Diabetes and alcohol
Alcohol - diabetes; Diabetes - alcohol use

Diabetes is on the rise worldwide, and is a serious, lifelong disease that can lead to heart disease, stroke, and lasting nerve, eye and foot problems. Let's talk about diabetes and the difference between the three types of diabetes. So, what exactly is diabetes and where does it come from? An organ in your body called the pancreas produces insulin, a hormone that controls the levels of your blood sugar. When you have too little insulin in your body, or when insulin doesn't work right in your body, you can have diabetes, the condition where you have abnormally high glucose or sugar levels in your blood. Normally when you eat food, glucose enters your bloodstream. Glucose is your body's source of fuel. Your pancreas makes insulin to move glucose from your bloodstream into muscle, fat, and liver cells, where your body turns it into energy. People with diabetes have too much blood sugar because their body cannot move glucose into fat, liver, and muscle cells to be changed into and stored for energy. There are three major types of diabetes. Type 1 diabetes happens when the body makes little or no insulin. It usually is diagnosed in children, teens, or young adults. But about 80% of people with diabetes have what's called Type 2 diabetes. This disease often occurs in middle adulthood, but young adults, teens, and now even children are now being diagnosed with it linked to high obesity rates. In Type 2 diabetes, your fat, liver, and muscle cells do not respond to insulin appropriately. Another type of diabetes is called gestational diabetes. It's when high blood sugar develops during pregnancy in a woman who had not had diabetes beforehand. Gestational diabetes usually goes away after the baby is born. But, still pay attention. These women are at a higher risk of type 2 diabetes over the next 5 years without a change in lifestyle. If you doctor suspects you have diabetes, you will probably have a hemoglobin A1c test. This is an average of your blood sugar levels over 3 months. You have pre-diabetes if your A1c is 5.7% to 6.4%. Anything at 6.5% or higher indicates you have diabetes. Type 2 diabetes is a wake up call to focus on diet and exercise to try to control your blood sugar and prevent problems. If you do not control your blood sugar, you could develop eye problems, have problems with sores and infections in your feet, have high blood pressure and cholesterol problems, and have kidney, heart, and problems with other essential organs. People with Type 1 diabetes need to take insulin every day, usually injected under the skin using a needle. Some people may be able to use a pump that delivers insulin to their body all the time. People with Type 2 diabetes may be able to manage their blood sugar through diet and exercise. But if not, they will need to take one or more drugs to lower their blood sugar levels. The good news is, people with any type of diabetes, who maintain good control over their blood sugar, cholesterol, and blood pressure, have a lower risk of kidney disease, eye disease, nervous system problems, heart attack, and stroke, and can live, a long and healthy life.
Diabetes and the Risks of Drinking Alcohol
For people with diabetes, drinking alcohol can cause low or high blood sugar, affect diabetes medicines, and cause other possible problems.
LOW BLOOD SUGAR
Your liver releases glucose into your blood stream as needed to help keep your blood sugar at normal levels. When you drink alcohol, your liver needs to break down the alcohol. While your liver is processing alcohol, it stops releasing glucose. As a result, your blood sugar level can drop quickly, putting you at risk for low blood sugar (hypoglycemia). If you take insulin or certain types of diabetes medicine, it can cause seriously low blood sugar. Drinking without eating food at the same time also greatly increases this risk.
The risk for low blood sugar remains for hours after you take your last drink. The more drinks you have at one time, the higher your risk. This is why you should only drink alcohol with food and drink only in moderation.
ALCOHOL AND DIABETES MEDICINES
Some people who take oral diabetes medicines should talk with their provider to see if it is safe to drink alcohol. Alcohol can interfere with the effects of some diabetes medicines, putting you at risk for low blood sugar or high blood sugar (hyperglycemia), depending on how much you drink and what medicine you take.
OTHER RISKS FOR PEOPLE WITH DIABETES
Drinking alcohol carries the same health risks for people with diabetes as it does in otherwise healthy people. But there are certain risks related to having diabetes that are important to know.
- Alcoholic drinks such as beer and sweetened mixed drinks are high in carbohydrates, which can raise blood sugar levels.
- Alcohol has a lot of calories, which can lead to weight gain. This makes it harder to manage diabetes.
- Calories from alcohol are stored in the liver as fat. Liver fat makes liver cells more insulin resistant and can make your blood sugars higher over time.
- Symptoms of low blood sugar are very similar to symptoms of alcohol intoxication. If you pass out, those around you may just think you are intoxicated.
- Being intoxicated makes it harder to recognize the symptoms of low blood sugar and increases the risk.
- If you have diabetes complications, such as nerve, eye, or kidney damage, your provider may recommend that you do not drink any alcohol. Doing so may worsen these complications.
How Much Alcohol is Safe?
To drink alcohol safely, you should be sure of the following:
- Your diabetes is in good control.
- You understand how alcohol may affect you and what steps to take to prevent problems.
- Your provider agrees that it is safe.
Anyone who chooses to drink should do so in moderation:
- Women should have no more than 1 drink per day.
- Men should have no more than 2 drinks per day.
One drink is defined as:
- 12 ounces (oz) or 360 milliliters (mL) of beer (5% alcohol content).
- 5 oz or 150 mL of wine (12% alcohol content).
- 1.5-oz or 45-mL shot of liquor (80 proof, or 40% alcohol content).
Talk to your provider about how much alcohol is safe for you.
Things to Keep in Mind If You Choose to Drink
If you decide to drink alcohol, taking these steps can help keep you safe.
- Do not drink alcohol on an empty stomach or when your blood glucose is low. Any time you drink alcohol, there is a risk of low blood sugar. Drink alcohol with a meal or with a carbohydrate-rich snack to maintain normal blood sugar levels.
- Never skip meals or have alcohol in place of a meal.
- Drink slowly. If you consume liquor, mix it with water, club soda, diet tonic water, or diet soda.
- Carry a source of sugar, such as glucose tablets, in case of low blood sugar.
- If you count carbohydrates as part of your meal plan, talk with your provider about how to account for alcohol.
- Do not exercise if you have been drinking alcohol, as it increases the risk for low blood sugar.
- Carry visible medical ID stating that you have diabetes. This is important because the symptoms of too much alcohol and low blood sugar are similar.
- Avoid drinking alone. Drink with someone who knows that you have diabetes. The person should know what to do if you start having symptoms of low blood sugar.
Because alcohol puts you at risk for low blood sugar even hours after you drink, you should check your blood glucose:
- Before you start drinking
- While you are drinking
- A few hours after drinking
- Up to the next 24 hours
Make sure your blood glucose is at a safe level before you go to sleep.
When to Call the Doctor
Talk with your provider if you or someone you know with diabetes has an alcohol problem. Also let your provider know if your drinking habits change.
Call your provider if you feel symptoms of low blood sugar such as:
- Double vision or blurry vision
- Fast or pounding heartbeat
- Feeling cranky or acting aggressive
- Feeling nervous
- Headache
- Hunger
- Shaking or trembling
- Sweating
- Tingling or numbness of the skin
- Tiredness or weakness
- Trouble sleeping
- Unclear thinking
References
Centers for Disease Control and Prevention website. Diabetes and kidney disease: what to eat?
ElSayed NA, Aleppo G, Aroda VR, et al. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Supple 1):S68-S96. PMID: 36507648
Petrie JR, Boyle JG. Diabetes mellitus. In: Penman ID, Ralston SH, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 24th ed. Philadelphia, PA: Elsevier; 2023:chap 21.
Riddle MC, Ahmann AJ. Therapeutics of type 2 diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 35.
Version Info
Last reviewed on: 5/12/2023
Reviewed by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
