If you have diabetes, it’s important to know how to drink alcohol safely, as alcohol can affect your blood sugar levels.
How does alcohol affect blood sugar levels?
Just because you have diabetes doesn’t necessarily mean you can’t drink alcohol. But that means you need to be smart about your drinking.
Moderate alcohol consumption may help slightly lower blood sugar levels and improve insulin sensitivity in people with type 2 diabetes. This effect is usually observed with moderate intake and can increase the action of insulin and lower blood sugar levels.
However, if alcohol is not consumed responsibly, it can negatively impact blood sugar levels in people with type 1 and type 2 diabetes. Behaviors such as drinking too much alcohol or drinking on an empty stomach can cause both low blood sugar (hypoglycemia) immediately after drinking alcohol and high blood sugar (hyperglycemia) afterwards.
Additionally, alcohol can interact with diabetes medications, further complicating blood sugar management.
Hypoglycemia (hypoglycemia)
Immediately after drinking alcoholic beverages (especially on an empty stomach), blood sugar levels may drop. This is because the liver stops releasing glucose because it is busy processing alcohol and is not paying attention to blood sugar levels.
This effect can cause blood sugar levels to drop too low, or in some cases, to drop too quickly. People who take insulin or diabetes drugs called sulfonylureas are more likely to experience hypoglycemia than people who take metformin or other types of diabetes drugs.
Symptoms of hypoglycemia, such as slurred speech, behavioral changes, drowsiness, and difficulty walking, are also symptoms of drinking too much alcohol. If you are in this situation and need help treating hypoglycemia, the worry is that others with you may not realize that your blood sugar levels are low and that you need help.
Other concerns regarding alcohol consumption and hypoglycemia include:
- Subconscious hypoglycemia, a condition in which you do not feel the typical symptoms of hypoglycemia. This means you may not realize you need to treat low levels.
- Hypoglycemia occurs several hours after the last drink (and it occurs continuously).
Drinking too much alcohol is especially concerning if you have used glucagon to treat hypoglycemia. Glucagon is a hormone that increases blood sugar levels and is often used by people with type 1 or type 2 diabetes who take insulin when they are unable to swallow liquids or food due to symptoms of hypoglycemia.
If you are consuming alcohol (especially if you drink to excess), glucagon administered nasally or injected may not be able to raise your blood sugar levels. That’s because the liver is not paying attention to the release of glucose and is busy detoxifying alcohol.
Hyperglycemia (hyperglycemia)
Although alcohol can initially cause a drop in blood sugar levels, drinking alcohol can also cause blood sugar levels to rise. Here’s why:
- Some alcoholic drinks, especially mixed drinks, are high in carbohydrates (carbohydrates). For example, a 6-ounce chocolate martini contains 33 grams of carbohydrates, and a 12-ounce pina colada can contain as many as 85 grams of carbohydrates.
- You may drink alcohol while eating high-carbohydrate foods, especially if you are attending a special event such as a party or wedding.
- Alcohol interacts with diabetes medications and can put you at risk for hypo- or hyperglycemia, depending on the type of medication you take and how much you drink.
See below for more information. The best and worst alcoholic drinks for people with diabetes.
How to drink alcohol safely for people with diabetes
If you currently drink alcohol or are unsure whether it is safe to drink alcohol, it is best to talk to your health care provider about the risks and benefits. Your health care provider should consider your overall health, how well your diabetes is controlled, any medications you are taking, and any other health problems you may have.
Many health experts agree that people with diabetes can drink alcohol in moderation. Here are additional steps you can take to stay safe if you choose to drink alcohol.
- Avoid drinking alcohol if you are pregnant, under 21, or have a health condition such as alcohol use disorder, liver disease, pancreatitis, heart disease, certain digestive disorders, or some mental health disorders.
- Avoid drinking alcohol if your blood sugar levels are low or if you are at high risk of hypoglycemia.
- If your blood sugar levels fluctuate frequently, perhaps because you start a new diabetes medication or change your diet or exercise plan, you may want to avoid alcohol until your blood sugar levels stabilize.
- Avoid binge drinking and eating. This is defined as drinking five or more drinks on one occasion for men and four or more drinks on one occasion for women.
- Be careful about drinking alcohol if you are exercising or doing any physical activity. Combining exercise and drinking alcohol significantly increases the risk of hypoglycemia.
- If you drink alcohol, do so in moderation and always drink alcohol with a meal or snack that contains carbohydrates, especially if you are taking insulin or sulfonylureas. Do not drink on an empty stomach.
- Choose your alcoholic beverages wisely. Better options are light beer, white wine, red wine, sparkling wine, or spirits (gin, vodka, rum) with ice or mixed with water, sparkling water, or diet soda.
