While some people ignore or merely glance at the nutrition information on food and beverage packaging, others closely review the label for carbohydrate information if they are on a certain low-carb diet and want to lose a few pounds. However, for those with type I or type II diabetes, the carbohydrate information provided on nutrition labels serves an even more critical role, helping those populations to manage a potentially life-threatening disease in large part through their diet. Without reliable, accurate nutrition information, those with diabetes are unable to accurately calculate the amount of insulin needed for the carbohydrates in the foods and beverages they consume.
Why are carbohydrates the most important nutrient for those with diabetes to monitor? Of the three main nutrients – protein, carbohydrates, and fat – carbohydrates have the greatest impact on blood sugar levels because the body breaks carbohydrates down into glucose, or, in simple terms, sugar. Those who do not have diabetes produce insulin, the hormone needed to let glucose into cells so that the glucose can in turn fuel the body’s activities. Those with diabetes have a problem producing insulin, and need to inject insulin or take medication when consuming carbohydrates in order to enable the glucose to be used by their body’s cells, instead of remaining as sugar in the blood stream (hence the term “high blood sugar”). This is why accurate information about the carbohydrate content of foods and beverages is essential for calculating an appropriate insulin dosage. It is also important to note that various components comprise the total carbohydrate count, and there are different types of physiological effects of each. For example, the total sugar and added sugars declared on labels would increase blood sugar levels, while dietary fiber, which is also considered a carbohydrate, would not.
As you can see, people with diabetes expect that the carbohydrates, specifically sugars and added sugars, listed on nutrition labels will have an impact on their blood glucose level. This is why listing the new low-calorie sweetener allulose as a total sugar and added sugar under the total carbohydrate count on nutrition labels would be especially misleading, confusing, and potentially dangerous for the over 100 million U.S. adults now living with diabetes or prediabetes. Allulose, a “rare sugar” discovered in small quantities in natural sources such as figs and maple syrup, is technically a monosaccharide and classified as a “sugar” based on its molecular formula. However, allulose is not metabolized by the body and therefore contributes negligible calories and does not impact blood glucose levels. A comprehensive label study included in a citizen petition to the U.S. Food and Drug Administration (FDA) corroborates the belief that consumers will be misled by the labeling of allulose as a carbohydrate and sugar. In this study of over 4,000 U.S. adults, the labeling of allulose as an added sugar led to confusion about the impact on blood glucose. In total, 52 to 65 percent of respondents with diabetes evaluating labels mistakenly believed that a flavored beverage with allulose contained sugar.
The FDA is responsible for protecting public health by ensuring the safety, efficacy, and security of the nation’s food supply. Those living with type I and type II diabetes must place significant trust in FDA, and other regulatory bodies when abroad, to protect the accuracy and integrity of nutrition information provided on food and beverage packaging. New draft guidance published in April 2019 indicates FDA’s efforts to reduce consumer confusion over the new nutrition facts label by allowing allulose to be excluded from total and added sugar listings on labels when used as a food ingredient. For those living with or without diabetes, this will help provide additional clarity around the total carbohydrate counts on nutrition labels and allow for the enjoyment of foods and beverages sweetened with allulose, while hopefully minimizing unintended health consequences of misinformation.
 New CDC report: More than 100 million Americans have diabetes or prediabetes. CDC Online Newsroom. CDC. (2017, July 18). Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
 Citizen Petition from Tate and Lyle. Regulations.gov. https://www.regulations.gov/document?D=FDA-2015-P-1201-0001. Published April 14, 2015.