Current nutritional recommendations emphasize that people with diabetes do not need to completely avoid fruit. However, many people wonder whether they should eat it whole, in slices, or drink it as juice.
Many people consume more carbohydrates than they realize when drinking fruit juice - Illustration.
Sharing his thoughts on this matter, Dr. Duong Minh Tuan, from the Endocrinology - Diabetes Department at Bach Mai Hospital, stated that the ADA 2026 (Medical Care Standards for Diabetes published by the American Diabetes Association in 2026) continues to emphasize that fruit, especially whole fruit, can be part of a healthy diet for people with diabetes when counted in the total carbohydrate intake of a meal.
Whole fruit or fruit juice?
According to Dr. Tuan, in whole fruit, sugar is not present alone but is held within the plant's cellular structure, along with fiber, water, vitamins, minerals, polyphenols, pulp, membrane, segments, and thin peel.
When you eat an orange segment, a piece of apple, or a few strawberries, your body has to chew, grind, and digest them before releasing the sugar slowly. The fiber in the fruit slows down gastric emptying and slows glucose absorption in the intestines, so post-meal blood sugar usually rises more slowly.
Meanwhile, fruit juice, when processed by a juicer, breaks down the cell structure, separating the sugary water from the fibrous pulp. A glass of orange, apple, or grape juice may contain the sugar of 2–4 fruits, but it almost completely lacks the intact fiber needed to slow absorption.
Juices and smoothies often have some of their fiber removed or broken down, turning the fruit sugars into more easily absorbed "free sugars"; they are also easy to consume in large quantities in a short period, increasing overall energy and carbohydrate intake.
Therefore, patients may observe a phenomenon: eating an orange causes only a slight increase in blood sugar, but drinking a glass of orange juice causes a rapid spike in blood sugar.
"Eating two oranges might make you feel full. But squeezing two or three oranges into a glass of juice can be finished in less than a minute. This makes it easy for patients to consume more carbohydrates without realizing it. Not to mention that many store-bought juices may have added sugar, condensed milk, syrup, or use very large amounts of fruit."
"For people with diabetes, especially those managing postprandial blood sugar, with elevated triglycerides, fatty liver, or who are overweight or have abdominal obesity, fruit juice should not be considered a healthy beverage to consume freely," Dr. Tuan explained.
Dr. Tuan also said that people with diabetes should eat fruit, if they choose the right kind and eat the right amount. Whole fruits provide fiber, potassium, vitamin C, folate, and many beneficial bioactive compounds.
A large epidemiological study published in BMJ showed that consuming certain whole fruits like blueberries and apples was associated with a lower risk of type 2 diabetes, while fruit juice tended to be associated with a higher risk.
Of course, for people with diabetes, fruit is still a source of carbohydrates, so it needs to be counted in their total daily intake.
Fruits with a low glycemic index (GI) should be prioritized
GI, or the glycemic index of food, reflects the rate at which blood sugar levels rise after consuming carbohydrate-containing foods. Foods with a low GI are generally understood to have a GI ≤ 55. Diabetes Canada and the University of Sydney's GI database both use this threshold in classifying low-GI foods.
Some fruits generally have a low or relatively low glycemic index (GI), making them more suitable for people with diabetes when consumed in the right amounts, such as apples, pears, whole orange segments, grapefruit, guava, strawberries, blueberries, raspberries, plums, peaches, apricots, kiwi, pomegranates, and grapes (but the amount should be controlled because they are easy to overeat due to their delicious taste).
Some popular glycemic index (GI) lists that fruits like cherries, strawberries, grapefruit, pears, oranges, plums, apples, peaches, and grapes generally fall into the low to medium-low GI group, depending on the variety, ripeness, and measurement method.
These are the types of fruits that patients need to be more cautious about
Dr. Tuan emphasized that while this type of fruit doesn't mean people with diabetes absolutely shouldn't eat it, they should pay attention to portion sizes, especially for very sweet fruits that are easy to eat in large quantities, such as ripe mangoes, jackfruit, longan, lychee, durian, fully ripe bananas, watermelon, sweet grapes, sapodilla, and dried fruits.
Dried fruit is particularly likely to raise blood sugar levels because the sugar is concentrated in a small volume. A small handful can be equivalent to several servings of fresh fruit.
5 principles to keep in mind
Firstly, eat the fruit whole, in its segments, instead of drinking juice. Oranges should be eaten in segments, apples in slices, and guavas with their fibrous parts; they shouldn't be juiced by straining out the pulp.
Secondly, avoid eating too much at once. Each serving should be moderate, for example, a small apple, a small pear, a medium-sized piece of grapefruit, a small bowl of strawberries, or a portion of fruit equivalent to about 15g of carbohydrates, depending on your individual eating plan.
Thirdly, avoid drinking fruit juice daily as a "nutritional supplement." If you really want to consume it, limit your intake to small amounts, ideally during meals, and count it towards your total carbohydrate intake. Diabetes UK suggests limiting juice consumption to about one small glass (150ml) per day, but for those with poorly controlled blood sugar, whole fruit is still the best option.
Fourth, fruit should be eaten after main meals or as a controlled snack, avoiding fruit juice on an empty stomach. When consumed with protein, healthy fats, and fiber, the rate of sugar absorption is usually slower than when consumed alone.
Fifth, monitor your blood sugar after meals to understand your body. The same fruit can have different blood sugar responses from person to person, depending on HbA1c levels, medications being taken, physical activity, liver and kidney function, gut microbiota, and the overall meal consumed.