The Alcohol and Diabetes Guide

Editor’s Note: This content has been verified by Marina Basina, MD, a Clinical Associate Professor at Stanford University. She’s a clinical endocrinologist and researcher with a focus on diabetes management and diabetes technology. Dr. Basina is an active member of multiple medical advisory boards and community diabetes organizations, and she is on the Beyond Type 1 Science Advisory Council. 

Alcohol and diabetes: do they mix? The short answer is yes, you can drink if you have diabetes. But before you drink, it’s a good idea to educate yourself on how drinking can impact your body and specifically your blood glucose management. Here are some tips on drinking responsibly with diabetes.

Alcohol + your body

The liver is the part of your body that stores glycogen (the stored form of glucose). Usually, your liver’s job is to steadily convert glycogen to glucose, regulating your blood glucose level (BGL). But when you drink, your liver sees alcohol, thinks “poison!” and switches gears to detoxing your body of that alcohol. This means that your liver is no longer as focused on releasing glucose, which in turn affects your blood glucose management.

Alcohol-induced hypoglycemia with diabetes

Because alcohol decreases your liver’s efficiency at releasing glucose, drinking puts you at risk of an alcohol-induced hypoglycemia. Hypoglycemia, or a hypo, is when you don’t have enough glucose in your bloodstream so your BGL is dangerously low.

A hypo can happen immediately, or up to 12 hours after drinking. Plus, if you are on insulin for diabetes or you are taking diabetes medication that stimulates insulin-creation, your insulin will continue to work and drop your blood sugar further.

Add to that the fact that a hypo can look a lot like being drunk: drowsiness, unsteady movements, slurred speech, etc. A severe hypo can lead to mental confusion, unconsciousness, or seizures, which can all be extremely dangerous to your physical well being and ability to treat yourself. Learn more about the signs of hypoglycemia and how to treat it.

Alcohol-related hyperglycemia with diabetes

Since sugar or other carbs are often the vehicle that makes alcohol more palatable (think margarita mix, rum+coke, or other sugary chasers, etc.), these fast-digesting carbs will be quickly converted to glucose and enter the bloodstream, raising your BGL. The Joslin Diabetes Center indicates hyperglycemia occurs with a blood sugar above 8.9 mmol/L160 mg/dL.

If you have type 2 diabetes, it’s important to count your carbs and monitor your BGLs while drinking. (Remember, hard alcohol by itself has zero carbs and will not raise your BGLs but still can put you at risk for hypos that can occur hours after hard liquor ingestion).

Read this to learn more about the signs of hyperglycemia and how to treat it.

Talk to your doctor

Ask your doctor if you are healthy enough to drink alcohol. Especially if you are on other medications, it is imperative you ask your physician if you’re able to consume alcohol while on them. If you are insulin dependent, your doctor may want to adjust your dosage recommendation while drinking. Be sure to be honest about the amount of alcohol you drink on a daily basis and always ask your physician to explain your medication effects if you don’t understand.

Risks for drinking

There are always risks that accompany drinking alcohol. You may experience any of the following symptoms:

• Decreased awareness
• Lack of coordination
• Impaired judgment, behavioral changes
• Slurred speech
• Fatigue
• Malnutrition

Prolonged or chronic alcohol-use risks:

• Liver, heart and pancreas damage
• Shrinking of the frontal lobe
• Heightened risk for cancer

Increased risks of damage to the body if you have diabetes:

If you have type 2 diabetes and drink alcohol you may be at a heightened risk for diabetes complications.

• Neuropathy – worsened nerve problems
• Increased triglycerides – fatty acids that put you at risk for stroke
• Increased blood pressure
• Retinopathy or damage to the eyes
• Liver damage or cirrhosis

If you’re having frequent trouble in managing your BGLs, you should consider if it’s safe for you to drink alcohol.

Drinking with diabetes to-do checklist

Alright, you get it. There are risks associated with drinking alcohol with diabetes. But is there a way to drink with diabetes? Yes! Here are a few tips on how to drink responsibly.

1. Talk to your doctor. Ask your doctor how you can drink while staying safe. Talk about any medication that you are on, and if you are taking insulin, talk about how you should modify your dosages while drinking; they may want to lower your basal insulin.
2. Talk to the people drinking with you about your diabetes. Don’t drink alone! Carry diabetes identification when you go out drinking and make sure you have friends who know about the risks of drinking with diabetes. Emphasize the fact that a hypo might look like you are drunk. Show them the hypoglycemia handout before going out so that they know how to help you.
3. Don’t drink alcohol on an empty stomach. Eat something with slow-acting carbs before you go out drinking alcohol. This will help prevent an alcohol-induced hypo, and it will also help your body process the alcohol more effectively.
4. Know your alcohol. Keep track of how much you are drinking, the alcohol content, the sugar/carb content and pace yourself. Light beers and traditional pilsners generally carry the lowest carb contents (6g), with some brews being created specifically for low carb content. Those bigger flavors and higher alcohol contents often come with elevated carb levels. Generally speaking, craft brewery stouts and wheat beers contain around 20g of carbs per bottle. Porters are often a little lower, in the 15g range. IPAs may offer your best bet for getting a big, hoppy flavor and a manageable amount of carbs. Many IPAs clock in around 12g of carbs a bottle. While that’s still twice as much as many pilsners, it’s a good in-between.
5. Test, test, test your blood! Before you drink, while you are drinking and after you drink. Do not drink if your BGL is low. Also test before you go to bed and after you wake up. Alcohol does funky things to your BGLs.
6. Come prepared. Bring your blood testing kit, glucose tabs, a snack, etc. And remember: glucagon won’t help an alcohol-induced hypo.