Alcohol and Diabetes: What You Need to Know

Photo credit: Helena Yankovska (Unsplash)

Medical review by Dr. Mike Natter.

If you have diabetes, you can still safely enjoy alcohol. But there are a few things that you should know about the way alcohol consumption affects diabetes management.

Alcohol puts people with diabetes – especially those that use insulin or sulfonylureas – at a significantly enhanced risk of hypoglycemia, both during drinking episodes and in the hours after. This unwanted drop in blood sugars can have dangerous consequences. Long-term heavy drinking is also associated with dramatic health problems, including for people with diabetes.

But there is some evidence that moderate drinking might confer long-term benefits for people with diabetes, such as enhanced insulin sensitivity. Large observational studies show that moderate drinkers are less likely to develop type 2 diabetes in the first place, although the American Diabetes Association (ADA) and other authorities certainly do not endorse alcohol consumption as a means of preventing or treating diabetes.

This article will help explain the unique effects that alcohol has on people with diabetes, and how readers might minimize the dangers and maximize the benefits.

Short-Term Effects

The most important thing to know is that alcohol consumption can cause a significant blood sugar drop (hypoglycemia).

Every person at risk of hypoglycemia should be aware of this dangerous side effect. That’s a group that includes everyone with type 1 diabetes and all those with type 2 diabetes that use insulin or other medications that can cause low blood sugars, such as sulfonylureas.

Why does it happen? Briefly, alcohol interrupts the liver from doing its regular work of releasing stored glucose into the bloodstream. When the liver finds that it has to break down alcohol instead, this work slows or stops – leading to lower blood sugar levels. At the same time, alcohol also increases insulin sensitivity.

This alcohol-induced hypoglycemia may have a delayed effect, hitting you after you’ve stopped drinking, possibly after you’ve fallen asleep, or even the next day.

As an added complication, there is substantial overlap between the feeling of tipsiness (or drunkenness) and the symptoms of hypoglycemia. And if you’re a little drunk, you’re definitely not in the right condition to recognize your hypoglycemia and react to it properly. People nearby, whether friends or strangers, may also misinterpret your symptoms, with potentially disastrous results. Alcohol is a factor in many hospital admissions for hypoglycemia.

While moderate drinking is not likely to create an undue risk of hypoglycemia (although it can), heavy drinking (and binge drinking) can be dangerous. Young adults, especially college students, may be at an especially high risk, given their tendency to engage in risky drinking behaviors. Many college students already struggle to maintain optimal glucose control, an effort that a heavy dose of alcohol only makes even harder. Going to sleep drunk is especially high risk, as the symptoms of hypoglycemia which would normally wake one up may be inhibited.

The Morning After

The glucose-lowering effect of alcohol is definitely not restricted to the peak of drunkenness – it actually peaks hours later.

In a 2001 study published in Diabetes Care, scientists got six men with type 1 diabetes drunk on about one bottle of white wine each, and then watched what happened. The brave volunteers drank their fill between 9:00 pm and 10:30 pm, a few hours after eating dinner. Alcohol caused their blood sugar to drop, as we would expect, but what was surprising was how long that effect took to show up. Five of the six men experienced symptomatic hypoglycemia, and they all did between 10:00 am and noon the next morning, about 12 hours after drinking.

That means that you’re just as likely to have blood sugar issues the morning after drinking. And the more you drink, the greater the likelihood of low blood sugar, and the less capable you will be of dealing with it.

If you want more detail on morning-after woes and blood sugar problems, and how to treat and avoid them, check out our article on the subject: Diabetes and Hangovers: What You Need to Know.

Long-Term Effects

First of all, here’s a warning that hopefully shouldn’t be necessary: heavy drinking isn’t good for anyone. Binge drinking and alcoholism both have far-reaching negative health effects, regardless of diabetes. And the combination of alcoholism and diabetes is “double trouble,” associated with the acceleration of diabetic complications “such as disturbances in fat metabolism, nerve damage, and eye disease.”

At the same time, you may have heard that a drink or two most nights is actually good for your heart – a relationship that may hold true for people with diabetes, too. This is still a somewhat contested subject, and some more recent data shows that the negatives may outweigh the positives. But given how detrimental cardiovascular disease is to people with diabetes, it may be a factor worth considering.

Studies have shown that moderate drinking is also linked to some positive effects on blood sugar metabolism. As discussed above, alcohol use can cause an acute rise in insulin sensitivity, an effect that can be dangerous in the short term but in theory might be beneficial in the long term. In people without diabetes, alcohol use is associated with lower A1C levels, an effect that may help fight the development of diabetes. This 2015 meta-analysis found that moderate drinkers had a whopping 30% reduced risk of type 2 diabetes, although the study could not prove that alcohol actually caused this positive effect. 

