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Diabetes and alcohol

Alcohol - diabetes; Diabetes - alcohol use

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If you have diabetes, you may wonder if it's safe to drink alcohol. While many people with diabetes can drink alcohol in moderation, it's important to understand the possible risks of alcohol use and what you can do to lower them. Alcohol can interfere with how the body uses blood sugar (glucose). Alcohol can also interfere with certain diabetes medicines. You should also talk with your health care provider to see if it is safe for you to drink.

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? www.cdc.gov/diabetes/healthy-eating/diabetes-and-kidney-disease-food.html?CDC_AAref_Val=https://www.cdc.gov/diabetes/managing/eat-well/what-to-eat.html. Updated May 14, 2024. Accessed June 19, 2024.

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 pubmed.ncbi.nlm.nih.gov/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.

Review Date: 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.

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