of diet drink a day to pass the WHO limit.[16]
  1. Use sweeteners to replace added sugar in drinks or food rather than adding extra sweetness on top of your usual diet.[6]
  2. Choose water first, and use low-calorie or no-calorie drinks as a short-term swap for sugary drinks and fruit juice.[6]
  3. Check the nutrition label on "sugar-free" foods, because they can still contain substantial calories, fat and starch.[9]
  4. Never use diet drinks or nonnutritive sweeteners to treat low blood sugar, as they contain little or no carbohydrate.[1][9][17]
Pro Tip

Run your own check. If you test your glucose at home, compare readings on days with and without a sweetener and note what else you ate. Responses vary by person.[14] A log gives your GP or primary care team something concrete. Our guide to self-monitoring shows how.[6][14]

Sweeteners add little or no carbohydrate,[1][9] so diet drinks and sweeteners will not bring up a low. Lows are more likely if you use insulin or a sulfonylurea such as gliclazide or glimepiride, and low blood sugar usually means below 4 mmol/L (72 mg/dL) in the UK or below 70 mg/dL (3.9 mmol/L) in the US.[17][18] For a conscious low, the NHS advises fast-acting carbohydrate such as a small glass of fruit juice, a regular sugary fizzy drink or glucose tablets.[17] In the UK, the NHS says to call 999 if someone may have very low blood sugar and is not responding normally or is unconscious, and a glucagon injection is not available or you do not know how to use it, or they have not recovered within 10 minutes of a glucagon injection, or they have been drinking alcohol.[17] In the US, the ADA says to call 911 right away if someone is unconscious and glucagon is not available or no one knows how to use it.[18]

Questions to ask your diabetes team

  • Which sweeteners or sugar swaps fit my meal plan and cardiovascular risk profile?[6][15]
  • Since I use insulin or a sulfonylurea such as gliclazide or glimepiride, how should I adjust my doses if I swap sugary drinks for water or diet drinks?[6][17]
  • What fast-acting carbohydrate should I carry for hypos so I do not accidentally grab a sugar-free drink?[9][17][18]
  • Can we review my home glucose log to see whether specific sweeteners affect my post-meal readings?[6][14]

Frequently asked questions

Does stevia raise blood sugar?

Not in the trials reviewed so far. A meta-analysis of 26 studies and 1,439 people found a small difference in blood glucose and no significant effect on HbA1c or insulin, though certainty was low.[5]

Can people with diabetes use artificial sweeteners?

Yes, in moderation. The ADA says nonnutritive sweeteners can be used in place of sugar-sweetened products if consumed in moderation and for the short term. Ask your GP or primary care team what fits your plan.[6]

Is sucralose safe for people with diabetes?

The evidence is mixed. Two trials of 12 to 13 weeks in adults with type 2 diabetes found no change in HbA1c. Short tests in people without diabetes showed larger glucose responses.[3][13][4]

Does the WHO tell people with diabetes to avoid sweeteners?

No. The 2023 WHO advice against sweeteners for weight control applies to all people except those with pre-existing diabetes, and it is a conditional recommendation.[8]

Where to go next

For more on tracking your readings, choosing everyday foods and checking what is in our supplement, see:

Note: If you are pregnant, breastfeeding, or considering giving any supplement or herbal product to a child, consult your healthcare provider before making any changes to your diet, supplement routine, or prescribed medications.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Talk to your doctor before changing your diet, your activity or your medicines, and before starting any supplement.

