Trial Testing 4 Shakes Made for People with Diabetes

It all started in 1959. That’s when baby food maker Mead Johnson decided to expand its market to adults and created Metrecal, the world’s first meal replacement shake. Originally a powdered product, and later sold as canned shakes, the product — although apparently foul-tasting — hit the public at just the right time with clever marketing, and became the first true fad diet sensation.

Later came the wildly popular SlimFast Original shakes, not a realistic option for PWDs thanks to a whopping 21 net carbs from 19 grams of added sugar. But following the introduction of low-carb diets with the Atkins craze of the late ’80s, low-carb shakes began springing up like mushrooms and were widely adopted as a blood sugar-friendly meal alternative or diet tool for PWDs.

Testing the shakes for DiabetesMine were myself, a type 1 diabetes advocate, author, and former diabetes coordinator at a federal clinic in New Mexico; and Lisa F. Bentson, a scientist and certified diabetes care and education specialist (CDCES) who also lives with type 1 diabetes.

We tested the shakes in the early morning as a breakfast replacement, noting baseline blood sugar via continuous glucose monitor (CGM), and then checking readings at 1, 2, and 3 hours after consumption. Each shake brand got two tests on different days. No other food was in the mix.

Note that we both dosed insulin for these shakes in accordance with the carb counts provided in the nutrition info.

Company info: Glucerna is made by the pharma giant Abbott, which knows a thing or two about diabetes. Originally introduced in 1989, the product was created as a tube feeding formula. The tube feeding products are still around, in various calorie ratings, but the line has been expanded to include drinkable bottled and powder shakes, as well as snack bars. At one time, Abbott made a Glucerna breakfast cereal too, but that doesn’t appear to be on the market anymore.

Product details: The Glucerna Hunger Smartshake is slightly smaller than the typical 11-ounce meal replacement shake, clocking in at 10 fluid ounces. Interestingly, unlike most meal replacement shakes — which use a plastic-y carton — all three varieties of these ready-to-drink products come in plastic bottles with screw caps, featuring wide mouths that made drinking from them pleasant.

The Glucerna shake label features numerous trademark phrases like “hunger smart” and “carb steady” — the latter being described as “a unique blend of slow-release carbohydrates, to help manage blood sugar.” But there’s also a footnote that reads, “compared to high-glycemic carbohydrates.” So that’s basically saying it’s better than drinking pure sugar, it seems.

In their marketing to illustrate relative low-carb content, Abbott actually compares Glucerna to potatoes, bread, and oatmeal. They even have a graph showing a head-to-head comparison of Glucerna to instant oatmeal, the problem being that when you read the fine print you discover the blood glucose (BG) curve for the oatmeal is from a published study by Abbott employee Amy A. Devitt that was sponsored by the company, while the curve from the shake is from an entirely different Abbott in-house study.

We tested the ready-to-drink Hunger Smart product (that’s also available in a mixable powder form).

Abbott makes a point of billing these shakes as “a delicious meal or snack replacement to help manage blood sugar… and hunger.”

Yet the label advises users NOT to use the product “as a sole source of nutrition.” It also recommends using the product “under medical supervision as part of a diabetes management plan,” and that we should “replace one poor meal or snack choice” with the product.

From the Rich Chocolate flavor Nutrition Facts Label:

• Size: 10 fluid ounces
• Carbs: Net 10
• Protein: 15 grams
• Calories: 180

Shelf life: Approximately 1 year

Taste test

The “easy-open” bottle didn’t live up to its promise. Just sayin’. But once you get your pocket knife out and slice away the safety seal, the cap unscrews readily enough.

The drink is smooth, medium thick, and just ever-so-slightly chalky. I thought the Rich Chocolate flavor should more properly be called Pleasingly Mild Chocolate flavor, and declared it to be “lip-smackingly good.” Both found it thicker than the average meal replacement shake, which we agree tend to run on the watery side.

But if you don’t love the taste, according to the product’s webpage, Abbott will give you your money back. Other flavors of Glucerna Hunger Smart include Homemade Vanilla, Creamy Strawberry, and Peaches & Creme. On round two, I tried the Vanilla, which I found to be a very yummy, rich, and sophisticated flavor.

Lisa found that the Hunger Smart, did, indeed, hold her hunger at bay very well. I had mixed results. It did a good job for me the first time but left him hungry at 2 hours in the second round.

