Can people with diabetes consume alcohol?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
I always get a little frustrated when I hear doctors answer this question, because they usually respond as though it’s a medical question. But people don’t drink alcohol because it’s good or bad for them. They drink because they like it. They like the way alcohol makes them feel or they find it easier to socialize when they include alcohol in the mix.  Sometimes they have an alcohol addiction or dependency, plain and simple. Even when we do focus just on the health aspects, there are pros and cons. Alcohol in moderation may reduce heart disease risk, but it appears also to increase the risk of certain cancers, notably breast cancer. So deciding whether and how much anyone drinks, whether or not they have diabetes, can be complex and depends on many factors. 

There are specific things someone with diabetes needs to keep in mind about alcohol use. Alcohol can have a major impact on blood sugar levels, but the precise effect depends on what you are drinking and how much. Beer and sweet wines have alot of sugar and unfermented carbohydrate in them, so they will raise the blood sugar for a few hours after drinking. And, of course, many spirits are mixed with soda or other things that may contain a lot of carbohydrate.  These, too, may raise the blood sugar. On the other hand, alcohol itself will typically lower blood sugar by stimulating insulin release. So a straight up drink will usually have the opposite effect from a drink with sweet mixers. This effect is intensified by drugs that prompt additional insulin production by the pancreas -- especially the sulfonylurea medications like glipizide. 

The bottom line on alcohol and diabetes is sort of what you would expect from common sense. You can drink safely in moderation, but be careful about the impact on your blood sugar, especially with certain medications. And remember that if you have diabetic neuropathy, you may experience difficulty with your coordination with less alcohol in your system than might be true of someone who has no nerve damage. And for everyone, best to be completely alcohol-free when driving. 
Drinking too much can lower blood glucose too much, and too much alcohol can cause confusion and disorientation which could be confused with hypoglycemia. If you are experiencing hypoglycemia and not treated for it because it is mistaken as too much alcohol, it could be fatal. 
Athena Philis-Tsimikas, MD
Endocrinology Diabetes & Metabolism
Having type 2 diabetes doesn't mean you have to give up alcohol for good. In this WisePatient video, endocrinologist Athena Philis-Tsimikas, MD, of Scripps Health, explains when alcohol is OK and which kinds of alcoholic drinks you should avoid.
Emilia Klapp
Nutrition & Dietetics
There is no clear-cut answer. Your medical team should evaluate your history of alcohol consumption, the medications you take to control blood glucose, and other factors. If you have frequent hypoglycemia or a history of severe hypoglycemia, ingesting alcohol may be too big a risk. In general, you should drink only if your diabetes is under control, because alcohol can make some diabetes problems worse. Also drink in moderation: No more than two drinks daily for men and one drink daily for women. Never drink on an empty stomach. Also, do not drink alone; inform the people with you that you have diabetes in case you have a hypoglycemic reaction. Carry identification that indicates you have diabetes as well.
A common myth is that people with diabetes can’t drink alcohol. This is just not true. If your blood glucose levels are on target, it is unlikely that an occasional alcoholic drink at mealtime will harm you. In fact, some studies have shown that light to moderate alcohol intake is associated with reduced risk of death from coronary heart disease for people with type 2 diabetes.

The key is to drink moderately. Moderate drinking is defined as no more than one drink a day for women and two drinks a day for men. One drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (liquor). If you do not tolerate alcohol well or have had problems with it in the past, however, you should avoid drinking.
William Lee Dubois
Endocrinology Diabetes & Metabolism
Hang on just a second, I’m having some problems with my cork screw. Poppp! OK, now what were you asking?

Of course we can still drink alcohol. But there are a few things you need to be aware of.

First, alcohol often doesn’t stand alone. It’s not the rum in the Rum & Coke that’s the problem, it’s the Coke. So if you want a mixed drink that’s soda pop based, you need to substitute diet soda.

Second, there can be a lot of sugar hiding in other bar drinks. Margaritas have a ton of sugar for instance. Even club soda is brimming with sugar.

Third, everything in moderation is the “standard of care” for diabetes. Too much alcohol is hard on the liver, as are some diabetes and cholesterol meds. So you don’t want to overload your liver. Too much alcohol will also cause your blood sugar to drop, a lot, many hours after drinking. Usually when you are sleeping it off. And of course if you are drunk you might either take too little or too much of your medications.

Fourth, alcohol often has calories. Especially beer. If you are trying to lose weight, you might want to cut back on the brewskies.

And fifth, diabetes doesn’t play alone. It brings all its friends to party in your body in the form of other diseases we call comorbidities. Many of these other conditions need to be treated with medications that don’t go well with alcohol. Call you doc before you go to the bar.
Tonya Bolden
Alternative & Complementary Medicine
Some diabetics should not drink alcohol at all because it exacerbates ongoing problems, such as nerve damage, eye disease, and high blood pressure. Diabetics who can have alcoholic beverages must drink in moderation. “Moderation is defined as two drinks a day for men and one drink a day for women,” says the American Diabetes Association (ADA). “A drink is a 5-ounce glass of wine, a 12-ounce light beer, or 11⁄2 ounces of 80-proof distilled spirits. Make sure that your medications don’t require avoiding alcohol, and get your doctor’s OK.”
Half the Mother, Twice the Love: My Journey to Better Health with Diabetes

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Half the Mother, Twice the Love: My Journey to Better Health with Diabetes

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