Staying well hydrated is important for maintaining good health and wellness. But for those who have diabetes — a chronic condition in which your blood sugars are too high — there are certain dietary changes you’ll need to make that can limit your choices of what to drink.
“Having diabetes means you need to try to eat a healthy, balanced diet. If you don’t, then the medications don’t work as well as they could, and you may need more medications,” says Dr. Kathleen Wyne, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus.
Diabetes comes in two primary varieties:
— Type 1: The pancreas makes very little or no insulin, a hormone that helps regulate blood glucose or blood sugar levels. It’s an autoimmune condition in which the immune system mistakenly attacks the cells of the pancreas and stops them from working properly.
— Type 2: A chronic health condition that tends to affect older adults and is typically related to obesity and poor diet. People with Type 2 diabetes may make some insulin, but their bodies don’t respond as well to it as they should, and that leads to blood sugar levels that are too high.
Adjusting Your Diet
With both types of diabetes, regulating what you eat and drink is an important part of the health-maintenance equation. “When we’re talking about Type 1 diabetes, we don’t restrict the diet except to recommend the patient eats a heart-healthy diet,” Wyne says. Still, people with Type 1 diabetes should know how many and which type of carbohydrates they’re eating and use that to help gauge the correct dosage of insulin. Your endocrinologist can help you learn how to do that properly.
Although insulin use is more common for people with Type 1 diabetes, some people with Type 2 diabetes take insulin as well, notes Jill Weisenberger, a Virginia-based registered dietitian nutritionist and author of “Prediabetes: A Complete Guide” and “Diabetes Weight Loss: Week by Week.” In that case, they, too, can learn how to “cover” their carbohydrates with insulin. Otherwise, “If you have no ability to change your medications, then you either have to stay in a certain range of carbohydrates,” she says, or go no higher than a specified carbohydrate maximum per meal.
For people who have Type 2 diabetes, especially if they’re overweight — which is a major risk factor for developing the disease — “when you’re first diagnosed, the focus is on trying to lose at least 15 to 20 pounds, as that has a huge impact on glucose levels for the short term and on how many medications you need,” Wyne says. If you can keep the weight off, that “helps to keep the glucose down and the number of medications (you need to take) down.”
To do this, Wyne says the focus should be on “healthy eating and portion control. Healthy eating means avoiding high-fat meals, such as fried foods, concentrated sweets and animal fats.” And portion control means eating smaller amounts.
Overall, people with Type 2 diabetes should be looking to:
— Restrict portion size.
— Eat less fast food.
— Cook at home more often so they can control what they’re eating and keep portion sizes in check.
— Control the ratio of fat, carbohydrates and protein in their diet.
— Limit salt intake.
Why Sugary Drinks Are Especially Harmful
Over time, diabetes takes a heavy toll on the body, and spikes in blood sugar can hasten the damage that it can wreak on other organs and systems. “In the long term the spikes in glucose from the simple sugars play a key role in developing the complications such as heart disease, stroke, kidney disease, eye disease and nerve damage,” Wyne says.
The challenge with drinking beverages that contain high levels of sugar is the speed with which those sugars enter the bloodstream and the spikes they can cause. Liquids are broken down by the digestive system quickly — faster than food — and the sugars contained in sugary coffees, energy drinks or regular sodas find their way into your bloodstream very quickly. Drinking such beverages with food can help slow their ability to enter the bloodstream and give your body time to catch up in processing the sugars, but you still have to think about the overall total carbohydrates you’re ingesting.
“You should avoid sugared drinks because they cause a rapid rise in the blood glucose level,” Wyne says. “This can lead to dehydration and, possibly, to diabetic ketoacidosis,” a dangerous condition that occurs when blood sugar levels soar, causing the body to use fat for fuel. When fat burns, that creates a byproduct called ketones. These ketones build up in the blood, and if left untreated, they can become fatal.
The key is to opt for beverages that don’t contain added sugar and to limit your intake of natural sugars. You have to take care to limit your intake of such sweet drinks, “even juices that are 100% from fruits,” says Dr. Richard Seidman, chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S. “They’re high in fast-acting carbohydrates much like sugars, and a cup of soda or juice will have the equivalent of six teaspoons of sugar.”
Staying away from any sugary beverage such as cola, ginger ale, sweet tea and lemonade is key, Weisenberger agrees. “It doesn’t offer much in the way of nutrition other than hydration,” she says. “It’s high in calories, high in carbohydrates and jacks up blood sugar.”
And while diet sodas don’t contain calories or sugar, they have been linked to increased risk of obesity and heart disease in some studies. Certainly, they’re a better option than their high-sugar counterparts, but you should still be seeking to limit your intake of diet sodas.
What Can I Drink With Diabetes?
If you’ve recently been diagnosed with diabetes, you’ll need to consider not just what you’re eating, but also what beverages you enjoy. “Sometimes you may not think of what you drink as having much relevance, but your choice of beverages can have a big impact on your blood sugar levels,” Seidman says.
As a general recommendation, people with diabetes should avoid drinking sugar-sweetened beverages, as this “is an effective way of staying within your personal carbohydrate goal,” Seidman says. “It’s best to choose nutrient dense, high-fiber foods to provide you with your ‘per meal carbohydrate budget’ instead of using empty calorie foods or drinks such as regular sodas.”
Your best bet for staying hydrated throughout the day, Seidman says, is by sipping plain water. But not everyone enjoys the taste of tap or bottled water, and it may seem boring sometimes.
