Can I Drink Alcohol if I Have Diabetes?

Can I Drink Alcohol if I Have Diabetes?

It’s important to understand the potential risks before deciding to imbibe.

If you have diabetes, you’re likely up to speed on the many dos and don’ts that help you manage your condition: Do check your blood glucose and take your meds as directed. Do follow a healthy eating plan and get in 30 minutes of exercise most days of the week. Don’t smoke or allow yourself to get dehydrated.

But what about drinking? No healthcare provider is going to tell you to include alcohol consumption on your to-do list. But if you have diabetes, is alcohol completely off limits?

Not necessarily.

But if this doesn’t sound like a ringing endorsement for happy hour, it’s because it isn’t.

The serious health risks of heavy drinking are widely known, but even moderate or light drinking isn’t completely risk-free—even for those who don’t have diabetes. If you do have the condition, drinking could trigger or worsen some serious diabetes-related complications. So, if you choose to drink, it’s important to understand how alcohol can affect your condition and learn what you can do to protect your health. And one of the first steps in making an informed decision about alcohol is putting widely touted health claims into perspective.

Can alcohol reduce health risks?
Research has suggested that for some people, moderate drinking (defined in the US as up to two drinks per day for men or one for women) may provide some health perks, particularly a lower risk for heart problems, such as heart attacks and stroke. This could be beneficial for people with diabetes who have a higher risk of developing heart disease. More research will help to answer this question.

A trial published in 2015 in the Annals of Internal Medicine found that people with type 2 diabetes assigned to drink 5 ounces of red wine per day had better cholesterol and glucose control.

But the evidence suggesting that moderate drinking offers health benefits isn’t definitive. Studies like this one show some associations but don’t prove cause and effect. What is clear, however, is that the risk for some serious chronic health issues, including some forms of cancer, increase along with alcohol consumption.

US health officials do not recommend that people who don’t consume alcohol start drinking for any reason. So, if you don’t already drink, you shouldn’t start just to gain possible health benefits. The downsides of drinking—described below—may ultimately outweigh any possible benefits.

Your blood sugar could drop too low
You may assume that drinking will trigger a spike in your blood sugar level. After all, alcohol is loaded with carbs, right? Not always.

“Many people think that alcohol will raise blood glucose or that it has a lot of sugar in it,” says Cara Schrager, MPH, RD, CDE, a registered dietitian and certified diabetes educator at Joslin Diabetes Center in Boston. “But the average glass of wine has only 4 grams of carbs and spirits on their own contain no carbohydrates at all.” (Beer does contain carbohydrates—usually about 13 grams in a regular draft but less in some lighter brews—and mixed drinks may contain a lot more if they’re made with sugary syrups or sodas.)

As soon as you start drinking, your body begins working to get rid of the alcohol and your blood sugar may drop. In fact, alcohol can cause your blood sugar levels to drop for up to 24 hours.

“Alcohol is metabolized in the liver, shutting down the liver’s ability to provide you with glucose when you need it,” Schrager explains. The liver contains “emergency stores” of glucose to raise your blood sugar if it drops too low, but once those stores of glucose are used up, you can’t immediately replace them if you’d had a lot to drink, and that can lead to low blood glucose levels, according to the American Diabetes Association (ADA).

If your stomach is empty or if you’re on insulin or another diabetes medication that can lower your blood sugar by either triggering the production of insulin or making your body more sensitive to insulin (such as metformin, glyburide, etc.), you may be at even greater risk for very low blood sugar, or hypoglycemia, while drinking.

Hypoglycemia can cause worrisome symptoms, including sleepiness, dizziness, nausea or vomiting, headache, shakiness, sweating, irritability and disorientation, which can easily be confused for drunkenness.

Hypoglycemia must be treated right away, but if people around you think you’re just tipsy you may not get the help you need. If you’ve been drinking, it might even be difficult for you to realize that your blood sugar is too low.

Your condition may be more difficult to manage
For the prevention of alcohol-related health risks, health officials advise adults who choose to drink to do so in moderation. That means men should have no more than two drinks per day and women should not have more than one. Keep in mind, a single serving of alcohol is defined as:

  • 12 ounces of regular beer, which is usually about 5 percent alcohol
  • 5 ounces of wine, which is often around 12 percent alcohol
  • 1.5 ounces of distilled spirits (gin, vodka, whiskey, etc.), which is roughly 40 percent alcohol

The same guidelines apply to people with diabetes, according to the ADA. But it’s important to remember that some types of beer, wine or liquor have more alcohol than others. In some cases, you may be consuming more than you realize. Exceeding the recommended daily limits on alcohol could affect your ability to control your condition.

Your judgment could also be impaired by alcohol, Schrager cautions—even if you’ve only had one drink. This could affect your ability to stick to your diabetes treatment regimen. “You could miss taking medications for your diabetes, such as long or rapid-acting insulin, leading to hyperglycemia (high blood glucose).”

You could gain unwanted pounds
With diabetes, there’s so much focus on carbs, it’s easy to forget about the calories in that glass of wine or bottle of beer.

“Because alcohol contains 7 calories per gram, greater consumption may lead to weight gain,” says Schrager, echoing the results of a study published in January 2019 in the journal Obesity. Researchers followed 5,000 overweight people with type 2 diabetes for four years and found that teetotalers in the group lost significantly more weight than those who drank heavily.

In addition to gaining extra pounds, drinking could elevate your triglyceride levels, increasing your risk for heart attack and stroke. This is particularly problematic if you have diabetes since the condition tends to lower "good" HDL cholesterol levels while raising "bad" LDL cholesterol levels as well as triglycerides.

How to play it safe
Some people should not consume any alcohol, including pregnant women, those with a personal or family history of alcoholism or those with a history of alcohol-related liver or pancreatic disease.

Talk to your doctor about what’s best for your situation and if drinking will affect your current diabetes treatment plan.

If you do drink, follow the recommendations for light or moderate drinking. It’s also important to be mindful about your portions and the alcohol content of your alcohol beverages. You can track your alcohol intake with the Sharecare app (available for iOS and Android).

Here are some other tips to consider:

Shave calories: Choose sugar-free drink mixers such as diet soda, club soda, diet tonic water or water when making a mixed drink. Pick light over regular or craft beer, which can have double the alcohol and calories of light beer.

Don’t drink alone: Let those who enjoy drinking with you know you have diabetes and explain what they should do if you have a low-glucose reaction. Wearing a diabetes ID bracelet will also help ensure you get the medical attention you need if your blood sugar level drops too low.

Don’t forget to eat: If you’re going to drink, avoid doing so on an empty stomach or when your blood glucose is low. It’s particularly important to have some food with your drink if you’re on insulin or taking diabetes pills that lower blood sugar levels.

Don’t swap food for alcohol: If you are counting carbohydrates, it’s never a good idea to replace food from your meal plan with an alcoholic drink.

Monitor your blood sugar: When you imbibe, be proactive—not reactive—about checking your blood sugar. “People with diabetes should check their blood glucose more frequently when drinking alcohol,” says Schrager. How often? The ADA recommends doing so before you drink, while you drink, before you go to bed and during the night.

Stay hydrated: Every time you have an alcoholic drink you should have a zero-calorie beverage, like water, along with it to avoid dehydration.

Medically reviewed in February 2019.

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