Drinks are easy to forget. A soda with lunch, a sweet iced tea in the afternoon, a bubble tea with friends or a glass of horchata with dinner rarely feel like "food". But after a diabetes diagnosis, drinks are often one of the first things a care team asks about.

This article explains why. It covers what common sweet drinks hold, what the American Diabetes Association recommends, what research has found, and where diet drinks fit.

What a drink holds

Here is a regular cola and a diet cola, each at one medium fountain drink, as USDA FoodData Central measures them:

Compare the carbohydrate on the two cards. Almost all of the regular cola's carbohydrate is sugar, and there is no fiber at all. Open each food page to see the sugars line. On the page you can also pick a can, a bottle, or a small, large or extra large drink. The size you choose changes the carbohydrate a great deal.

Bottled iced tea, the regular kind and the unsweetened kind:

The same tea, with and without sugar, sits at two ends of the scale. Unsweetened tea has next to no carbohydrate. The sweetened one is close to the regular cola.

Two drinks that many families love, bubble tea and horchata:

The bubble tea card opens at one fluid ounce, which is far less than anyone drinks. On the food page, choose USDA's measure "1 item, any size" or "1 cup" to see a realistic drink. Everything in the cup, pearls included, is in that figure. Horchata opens at one cup.

If "carb choice" is a new term, What is a carb choice? explains it. Many sweet drinks hold several carb choices in a single glass.

What the ADA recommends

The American Diabetes Association's Standards of Care 2026 are direct about drinks. Recommendation 5.25 advises people with diabetes, and those at risk, to "replace sugar-sweetened beverages (including any juices) with water or low-calorie or no-calorie beverages and minimize foods with added sugar", to help manage glucose and reduce the risk of heart and metabolic disease.

Recommendation 5.21, given the ADA's highest evidence grade, encourages water over other drinks. The ADA's table of eating advice says that for people who do not prefer plain water, "no-calorie alternatives are the next best choice".

NIDDK, part of the US National Institutes of Health, gives similar advice in plain terms. It lists soda, juice, flavored coffee and sports drinks as "sweet drinks" to have less of. It suggests water, unsweetened tea or coffee, sparkling water, and low-fat or non-fat milk as drinks with little or no added sugar.

What research has found

  • Imamura and colleagues (2015) pooled 17 groups of people without diabetes. Each extra daily serving of sugar-sweetened drinks was linked with an 18% higher rate of type 2 diabetes, and 13% after allowing for body weight. The authors found no clear sign of bias in this result.
  • Ma and colleagues (2023) followed about 15,500 US adults who already had type 2 diabetes, for an average of 18.5 years. People who drank the most sugar-sweetened drinks had a higher risk of death and of heart disease than those who drank the least. Higher intakes of plain water, coffee and tea were linked with lower risk of death.

Both are observational studies. They show links, not proof that the drinks cause the harm. But they are large, they agree in direction, and they are the reason the ADA's advice on sugary drinks is firm.

Where diet drinks fit

Diet drinks are sweetened with non-nutritive (low- or no-calorie) sweeteners. The question of whether they are a good long-term choice is not fully settled.

  • The ADA's recommendation 5.22 says these sweeteners "can be used in place of sugar-sweetened products if consumed in moderation and for the short term". The Standards note they "do not appear to have a significant effect on glycemic management".
  • In the Ma study of people with type 2 diabetes, replacing sugary drinks with artificially sweetened drinks was linked with lower mortality. Replacing either one with water, coffee or tea was also linked with lower mortality.
  • In the Imamura review, artificially sweetened drinks were also linked with diabetes risk, but the authors found signs of bias in those studies. They concluded that such drinks were "unlikely to be healthy alternatives" for preventing diabetes.

So diet drinks are generally described as a step away from sugary ones, and water as the drink guidelines put first. What suits you is a question for your care team.

When a sugary drink has a real job: treating a low

If you take insulin or another medicine that can cause low blood glucose, a regular (not diet) soda can be useful. NIDDK lists half a can of regular soda, "not low-calorie or reduced-sugar soda", among the quick options when glucose falls below 70 mg/dL, then checking again after 15 minutes. The ADA Standards say glucose is the preferred treatment, but "any form of carbohydrate that contains glucose may be used".

That is the one place where the sugar in a drink is the point. A diet soda will not raise a low. Your care team will tell you what to keep on hand.

If you are cutting back on sugary drinks and you take one of these medicines, your glucose may run lower than before. Talk to your diabetes team, as your medicine may need adjusting.

Seeing it in your day

The Today page adds up what you log. Logging your usual drink, at the size you really buy, often shows how much of the day's carbohydrate comes from a cup.

Related reading: fruit juice and diabetes and coffee and diabetes.

Your numbers are yours

How much carbohydrate fits in your day depends on your medicines, your glucose goals and your body. Your doctor, diabetes educator or dietitian sets those numbers, and their advice comes before anything you read here. If sweet drinks are a big part of your day, say so at your next appointment. Your team can help you plan any change.

Sources

  • American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care, 2026; 49(Suppl 1): S89–S131 (recommendations 5.21, 5.22 and 5.25, Table 5.2). pmc.ncbi.nlm.nih.gov/articles/PMC12690188 (checked 8 October 2026)
  • American Diabetes Association Professional Practice Committee. 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026. Diabetes Care, 2026; 49(Suppl 1): S132–S149 (recommendation 6.15). pmc.ncbi.nlm.nih.gov/articles/PMC12690178 (checked 8 October 2026)
  • Imamura F, O'Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ, 2015; 351: h3576. pubmed.ncbi.nlm.nih.gov/26199070 (checked 8 October 2026)
  • Ma L, Hu Y, Alperet DJ, et al. Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study. BMJ, 2023; 381: e073406. pubmed.ncbi.nlm.nih.gov/37076174 (checked 8 October 2026)
  • NIDDK. Healthy Living with Diabetes (last reviewed October 2023). niddk.nih.gov (checked 8 October 2026)
  • NIDDK. Low Blood Glucose (Hypoglycemia) (last reviewed July 2021). niddk.nih.gov (checked 8 October 2026)
  • USDA FoodData Central: Soft drink, cola (FNDDS 2710541); Soft drink, cola, diet (FNDDS 2710542); Tea, iced, bottled, black (FNDDS 2710527); Tea, iced, bottled, black, unsweetened (FNDDS 2710531); Tea, bubble (FNDDS 2710508); Horchata, made with water (FNDDS 2710602). fdc.nal.usda.gov (checked 8 October 2026)
  • Food figures on this page: USDA FoodData Central, via the DiabeticIndex food database.

This article is general information, not medical advice. Talk to your diabetes care team before changing how you eat or how you take your medicines.