“Maybe you need a water filter because there’s something in your water that doesn’t taste good,” Weisenberger suggests. “Or, just flavor your water.”
Here are some additional suggestions for other low- or no-calorie things you can drink, even if you have diabetes:
— Mineral or seltzer water. If plain water doesn’t do it for you, why not reach for mineral of seltzer water? The bubbles are fun and some varieties contain sugar-free flavors that add no calories, just a fruity taste. Just check the label first, as some brands can contain higher levels of sodium than others.
— Unsweetened herbal teas. The world is your oyster when it comes to herbal teas. Steeping a cup of hot or iced herbal tea adds lots of flavor to water and provides excellent hydration with no sugar or calories. Best to make your own at home to ensure it’s sugar-free. Or try ginger tea.
— Water with a twist. A simple mix of plain water with a slice or two of citrus, a couple of muddled berries or mint leaves can be a lot tastier and inviting without adding too much sugar or many calories. You could also add basil, lavender or cucumber, Weisenberger says, or give ginger water a try.
— Coffee or black or green tea. In their unadulterated states, coffee and tea are calorie-free and generally get the green light for inclusions in a healthy diet, though you do need to be aware of their caffeine content. “Caffeine is OK in moderation,” Wyne says. “The key is not to drink so much that you get dehydrated.” And don’t put a lot of milk, cream or sugar in any of these, rather use just a tiny splash of skim milk and skip the sugar entirely. “People tend to forget about this when they order coffee drinks at coffee shops,” Wyne says. Ordering those flavored and specialty coffees can mean a mega-dose of sugar and calories.
— Low-fat milk. A glass or two of low-fat milk each day is generally considered a safe option for people with diabetes because the fat and protein in the milk helps offset the rate at which the sugars in it are absorbed. Low-fat dairy products are a good source of vitamin D and calcium, which are important nutrients that should be part of any healthy diet.
— 100% fruit juice. Fruit juice, even if it’s 100% all natural juice with no added sugar, can be tricky. Natural sugars found in fruit are healthier than added sugars, but it’s still sugar that can elevate your blood glucose level. If the choice is between an all-natural juice and a regular soda, opt for the juice, just be careful to limit your portion size. You can also cut fruit juice with plain water to make it go farther with a little less sugar per serving. “If it’s a nutritious beverage like orange juice, then I’m all for it,” Weisenberger says. “I just want people to pay attention to the amount of carbohydrate in it, so they don’t go over whatever their limit is.”
— Smoothies. It’s much the same story for smoothies as for fruit juice. They can be delicious and packed with nutrients and immunity-boosting good stuff, but they can also contain a lot of calories and natural sugars from the fruit. Just be mindful of how much you’re drinking and your overall daily calorie and carbohydrate counts. Weisenberger warns against gulping smoothies down in place of solid food: “People tend to drink them faster than they would a meal, so the blood sugar addition is more of a spike,” she says. For an adult with Type 2 diabetes who wants healthy smoothies, she says, “Pick wholesome ingredients. Make the base a nonfat, Greek yogurt or nonfat cottage cheese.” Berries are a good fruit choice, she adds, and using frozen fruit lets you get more flavor by avoiding dilution from ice.
— Soup. Soups contain a lot of water and can be low-carb, nutritious and delicious. Chicken soup with low-sodium chicken broth, or vegetable soups such as split pea, minestrone or bean are among the many options for people with diabetes.
— Tomato juice. Tomato juice is nutrient-rich but not high in carbs or calories, Weisenberger says, and it quickly reduces hunger. Sodium content is the only concern, she notes. You can opt for a lower-sodium version or mix regular and low-sodium tomato juice for a bit more taste.
[SEE: 6 Portion Control Tips.]
A Word About Alcohol
Though alcohol is OK for people with diabetes to drink, it must be consumed in moderation because it contains a lot of calories. “Alcohol can have a mild effect to lower glucose, but that’s often more than offset by the carbs in the drink,” Wyne says.
“Contrary to popular belief, alcohol itself does not turn to sugar but it will have a delayed effect on the stability of your blood sugar levels,” Seidman adds. Because of this effect, “drinking alcoholic beverages may increase the risk of having a low blood sugar later on for some people, especially if they take insulin or other glucose lowering medications.” Therefore, he says “it’s important to discuss the risk of alcohol and low blood sugar with your health care provider.”
Wyne notes that you “should never take a dose of insulin for the calculated carbs in the drink because of this offset of the alcohol on the liver that can lower the glucose level.” Also, if you’re planning to drink hard alcohol, such as shots of tequila or martinis, “then I recommend eating before going out,” she says, as the food in the stomach will help absorb some of the alcohol and slow the release of sugars into the blood stream.
Weisenberger adds these cautions for those with diabetes: “People will often mix alcohol with very high-caloric and high-carbohydrate juices and sodas. Also, whenever we drink, we loosen up some and lose some of our inhibitions, so we’re most likely to overeat.”
What’s more worrisome, depending on your medications, Weisenberger emphasizes, “is when high alcohol intake — or even just average alcohol intake for some people with diabetes — can cause low blood sugar,” particularly several hours after you’ve had a lot to drink in the evening. “You can have a low blood sugar in the middle of the night and not be aware.”
If you’ve recently been diagnosed with diabetes, be sure to speak with your doctor about recommended dietary changes. Seidman also recommends working with a registered dietitian to make sure you’re getting adequate nutrition and eating right for your situation.
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Update 04/15/21: This article was previously published and has been updated with new information.