Some people with diabetes avoid fruits, worrying that it will raise their blood sugar quickly as they can be naturally sweet.
Type 2 diabetes mellitus (T2DM) is one of the most common diseases in Malaysia.
According to the 2023 National Health and Morbidity Survey (NHMS), 15.6% of adults have diabetes, with two out of five being unaware of their condition.
Unhealthy eating patterns, physical inactivity and obesity increase the risk of developing diabetes.
In managing T2DM, controlling the amount of carbohydrates in meals is crucial, especially foods such as rice, noodles, bread, biscuits and dairy products.
All fruits contain carbohydrates, which are mainly natural sugar.
Unsurprisingly, many people think that all sweet foods worsen diabetes.
However, whole foods containing natural sugar, like fruit, can be beneficial if eaten in the right amount, at the right time and when prepared appropriately.
Therefore, people with diabetes can indeed eat fresh fruit under the right conditions.
Eating them right
Besides carbohydrates, fruits provide essential nutrients such as dietary fibre, vitamins, minerals and antioxidants.
Whole fruits are a better choice for people with diabetes because of the dietary fibre.
Dietary fibre slows down how fast the natural sugar from fruit enters your bloodstream, so your blood sugar rises slowly and steadily, instead of spiking, as long as you are consuming the fruit in the appropriate amounts.
Dietary fibre also helps keep you full for longer by delaying stomach emptying, which means the food will stay in the stomach a little longer.
This reduces the chances of overeating and supports better insulin sensitivity, which is important for long-term blood sugar control.
It is also important to note that the sweetness of a fruit does not reflect its carbohydrate content.
The carbohydrate content is similar across different fruits (according to the appropriate portion size).
It’s the amount that is consumed, not the type of fruit, that matters.
It is recommended to consume two portions of fruit per day, with each portion roughly containing 15g of carbohydrate (see graphic below).
These can be spread across meals or snacks to prevent blood sugar spikes, rather than consuming two portions at once.
For example, you can have a medium-sized apple at breakfast and a slice of papaya at dinner, or a medium-sized orange during morning tea and another during afternoon tea.
Many may also wonder whether fruit should be eaten before or after meals.
This depends on the individual.
Eating a portion of fruit before a meal may help those who tend to overeat feel fuller, potentially reducing overall calorie intake.
For those who struggle to eat enough during meals, it is better to consume fruit as a snack between meals.
There is no strong evidence showing that eating at any specific time will provide better blood glucose control.
What about fruit juice?
It is actually best for people with diabetes to carefully consider their intake of fruit juices.
Fruit juice is not the same as whole fruit when it comes to blood sugar management.
Fruit juice can be divided into 100% pure juice and non-100% pure juice (i.e. sweetened or mixed fruit drinks).
Studies show that 100% pure fruit juice generally has a neutral effect on diabetes, providing no significant benefit, whereas whole fruits are associated with a slightly lower risk of T2DM.
Non-100% pure fruit juice, on the other hand, can increase diabetes risk due to added sugars, which make blood sugar rise even faster.
Many non-100% pure fruit juices sold commercially contain syrup, brown sugar, white sugar or honey.
Research also suggests that Asians, including Malaysians, are more sensitive to sugar from fruit juice, leading to faster and higher blood sugar spikes.
In addition, juice lacks the fibre of whole fruits.
This is because the physical and structural properties of fibre are largely broken down during juice processing.
As a liquid, fruit juice is digested much faster than solids like whole fruits.
Both these factors cause sugar to enter the bloodstream quickly and result in rapid spikes in blood sugar.
As juice requires no chewing, it is easy to unknowingly consume in large amounts, adding extra calories and increasing the risk of weight gain and diabetes.
More research is still needed to clarify “safe” amounts of fruit juice for people with diabetes.
Making wise choices
Eating fruits offers benefits beyond blood sugar control.
Dietary fibre supports digestion and slows sugar absorption.
Vitamins and antioxidants help strengthen immunity and protect heart health.
Natural sweetness satisfies cravings, reducing the temptation to consume processed sugar (e.g. white sugar, brown sugar and sugar-sweetened beverages).
Everyone’s body responds differently to fruit, so self-monitoring blood sugar after consumption can help identify personal tolerance.
Consulting a dietitian is recommended for tailored advice or when you are unsure about the effects of your diet.
When diabetes is not well controlled over time, high blood sugar can slowly damage the body, leading to long-term complications such as heart disease, stroke, kidney problems, nerve damage and vision issues.
These complications often develop quietly, hence, taking care of your diet and lifestyle early is important.
The good news is that fruits, which have many health benefits, are not something people with diabetes need to avoid.
By eating wisely, staying active and understanding how different foods affect your blood sugar, you can lower your risk of complications and support better long-term health in the years to come.
Cheong Zhi Xuen is a final-year dietetics student at Universiti Kebangsaan Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