It is even less clear whether or not moderate amounts of alcohol can help treat diabetes: a 2019 meta-analysis found that light drinking had a positive effect on the “blood glucose and fat metabolism” of people with type 2 diabetes, but it did not improve A1C.

It would probably be unwise to put too much faith in these purported benefits. Much of the evidence linking moderate drinking with health benefits relies on observational research, which can be unreliable. And for some people, moderate drinking is just a slippery slope to heavy drinking. If you don’t drink much alcohol now, it is unlikely that your doctor will endorse drinking more so you can experience the glucose-lowering effects. The medical community does not recommend using alcohol as a therapeutic option, given its many inherent downsides.

Heavy drinkers, by the way, do not benefit from any of these positive effects. In 2015 study mentioned above, those that consumed more than three or four drinks daily did not enjoy any T2D risk reduction. And binge drinkers are even more likely to develop T2D, perhaps because large amounts of alcohol have toxic effects on the pancreatic beta cells.

Carbs and Booze

Drinking just gets more complicated when you consider the immediate impact it can have on your blood sugar levels.

Alcohol, luckily, can be fairly low-carbohydrate. Many spirits (vodka, tequila, etc) have only trace amounts of carbohydrates; a glass of red or white wine has a handful of carbs or fewer; most of America’s best-selling beers have between 3 and 10 grams of carbohydrates per can. Moderate alcohol consumption, therefore, does not need to result in major blood sugar management challenges.

But some sweet wines and beers have more carbs than others, and the sugars in cocktails, hard seltzers, and similar drinks can make booze very high-carb indeed. These drinks may prompt a very rapid blood sugar spike, one that may be difficult to effectively counteract with insulin. These carbs may also not be very protective against delayed hypos, if the blood sugar spike has already dissipated by the time that the hypoglycemic effect of alcohol begins to take hold hours later.

Insulin’s effect is always at least somewhat unpredictable, and you also have the delayed blood sugar-lowering effect of alcohol to worry about. It may be safer to avoid sugary booze – and safer still to avoid any alcohol in the first place.

Safe Drinking Practices for People with Diabetes

Sadly, many people with diabetes do not receive adequate education on the subject of alcohol. We’re here to help.

Individuals who use glucose-lowering drugs, especially insulin and sulfonylureas, should aim to keep critically aware of their blood glucose levels while drinking and for up to 24 hours afterward.

Here are some other ideas on how to make drinking with diabetes a bit safer:

• Practice moderation! Anything more than a drink or two begins to increase both short- and long-term risks.
• Check your blood sugar frequently, both while you’re drinking and the day after.
• Consider what you’re eating. It may be possible to prevent hypoglycemia with a snack, or by eating more carbohydrates or protein than with your alcoholic beverage.
• Stay mindful of the carbohydrate counts of your drinks.
• Be especially cautious about exercising when drinking – including dancing and sex! – or during the day after. A workout can seriously drop your blood sugar.
• Have a sober friend with you that understands how your body might respond to alcohol use and that can help in a hypoglycemic emergency.
• Remember that hypoglycemia and drunkenness feel very similar, and the drunker you are, the more difficult it is to perceive the early subtle signs of a hypo.
• Wear a medical alert bracelet, so that a paramedic will be able to diagnose hypoglycemia more quickly. If you get woozy or pass out, others may presume that it’s from drunkenness, not hypoglycemia, and decline to offer the help you need.
• Remember that drinking can cause delayed hypoglycemia. You should be especially cautious about using insulin to correct high blood sugars during or after a night of heavier drinking.
• Talk to your doctor about adjusting your use of insulin and other glucose-lowering medications for a day or night of drinking.

Conclusions

People with diabetes should be able to enjoy moderate amounts of alcohol safely. It is even possible that light drinking confers some long-term health benefits, although the experts are not by any means unanimous on the point.

Drinking does, however, carry some real immediate risks. It is particularly important to be mindful of low blood glucose. Research indicates that “unexpected, frequent, and prolonged hypoglycemia is a substantial problem after alcohol ingestion in both type 1 and 2 diabetic subjects.” The hazards are greater for people that take medications that are known to cause hypoglycemia, especially insulin and sulfonylureas.

Binge drinking is never healthy, and is especially dangerous for people with diabetes.

Frequent heavy drinking is associated with many detrimental effects for people with and without diabetes. If you’re concerned about your own drinking habits, please reach out to a professional for help.