According to the National Institutes of Health, as of October 2022, approximately 34.2 million people are living with diabetes in the United States and another 88 million have prediabetes. 
Staying active is essential for all adults, especially those with diabetes or prediabetes. In fact, exercise is one of the most effective strategies for blood glucose management, per a 2019 review published in the Annals of Physical and Rehabilitation Medicine. So how can people with diabetes stay hydrated when traditional sports drinks are often loaded with added sugar?
Here we look at the best hydration drinks for people with diabetes and ones to avoid, with advice from Dr. Mitzi Rubin, a board-certified physician in family medicine and obesity medicine and Medical Director at Wellstar Center for Best Health and Meghan Duffy, Enterprise Customer Success Manager at Omada Health.  
Proper hydration is extremely important for everyone. Hydration impacts our health at the cellular level, supports adequate brain function, regulates internal body temperature, transports nutrients in our bloodstream and breaks down lipids in our bodies. Staying hydrated is especially important for those with chronic conditions, such as diabetes. 
When the body is not adequately hydrated, symptoms can range from mild to severe depending on the level of dehydration.
The key to avoiding dehydration and its potential dangers is simple: drink enough water each day to support your body's needs.
The exact amount of water varies from person to person and should consider factors like age and sex. For an estimate, Dr. Rubin shares that "the average, healthy adult needs a minimum of 64 oz of water each day to be properly hydrated." Other sources, like the United States Geological Survey—a scientific agency of the U.S. government, suggest that adult males need around 100 ounces of water and adult females 75 ounces of water daily.  
Daily intake is important. Hydration is not something you can do just before an event or after a workout or a big race. Hydration has to be constant. The goal is to stay consistently hydrated by drinking a minimum of 64 oz of water each day—more if possible, and then to supplement with additional water when you are sweating heavily, spending time in the heat or exercising.
Electrolytes are essential for basic life functioning and maintain electrical neutrality in cells; we get electrolytes from the food and drinks we consume, per StatPearls. Sodium, potassium and chloride are the main electrolytes, along with magnesium, calcium, phosphate and bicarbonate. When electrolytes are imbalanced—either too low or too high—basic bodily functions can be disrupted.
When the body becomes dehydrated due to excessive sweating, illness such as vomiting or diarrhea, or taking certain medications, electrolytes can deplete and create an imbalance that may require electrolyte supplementation.
"Water is always best," explains Rubin, "but you may need electrolyte replacement if you are exercising and sweating in the heat for more than an hour or if you are taking a medication that may reduce your body's electrolytes," explains Rubin. Diuretics, stimulants and certain diabetes medications can reduce electrolytes in the body. 
In addition to replacing any electrolytes, you might look for a hydration drink to give you some energy when exercising vigorously. But instead of relying on sugary drinks, especially if you have diabetes, choose low- or no-sugar options and pair your hydration drink with a healthy snack.
As you can see, water is best for everyday hydration. You can give it a hydrating boost with a squeeze of lemon and a pinch of salt. Including herbs, veggies or fruit provides a hint of flavor without added sugar. Try mint or basil, cucumber or celery, lemon, lime, orange or strawberry slices for various flavors without artificial ingredients or added sugar.
Coconut water is another beverage that can help people with diabetes hydrate. Coconut water has fewer grams of sugar than other fruit juices. According to the USDA, one cup of coconut water provides 46 calories, almost 2 grams of protein, 2 grams of fiber and 6 grams of sugar (naturally sourced, not added). The fiber in coconut water slows down digestion and prevents sugar spikes.
Additionally, coconut water naturally contains electrolytes—potassium, magnesium, sodium and calcium—to keep you hydrated.
It's important to remember that many brands add sugar sources to their products, so make sure you buy unsweetened coconut water.
Though it probably isn't the first thing that comes to mind when thinking of hydration drinks for people with diabetes, orange juice with no added sugar can be an option. Like coconut water, orange juice naturally provides sugar to fuel your body.
Orange juice is an affordable drink that's also high in potassium and vitamin C. One cup of orange juice has 110 calories, 2 grams of protein, 1 gram of fiber and 20 grams of sugar, per the USDA. Look for options without added sugar; if you want to reduce the sugar content, dilute your orange juice with water.
For someone who has prediabetes or is managing diabetes, I would recommend a brand like Ultima, says Duffy. Mix this stevia-sweetened hydration powder with water for a zero-sugar, zero-calorie electrolyte powder that also includes vitamin C. 
If you are looking for a hydration drink that has no artificial ingredients, is USDA organic, non-GMO, gluten-free, vegan-friendly, keto, paleo and has no added sugar, Nooma is for you. While it does have 4 grams of sugar from coconut water, those sugars are naturally occurring and are not "added sugar."  As a bonus, their packaging is eco-friendly and created for sustainability.
Propel is available in ready-to-drink or powdered form and provides a zero-sugar, low-calorie source of electrolytes, vitamin C and Zinc.
For those looking to hydrate while avoiding sodium, SmartWater provides calcium, magnesium and potassium with no sodium, no sugar, no calories and no artificial colors. 
Gatorade Fit boasts no added sugar or colors, no artificial sweeteners or flavors and 100% of the recommended daily value of Vitamins A and C. With only 15 calories and 1 gram of naturally occurring sugar, Gatorade Fit provides a more natural alternative to the original one.
Made by Powerade, Power Water is a zero-calorie, zero-sugar alternative to regular Powerade that also provides a boost of vitamins B3, B6 and B12.
Everyone should limit sugary beverages. With no fiber or protein to slow down the body's insulin response, sugary drinks wreak havoc on blood sugar, making them especially harmful for those with prediabetes and diabetes if not controlled. 
Both traditional Gatorade and Powerade are chock full of sugar. One 20 oz bottle of Lemon-lime Gatorade contains a whopping 34 grams of added sugar and 140 calories. Similarly, 20 oz of Powerade Fruit Punch also contains 140 calories and 34 grams of added sugar. 
Just one of either of these drinks would put you well over the recommended maximum of 25 grams of added sugar each day.
Vitamin Water Refresh is also among the high-sugar hydration drinks, with 27 grams of added sugar and 100 calories in one 20 oz bottle. 
Touted as a lower-sugar, higher-electrolyte alternative to traditional hydration drinks, Liquid IV still contains 11 grams of added sugar. 
Don't forget the value that hydrating foods bring to the table. For people with prediabetes and diabetes, choosing foods with a low glycemic index that are also hydrating provides a double win.
Both Rubin and Duffy recommend including vegetables like cucumber, celery, zucchini, yellow squash, jicama and romaine lettuce. All have a high-water content while providing fiber to slow down the body's insulin response. Fruits such as watermelon, cantaloupe, pineapple, plums and kiwi are hydrating, have fiber and provide a sweet treat without added sugar. And remember, talk to your health care provider to determine the best hydration options for you!


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