Blood sugar report

To compare our blood sugar responses, we’re reporting our baseline BG levels (at the start of each test), as well as readings at the 1, 2, and 3-hour marks after drinking each shake. We’ve also provided our combined average glucose excursion (number of points our BG spiked with each shake), along with the average time it took the two of us to return to baseline.

Overall average BG excursion: 42 mg/dL, returning close to baseline within 3 hours

Glucerna shakes are available at CVS, Walgreens, or on Amazon for roughly $1.58 per bottle.

Company info: Koia started as a juice company founded in 2012 by Maya French and Dustin Baker. The pair added a line of dairy-free protein drinks after French discovered she was lactose intolerant, and it was so successful they ended up dropping the juices altogether. Today the company features high-protein, low-sugar, keto-friendly meal replacement drinks. They use 100-percent plant-based products and non-GMO verified ingredients in a line of protein drinks, smoothies, keto drinks, coffee drinks, and “allergen-free” oat milk drinks called Thrive. They have recently partnered with our good friends over at Beyond Type 1 to promote their diabetes-friendly Koia shakes.

Product details: They boast the widest range of flavors, 21 by our count, across their various product lines; but unlike typical meal replacement shakes, this product needs to be kept refrigerated.

The label on our bottle of Koia Keta Cookies n’ Creme flavor boasts that it is a “super fuel for the brain that helps increase the production of ketones,” Lisa said. “As a diabetic, I cringe when I hear ketones. If ketones in your blood are bad, how can ketones in your brain be good?”

I cringed too, but dug into this claim and discovered that the brain can largely function on ketones in lieu of glucose and that this may be helpful for people suffering from epilepsy, Alzheimer’s, Parkinson’s, or migraines. A growing number of doctors are beginning to believe that fueling the brain with ketones could have general health advantages.

The Koia label also ruffled Lisa’s scientist feathers by stating that it contained “all nine essential amino acids to support your body’s natural renewal and maintenance.” Lisa points out that there are 20 amino acids, and all are required by the body to thrive. I dug into this, too, and discovered that FDA supports the labeling language of these as being the nine “essential” amino acids.

From the Keto Cookies ‘n Creme flavor Nutrition Facts Label:

• Size: 12 fluid ounces
• Carbs: Net 2
• Protein: 12 grams
• Calories: 200

Shelf life: Approximately 4 months, must be refrigerated

Taste test

The bottle itself is the sexiest of the lot. It’s a tall, lean, soft-edged rectangle, with cool graphics, and varied bright colors. It’s also easy to open.

First up from this vendor was their Cookies ‘n Crème flavor keto drink. I found the product more juice-like than shake-like. Perhaps Koia’s juice company DNA is showing through. It was watery in both consistency and in taste, with a weak watered-down chocolate flavor. It wasn’t bad, but it wasn’t good either. I’d have to call it uninspiring. It was also, for me at least, a lot of fluid on my stomach early in the morning. Lisa noted that her taste buds picked up on underlying coconut milk, and she also found it “mildly chalky.”

Despite the volume of the serving — the largest of the products we tested — it did not stave off hunger. Within an hour and a half, I was jonesing for a snack. Of course, for the sake of blood sugar science, I suffered in silence.

On the second round, I tried the Tropical Passion smoothie, which I had a hard time being passionate about. It smelled like cantaloupe and tasted a bit melon-like, too. But it was thick and creamy, with better consistency than the keto line. It got me thinking that a slightly thick juice trumps a slightly thin shake. But it, too, left me hungry at the 1.5-hour mark. Lisa gave the Chocolate Brownie flavor a test drive and declared it “unquestionably chocolate, not just something that says it’s chocolate.” That said, it still had a chalky consistency.

Blood sugar report

Average excursion: 41 mg/dL; mixed results on return to baseline

Koia protein shakes are available at Safeway, Whole Foods, and Mollie Stones markets for $3.99 per bottle.

Company info: This startup’s claim to fame is pioneering “food as medicine,” and all of their offerings are aimed straight at your gut. That’s right, Muniq claims to “harness the incredible power of the gut microbiome,” what scientists call the “good bacteria” in your digestive system. Muniq claims its team looked at more than 300 clinical studies on the microbiome when designing their product lineup.