Sources & References

  1. US Food and Drug Administration. Aspartame and Other Sweeteners in Food (content current as of 27 February 2025). fda.gov Funding: not applicable, this is official or charity guidance, not a funded study.
  2. Lohner S, et al. (2020). Non-nutritive sweeteners for diabetes mellitus. Cochrane Database of Systematic Reviews. pubmed.ncbi.nlm.nih.gov/32449201 Funding: WHO and German Federal Ministry of Education and Research support listed in the Cochrane review. COI: authors declared no competing interests.
  3. Mohan V, et al. (2024). Effect of replacing sucrose in beverages with nonnutritive sweetener sucralose on cardiometabolic risk factors among Asian Indian adults with type 2 diabetes: a 12-week randomized controlled trial. Diabetes Therapy. pubmed.ncbi.nlm.nih.gov/39046696 Funding: funded by Zydus Wellness Institute. COI: the study was sponsored by Zydus Wellness, maker of sweetener products; authors declared the funding and institutional roles in the paper.
  4. Nichol AD, Salame C, Rother KI, Pepino MY. (2019). Effects of sucralose ingestion versus sucralose taste on metabolic responses to an oral glucose tolerance test in participants with normal weight and obesity: a randomized crossover trial. Nutrients. pubmed.ncbi.nlm.nih.gov/31877631 Funding: USDA National Institute of Food and Agriculture and NIH grants. COI: the authors declared no conflict of interest.
  5. Zare M, et al. (2024). Effect of stevia on blood glucose and HbA1C: a meta-analysis. Diabetes & Metabolic Syndrome. pubmed.ncbi.nlm.nih.gov/39098209 Funding: none listed on the PubMed record. COI: the authors declared no competing interests.
  6. American Diabetes Association Professional Practice Committee. (2026). Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes, 2026 (Section 5, recommendations 5.22 and 5.25). Diabetes Care, 49(Suppl 1):S89. pubmed.ncbi.nlm.nih.gov/41358898 Funding: none listed on the PubMed record. COI: Duality of interest information for each contributor is available at https://doi.org/10.2337/dc26-SDIS.
  7. Zhang R, et al. (2023). The effect of non-nutritive sweetened beverages on postprandial glycemic and endocrine responses: a systematic review and network meta-analysis. Nutrients. pubmed.ncbi.nlm.nih.gov/36839408 Funding: funded by the Institute for the Advancement of Food and Nutrition Sciences (IAFNS) and CIHR. COI: senior author J.L.S. reported research support and honoraria from Tate & Lyle, the Calorie Control Council, the International Sweeteners Association and food/beverage companies.
  8. World Health Organization. (15 May 2023). WHO advises not to use non-sugar sweeteners for weight control in newly released guideline. who.int Funding: not applicable, this is official or charity guidance, not a funded study.
  9. Diabetes UK. Sugar, sweeteners and diabetes. Accessed 23 October 2026. diabetes.org.uk Funding: not applicable, this is official or charity guidance, not a funded study.
  10. Bundgaard Anker CC, Rafiq S, Jeppesen PB. (2019). Effect of steviol glycosides on human health with emphasis on type 2 diabetic biomarkers: a systematic review and meta-analysis of randomized controlled trials. Nutrients. pubmed.ncbi.nlm.nih.gov/31438580 Funding: none listed on the PubMed record. COI: the authors declared no conflict of interest.
  11. Kaim U, Labus K. (2025). Monk fruit extract and sustainable health: a PRISMA-guided systematic review of randomized controlled trials. Nutrients. pubmed.ncbi.nlm.nih.gov/40362742 Funding: Wroclaw University of Science and Technology. COI: the authors declared no conflicts of interest.
  12. Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. (2013). Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. pubmed.ncbi.nlm.nih.gov/23633524 Funding: NIH grants DK056341 and UL1 TR000448, and the American Diabetes Association. COI: no potential conflicts of interest relevant to the article were reported.
  13. Grotz VL, et al. (2003). Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. Journal of the American Dietetic Association. pubmed.ncbi.nlm.nih.gov/14647086 Funding: McNeil Nutritionals. COI: lead author affiliated with McNeil Nutritionals (maker of Splenda) and co-authors reported research support or consulting fees from McNeil.
  14. Suez J, et al. (2022). Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell. pubmed.ncbi.nlm.nih.gov/35987213 Funding: European Research Council and institutional grants. COI: E.S. and E.E. are paid consultants and co-founders of DayTwo, a personalised nutrition company.
  15. Witkowski M, et al. (2023). The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine. pubmed.ncbi.nlm.nih.gov/36849732 Funding: NIH and Office of Dietary Supplements grants. COI: S.L.H. reported co-inventorship on patents held by Cleveland Clinic relating to cardiovascular diagnostics and royalties/consulting fees as listed in Nature Medicine.
  16. World Health Organization. (14 July 2023). Aspartame hazard and risk assessment results released. who.int. Related paper: Riboli E, et al. (2023). Carcinogenicity of aspartame, methyleugenol, and isoeugenol. The Lancet Oncology. pubmed.ncbi.nlm.nih.gov/37454664 Funding: World Health Organization / IARC. COI: declared in the Lancet Oncology summary.
  17. NHS (reviewed 3 August 2023). Low blood sugar (hypoglycaemia). nhs.uk Funding: not applicable, this is official or charity guidance, not a funded study.
  18. American Diabetes Association. Hypoglycemia (low blood glucose): symptoms and treatment. Accessed 23 October 2026. diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose Funding: not applicable, this is official or charity guidance, not a funded study.
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