Are there safety or hypoglycemia risks reported in trials of manuka honey for people with diabetes?

1. Wound‑healing controversy: MGO and diabetic ulcers

Researchers have warned that methylglyoxal (MGO), the chemical largely responsible for manuka honey's antibacterial activity, could delay wound healing in diabetic patients; a peer‑reviewed commentary concludes that the participation of honey‑derived MG in healing diabetic ulcers is not settled and explicitly advocates randomized controlled trials to determine efficacy and safety in this population ^[1].

2. Trial evidence on wounds is limited and often excludes diabetics

Systematic reviews of honey trials show several wound studies but note that many trials excluded participants with diabetes or did not analyze diabetic subgroups separately; one trial comparing non‑manuka honey to povidone‑iodine for Wagner II diabetic foot ulcers found no significant difference in healing and suggested honey dressings can be a safe alternative, but manuka‑specific safety in diabetics remains under‑studied ^[1].

3. Systemic glycaemic risk: sugar content and advised caution

Commercial and health information sources consistently emphasise that manuka honey contains natural sugars and can affect blood glucose; guidance is to treat it like any added sugar — use portion control, pair with other nutrients, and consult a clinician — because it can raise blood glucose if consumed without adjustment ^{[2] [3]}.

4. Hypoglycaemia reports not found in current reporting

Available sources do not report clinical trials showing manuka honey causes hypoglycaemia in people with diabetes; mainstream guidance focuses on hyperglycaemia risk from its sugar content, not blood‑sugar drops ^{[2] [3]}. Claims that manuka honey causes “extremely low blood pressure causing hypotension” or direct severe hypoglycaemia in diabetics appear on some consumer sites but are not substantiated by the clinical literature provided here ^[4].

5. Conflicting claims about MGO’s systemic harms

Several non‑peer‑reviewed or commercial articles assert that MGO contributes to insulin resistance, β‑cell dysfunction, or broader vascular harm; these claims cite mechanistic or associative studies but the scholarly commentary included here calls for further detailed research rather than concluding definitive systemic harm from dietary manuka honey ^{[5] [1]}.

6. Practical framing for patients and clinicians

Clinical commenters and manuka producers agree on a pragmatic stance: topical application for wounds may be beneficial but needs diabetes‑specific evaluation; oral use should be modest and medically supervised because manuka is a concentrated source of sugar with a glycaemic index often cited below table sugar but still capable of raising blood glucose (GI estimates of ~54–59 vs. sugar ~65) ^{[1] [2]}.

7. Where the evidence is strongest and weakest

Evidence is strongest that manuka honey has unique antibacterial properties and that its sugar content can influence blood glucose ^{[2] [1]}. Evidence is weakest on whether MGO in manuka impairs diabetic wound healing in humans or causes systemic metabolic harm — existing commentary and mechanistic concerns call for randomized controlled trials explicitly recruiting people with diabetes ^{[1] [5]}.

8. Bottom line and recommendations

Current reporting supports cautious use: clinicians should not assume manuka honey is risk‑free for people with diabetes; topical use on wounds requires diabetes‑specific evidence and monitoring, and oral consumption should be limited, tracked, and discussed with a healthcare provider to avoid hyperglycaemia ^{[1] [2] [3]}. Randomized trials in diabetic populations are the decisive evidence gap identified repeatedly in the sources ^[1].