- Please drink slowly. If you wish to drink more, alternate with water or carbonated water.
- If you are at risk for hypoglycemia, always carry a fast-acting carbohydrate source, such as glucose tablets or glucose gel.
- Wear or carry your medical ID to let people know you have diabetes, especially if you need assistance due to low blood sugar.
- If you plan on drinking alcohol with others, let them know you have diabetes in case they need support.
- Carefully monitor your blood sugar levels before, during, and after drinking alcohol, and especially before bed.
- If you take insulin, talk to your health care team or diabetes educator about how and when to adjust your insulin dose if necessary when you drink alcohol. This is especially important if your blood sugar levels are low overnight after drinking alcohol.
- If you regularly consume alcohol, you may want to consider using CGM if you are eligible, as it can help you manage your blood sugar levels more effectively.
Other safety precautions when drinking alcohol
To ensure your safety when drinking, consider the following steps:
- Please wear your medical ID: Let people know you have diabetes, especially if you need help because of low blood sugar.
- Educate others: Teach the person you are with about the signs of hypoglycemia and how to treat it.
- Use a continuous glucose monitor (CGM). CGM allows you to monitor your blood sugar levels more effectively, especially if you consume alcohol regularly.
- Get trained assistance: If possible, be with someone trained in CPR, AED, and first aid.
How does drinking alcohol affect your health?
As Harvard University’s TH Chan School of Public Health eloquently states, “Alcohol is both a tonic and a poison.” Why is this? Many of alcohol’s harmful effects are based on dose, or how much alcohol a person drinks.
The definition of moderate drinking is:
- Women are limited to one drink per day.
- Up to 2 drinks per day for men
Binge or excessive drinking is defined as::
- 8 or more drinks per week for women
- Men: 15 or more drinks per week
One drink is:
- 12 ounces beer (regular or light)
- 5 ounces of wine
- 1.5 ounces of spirits (gin, whiskey, vodka, rum)
Although drinking alcohol in moderation is considered safe for most people, heavy drinking can pose short-term health risks, including:
- Injury (traffic accident, fall, drowning, burns)
- violence
- alcohol addiction
- miscarriage and stillbirth
- weight gain
The long-term effects of excessive alcohol consumption can lead to chronic diseases and other problems.
Notably, alcohol affects women differently than men. why? Women tend to be smaller than men, have less total body water, and more total body fat. Because of this, women’s blood alcohol levels rise faster and stay higher for longer than men. As a result, women are more susceptible to long-term health problems from alcohol than men.
Some health experts and health organizations (including the World Health Organization) say that no amount of alcohol is safe for your health.
However, some research suggests that moderate alcohol intake may protect against heart disease by increasing HDL (“good”) cholesterol, reducing plaque buildup in arteries, and preventing blood clots. Moderate alcohol consumption may further reduce the risk of type 2 diabetes.
What other risks are there of drinking alcohol if you have diabetes?
Drinking alcohol for people with diabetes can lead to a higher risk of heart disease, stroke, and cancer, as well as other health problems.
weight gain
Consuming too much alcohol can cause weight gain. Drinking an occasional 12-ounce bottle of light beer containing 100 calories is unlikely to lead to weight gain, but drinking many at a time over a week can add up quickly.
On the other hand, if your drink preferences lean toward fruity or sweet cocktails, even just a few regular drinks could lead to weight gain. For reference, a margarita has over 300 calories and a White Russian has about 400 calories.
For more information, see: How many calories and carbohydrates are in different types of alcohol?
Drinking alcohol can also make you feel hungrier because it affects certain hormones and neurotransmitters. This means you may be less likely to make healthy food choices or limit portions when you drink alcohol.
Ultimately, weight gain can lead to insulin resistance and increased blood sugar levels, especially if you have type 2 diabetes.
liver disease
Liver disease can be caused by a variety of factors, including excess abdominal weight, high cholesterol, high blood pressure, and type 2 diabetes. Also, if blood sugar levels remain high for a long period of time, it may cause liver damage.
Excessive alcohol consumption can also affect liver health, leading to conditions such as fatty liver, alcoholic hepatitis, and cirrhosis.
If you have diabetes and any liver disease, your risk of developing further liver problems is greatly increased. This is because both diabetes and liver disease can exacerbate each other’s effects, and liver damage can progress more rapidly.
neurological disorder
Certain diabetes complications, such as neuropathy (nerve damage), can be made worse by drinking alcohol.
Symptoms such as numbness, tingling, and pain are common in neuropathy caused by both diabetes and alcohol, but they may be nearly indistinguishable from each other. According to a study published in the journal 2021 diabetes treatmentIf a person with neuropathy continues to drink alcohol, the neuropathy continues to progress.
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