Alcohol and Type 2 Diabetes

How Does Alcohol Consumption Affect Type 2 Diabetes?

Alcohol can spike blood sugar in those with diabetes.


Can I drink alcohol with diabetes?
You might be asking this common question if you have diabetes or prediabetes. Alcoholic beverages can affect your blood sugar levels and insulin sensitivity, and drinking alcohol can have short-term and long-term consequences. 

Whether it is wine, cocktails, or beer and diabetes that you are wondering about, learn how alcohol consumption may affect you, which drinks may be better or worse than others because of their sugars and alcohol content, and how to drink more safely if you do choose to drink.

 

Alcohol and Risk of Hypoglycemia


Unlike with many other aspects of diabetes and diet, the immediate risk with alcohol consumption is severe hypoglycemia, or dangerously low blood sugar. This can be an emergency situation.

One reason for hypoglycemia with alcohol and diabetes is that alcohol can interfere with some diabetes medications, including sulfonylureas, metglitinides, and insulin. The result can be too much insulin action and a drop in blood sugar.

Another reason for hypoglycemia is that your liver is needed to metabolize alcohol, which takes its attention away from another duty: regulating blood sugar. The liver stores glycogen, a form of carbohydrate, and releases it to maintain blood sugar levels if they drop too much between meals. This mechanism is interrupted when you drink, and blood sugar can fall.

Hypoglycemia can also occur within 1 to 3 hours after drinking if you chose sugary mixed drinks or ate high-carbohydrate foods while drinking. This is known as reactive hypoglycemia because it happens as your body reacts to the sugar and other carbs by releasing more insulin. 

Signs of hypoglycemia include shakiness, anxiety, confusion, dizziness, fatigue, and nausea. Headaches and seizures are also possible. Check your blood sugar if you have any of these symptoms. If you are unable to check your levels, treat it as though you know that you have hypoglycemia. 

  • Do not drink any more alcohol.

  • If you have mild hypoglycemia with blood sugar 55-70 mg/dl, have 15 grams of carbohydrates and recheck your blood sugar in 15 minutes. Repeat until your number is higher than 70.

  • If you have severe hypoglycemia with blood sugar less than 54 mg/dl, you may need to use injectable glucagon. You can get a prescription for this and carry it on your body. Let others know how to use it so they can administer it in case you are unconscious due to hypoglycemia.

 

What’s in Your Alcoholic Beverage?


Before drinking, you should know what a serving size is, and how many calories and grams of alcohol and carbohydrates are in that serving. These are a few common alcoholic beverages to give you an idea.

Drink (% alcohol) Serving Size Grams of Alcohol Grams of Carbohydrates Calories
Beer (5%)
12 oz.
14
13
150
Wine (12%)
5 oz.
14
4
120
Spirits (40%)
1.5 oz.
14
0
100
Sherry (22%)
3.5 oz.
18
12
160
Sangria (11.5%)
8.5 oz.
18
18
160
Margarita
3.3 oz.
18
7
150
Irish Coffee
2 oz.
14
8
210
Manhattan
1.5 oz.
17
3
130

How Many Calories in Black Butte Porter Beer?

Let’s look at a specific type of beer and break down the calories and the dietary information. For this, we chose a dark beer, as it is one the most caloric varieties of beer.

Black Butte Porter Beer: 192 Calories
Serving Size
355 ml (12 oz.)
Serving Calories
192 Calories
Total Fat
0.0 g
Total Carbohydrates
18.4 g
Sugars
0.0 g
Cholesterol
0 mg


 

A1C and Alcohol


If alcohol leads to hypoglycemia, can you count on having lower blood glucose measurements and better A1C levels over time? Actually, A1C and alcohol may have a more complicated relationship. Some research suggests that people who drink more have lower A1C values. [1]

Alcohol affects insulin sensitivity, but not always predictably. Higher blood sugar levels are possible. Alcohol and prediabetes have a clearer relationship: heavier drinking raises diabetes risk if you have prediabetes.

The gains you may make with moderate drinking are outweighed by potential drawbacks. Drinking with diabetes makes weight control more difficult. There are the calories in alcoholic beverages that you choose to drink, plus calories in the carbohydrates you are eating to prevent hypoglycemia, plus any calories you take in without thinking about it, since alcohol lowers your inhibition. Obesity can raise risk for cardiovascular risk factors, including high triglycerides. Neuropathy is also a risk of drinking.

To reduce calories and the effects of alcohol on blood sugar, you can consider lower-alcohol alternatives. Alcohol-free beer and nonalcoholic beverages are good choices. If you believe beer and diabetes must mix, you can try low-alcoholic beer (about half the alcohol and one-third fewer calories than 5% beer) as a compromise. Finally, be aware of the sugars from soft drinks, syrups, or juices that may be in alcoholic beverages.

 

Can People with Diabetes Drink?


As a diabetic, be wary of the amount of sugar in cocktails. Photo from  Helena Yankovska  on  Unsplash

As you may have guessed, the answer is more complicated than a simple yes or no. It is safest to avoid alcohol completely, but that may not be a step that you are willing to take. If you insist on drinking, be sure to keep it in moderation to reduce the risk of alcohol-related health problems such as high blood pressure or liver disease. Limit yourself to no more than one (women) or two (men) drinks per day if you already drink. 

Other tips to stay safe from the American Diabetes Association are:[2]

  • Drink slowly to spread out your alcohol consumption.

  • Drink water as you drink alcohol and between drinks.

  • Consume some food with carbohydrates before and while drinking.

Each time that you do choose to drink, be sure that you are wearing an ID that states that you have diabetes. Also tell your friends or family members that you are at risk for hypoglycemia while drinking. The signs of an emergency situation as hypoglycemia can appear similar to those of being drunk, and you do not want people to “just leave you alone” if you are acting drunk but really need medical care for hypoglycemia. 

Follow these additional special precautions for diabetes patients.

  • Check your blood sugar before you start drinking, while you are drinking, at bedtime, and through the night. Be extra vigilant for a full 24 hours after you drink.

  • Do not start drinking unless your blood sugar is between 100 and 140 mg/dl.

  • Bring your own source of carbohydrates in case the place where you are drinking does not supply them. 

  • Carry your glucagon with you and tell your companions when and how to use it.

It is especially important to plan ahead when you will be drinking outside the home or in social settings. Those are situations when you can easily get caught up in the moment and get into trouble if you have not planned ahead.

The bottom line is that alcohol may not be the healthiest choice for people diabetes. It is a safety risk while drinking, and it can increase cardiovascular risk over time. The relationship between A1C and alcohol can be misleading, as the lower A1C can mask other concerns. Lark Diabetes Care can help you make healthy choices each day as you manage your diabetes and live your healthiest lifestyle.

 

Reference

  1.  Ahmed AT, Karter AJ, Warton EM, Doan JU, Weisner CM. The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry. J Gen Intern Med. 2008;23(3):275–282. doi:10.1007/s11606-007-0502-z

  2.  American Diabetes Association. Alcohol. Edited October 16, 2017. http://diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html

Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health