Product details: The two key ingredients are prebiotic resistant starch and prebiotic fiber. Unlike most starches that digest in the stomach or small intestines, resistant starch passes through to “ferment” in the large intestine, where it feeds those good bugs. In theory, this means blood sugar spikes are virtually eliminated. In fact, the company’s FAQ states that their product’s ingredients “aren’t digested — by you at least — so instead of spiking your blood sugar, they feed the beneficial bacteria in your gut.”

Of course, there’s more than just starch and fiber in the packet. In fact, the list of indigents is intimidatingly long.

Unique among our lineup, this is a powdered product that needs to be prepared by mixing it with 12 ounces of liquid, plus ice cubes. We are told to “start with half a packet to gently introduce this goodness to your gut.”

From the Chocolate flavor Nutrition Facts Label:

• Size: 14 fluid ounces once mixed with water and ice
• Carbs: Net 26
• Protein: 15 grams
• Calories: 170

Shelf life: Approximately 6 months, must be kept “in a cool, dry place away from direct light”

Taste test

On opening the pouch, the finely-milled chocolate-flavored powder smelled good, reminiscent of hot cocoa powder from childhood. The packet is easy to open, but the ease stops there. Into the blender with ice and water, it had to go. The instructions offer the choice of water or unsweetened milk, but at a whopping 41 base carbs per serving, we opted for water.

Once mixed, the taste struck me as very weird, like a metallic chocolate-covered cherry. It took me a while to decide if it was good or bad. Bad, I think, in the end. Lisa described it as tasting like an “early ’90s health drink.” It has an even sharper metallic aftertaste that reminded me of the first generation of artificial sweeteners, and the consistency is gritty. Lisa said that while it didn’t taste like chocolate to her, she liked the flavor well enough. I personally found it the least pleasing on the palette of all of the test products. Mixed, again, it was thicker than the typical diet shake product.

Other flavors include Vanilla Creme, Mocha Latte, Vegan Chocolate, and Vegan Vanilla.

On the second round we split a Mocha Latte. I found that it tasted exactly the same as the Chocolate, complete with the grit and metallic aftertaste.

Even at a half serving, it was similar in volume to the other products we tested. I can’t imagine drinking a whole serving, never mind the carb intake that would entail. Even so, I found it wasn’t too great a suppressing my hunger, although Lisa didn’t find herself hungry downstream of this one.

Not only is it slower to make, requiring a mixer and glasses — rather than just popping open a bottle and going for it — it’s also messy to clean up. Trust me on this, you’ll want to clean up right away. If you wait, as I did, you’ll find that a stubborn concrete-like crust forms on the edges of the glasses and mixer. All of this combined means Muniq is poorly suited for the PWD on the go, or for those seeking a meal at work.

Blood sugar report

Average excursion: 29 mg/dL, generally returning close to baseline within 3 hours

Despite the highest carb count — by far — of the test group, Muniq gave both of us the best blood sugar response. Sort of. I had an extremely mild bump at one hour, and a quick return to baseline. Lisa, however, had a BG low requiring intervention the first time she drank it. Apparently, their carb absorption magic works.

PWDs using the product may need to adjust their bolus, rather than rely on their standard ratio of insulin to net carbs.

Muniq shake mixes are available as “On-the-Go Packets” or in a bag with scoop via direct purchase, as a subscription or one-time shipment for $4.13 to $5.25 each.

Company info: The Splenda Diabetes Care Shake is brought to us by the folks at Splenda/Heartland Food Products Group, which sells sucralose, the USA’s most popular sugar substitute, with a 62 percent market share. In addition to the original sucralose powder, Splenda makes liquid sweeteners, creamers, sweet teas, and now Diabetes Care Shakes.

Product details: My first thought on seeing a Splenda shake was, ‘Man, that bottle looks small.’ At only 8 ounces, how on earth will this fill me up? Even the bottle’s label doesn’t say anything about keeping hunger at bay. It says the shake includes “a unique blend of slow-digesting carbohydrates and good-for-you fats to help manage blood sugar and help reduce blood sugar spikes.” It’s gluten- and soy-free.

