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Can I Drink Alcohol if I Have Diabetes?

Before deciding to imbibe, it’s important to understand the potential risks when it comes to alcohol and diabetes.

Medically reviewed in August 2021

If you have diabetes, you’re likely up to speed on the many do’s 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 at least 30 minutes of exercise most days of the week. Don’t smoke or allow yourself to get dehydrated.

But can you drink alcohol with diabetes?

The fact is, alcohol isn’t necessarily off limits, but even moderate or light drinking isn’t completely risk-free. That’s because drinking could trigger or worsen some serious diabetes-related complications. 

If you do plan on drinking alcohol and you have diabetes, it’s important to understand how it can affect your condition and what you can do to protect your health. One of the first steps in making an informed decision about alcohol is putting widely touted health claims into perspective.

Can alcohol improve your health?
Moderate drinking is defined in the United States as having up to two drinks per day for men or one for women. Some research has suggested that it may provide some health perks, primarily a reduced risk of cardiovascular problems such as heart attacks and stroke, which affect people with diabetes at a higher rate. It is not clear, however, if these perks come from the alcohol itself or occur because people who drink moderately often have healthier habits anyway. More research is needed to help answer this question.

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

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

U.S. health officials do not recommend that nondrinkers begin consuming alcohol for any reason. That means if you abstain, don’t start drinking for the potential health benefits. The risks of alcohol may ultimately outweigh any benefits. Those downsides include the following:

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 level to remain low 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’ve had a lot to drink. This leads 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, you may be at even greater risk for very low blood sugar while drinking.

Low blood sugar, or hypoglycemia, can cause worrisome symptoms, including sleepiness, dizziness, nausea or vomiting, headache, shakiness, sweating, irritability and disorientation. These symptoms can easily be confused with 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, officials advise adults who choose to drink to do so in moderation (a limit of two daily drinks for men, one for women). Keep in mind, a single serving of alcohol is defined as:

  • 12 ounces of regular beer, which is commonly 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 when it comes to drinking alcohol 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),” she says.

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 almost 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, along with triglycerides.

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

Talk to your healthcare provider about what’s best for your situation and whether 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 Sharecare (available for iOS and Android).

Here are some other tips to consider:

Shave calories when possible. Choose sugar-free drink mixers such as diet soda, club soda, diet tonic water or seltzer 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 with it, like water, to avoid dehydration.

Sources:

UpToDate.com. “Patient education: Type 2 diabetes: Treatment (Beyond the Basics).” March 2021. Accessed April 14, 2021.
American Diabetes Association. “The Big Picture: Checking Your Blood Glucose.” 2021. Accessed April 14, 2021.
American Diabetes Association. “Eat good to feel good.” 2021. Accessed April 14, 2021.
UpToDate.com. “Cardiovascular benefits and risks of moderate alcohol consumption.” March 2021. Accessed April 14, 2021.
National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetes, Heart Disease, and Stroke.” February 2017. Accessed April 14, 2021.
JI Blomster, S Zoungas, et al. “The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes.” Diabetes Care. 2014 May; 37(5): 1353-1359.
Y. Gepner, R. Golan, et al. “Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes. A 2-Year Randomized, Controlled Trial.” Annals of Internal Medicine. October 20, 2015. Volume 163, pages 569-579.
National Institute on Alcohol Abuse and Alcoholism. “The Link Between Stress and Alcohol.” 2012. Accessed April 14, 2021.
U.S. Department of Health and Human Services. “2015-2020 Dietary Guidelines.” December 2015. Accessed April 14, 2021.
Mayo Clinic. “Alcohol use: Weighing risks and benefits.” October 26, 2019. Accessed April 14, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Harmful Interactions: Mixing Alcohol With Medicines.” 2021. Accessed April 14, 2021.
National Institute on Alcohol Abuse and Alcoholism. “What Is A Standard Drink?” 2021. Accessed April 14, 2021.
AT Ahmed, AJ Karter, et al. “The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry.” Journal of General Internal Medicine. March 2008. 23(3), 275–282.
AM Chao, TA Wadden, et al. “Alcohol Intake and Weight Loss During Intensive Lifestyle Intervention for Adults with Overweight or Obesity and Diabetes.” Obesity (Silver Spring). 2019 Jan;27(1):30-40.
Mayo Clinic. “Triglycerides: Why do they matter?” September 29, 2020. Accessed April 14, 2021.
American Heart Association. “Cholesterol Abnormalities and Diabetes.” January 31, 2016. Accessed April 14, 2021.
Centers for Disease Control and Prevention. “Alcohol and Public Health: Dietary Guidelines for Alcohol.” December 29, 2020. Accessed April 14, 2021.
American Heart Association. “Is drinking alcohol part of a healthy lifestyle?” December 30, 2019. Accessed August 12, 2021.

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