From the Milk Chocolate flavor Nutrition Facts Label:

• Size: 8 fluid ounces
• Carbs: Net 3.5 (once subtracting the allulose)
• Protein: 16 grams
• Calories: 170

Shelf life: At least 9 months

Taste test

The tiny bottle is hard to open. First, the safety seal resists tearing at the “tear here” tab, then, once you get it off, the entire label — which is a plastic wrap covering the barrel of the bottle — spins when you try to free the cap.

But once you succeed in opening it, you are well rewarded. It’s tasty! The Milk Chocolate flavor is especially yummy — something somewhat rare among chocolate-flavored meal replacement shakes, which are usually only vaguely chocolate in taste.

Lisa noted the incredible smoothness of the drink, which is not the least bit gritty or chalky. It’s medium-thick, on the thick side for a meal replacement shake, which, of course, is nowhere near close to the thickness of an original ice cream shake.

Still, it’s the thickest of the four brands we tested, and very creamy. Plus, there is no nasty aftertaste. The French Vanilla flavor reminded me of Dairy Queen soft serve. Not quite a real ice cream flavor, but something you can learn to love.

Sipping the Strawberry Banana to sample it, however, I found that it tasted oddly like Pepto Bismol, with neither strawberry nor banana coming through to my taste buds. Lisa found it “very artificial” in flavor too.

The first time I drank the Splenda, it gave me some stomach upset requiring Tums. It also gave me gas. Significant gas that lasted for several days. Thank goodness for the quick mute feature on Zoom. On the second exposure, it was much milder but still uncomfortable. Lisa didn’t suffer any negative side effects.

Despite the half-pint size serving, both reviewers found it held our hunger nicely at bay. At least as a breakfast replacement, where I tend toward very small breakfasts and Lisa often forgoes breakfast altogether. In fact, she stated that she preferred the size, as she doesn’t like a lot on her stomach in the morning. We can’t say how it would fare for a lunch replacement.

Blood sugar report

Average excursion: 44 mg/dL, but generally not returning to baseline within 3 hours.

Splenda Diabetes Care Shakes are available at Walmart.com, Sam’s Club, select Walgreens locations or on Amazon for $0.88 per shake, the most affordable of this group.

Taste and consistency: For the two of us, Splenda was our number one, with Glucerna a solid (and not too distant) number two. The Koia was a distant third, with Muniq an even more distant fourth.

Convenience: Glucerna and Splenda tied for first place, with Koia trailing due to its need to be stored refrigerated. Muniq is in last place due to the long prep time, and a powdered packet that’s finicky in its storage requirements.

Blood sugar response: Muniq is in first place with almost no BG excursions at all. The rest were nearly neck-in-neck with respectable excursions in the low 40s, generally followed by a return to baseline in three hours. Of note, however, the Splenda product left us both mildly elevated over baseline despite our semi-automated pumps throwing insulin at the blood sugars for hours. So it seems that for folks on MDI (injection) therapy this “diabetes-friendly” product would require a lot of correction doses.

Keeping hunger at bay: Glucerna won here, followed closely by Splenda, with Muniq a distant third, and Koia failing in last place. None of these products did a very good job in this department, compared to mainstream low-carb, higher-protein alternates.

So much for our amateur test kitchen. Are there any real studies of these kinds of shakes in PWDs? In fact, there are quite a few, but most of them simply compare the effect of meal replacement shakes to alternate breakfast choices — and generally higher carb ones at that. Thus, these studies make the shakes look fabulous for blood sugar, but saying that a low carb shake is better for you than a bowl of Froot Loops really ain’t saying much.

What we really need is a head-to-head clinical trial comparing these products designed specifically for blood sugar control with other low carb meal replacements to see if there is any benefit. In other words, is there any benefit beyond being low carb? The only study we found that came close compared a low-carb nutritional supplement to the regular version. But that’s a bit like comparing the blood sugar responses of Diet Coke to Regular Coke — too darn obvious.

I confess to being a fan of the meal replacement shakes concept. I like a fast, convenient, meal-on-the-go that treats my blood sugar well, and is no muss, no fuss, for me. I also appreciate the fact that there are people out there working on our dietary needs.

Of the pack we tested here, we liked the taste of Splenda best — and it’s also the most affordable — while Glucerna kept us both feeling full the longest.

But over time, would I choose these products that claim to be designed specifically for diabetes over the many low carb meal replacement shakes already on the market? Probably not, without solid evidence that something “specially formulated for diabetes” is truly superior.