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 Committee.
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 sugar management. Here are some tips on drinking responsibly with diabetes.
Alcohol & Your Blood Sugar
The reason alcohol can be tricky for people with diabetes is mostly because of the way it affects your liver which interferes with your liver’s role in managing your blood sugar!
Your liver stores extra glucose (sugar) from the food you eat. This stored glucose is called glycogen. Every day, your liver helps to regulate your blood sugar level by converting stored glycogen into glucose. Your liver is releasing this stored glucose throughout every day and night to give your brain and body the fuel it needs to function. This is the same store glucose that contributes to high blood sugars during “dawn phenomenon,” too. And it’s part of why we need background / basal insulin throughout the day.
Meanwhile, when you consume alcohol, your liver sees this as a toxic poison that it needs to focus on processing to get it out of your body as quickly as possible. The more you drink, the longer this process takes.
When your liver is focused on processing and eliminating the alcohol you drink, it actually stops its other job of converting stored glycogen into glucose to regulate your BG.
Alcohol also slows down the digestion of food you just ate. This means that the insulin you may have taken for that meal is still working its way through your bloodstream while the food isn’t necessarily being broken down into glucose.
And that is why drinking a lot (or even a little) alcohol as a person with diabetes can be dangerous — especially if you take insulin or another medication that lowers blood sugar levels.
Alcohol-induced hypoglycemia with diabetes
Because alcohol decreases your liver’s efficiency at releasing glucose and slows down the digestion of food you just ate, drinking puts you at risk of “alcohol-induced hypoglycemia”. Hypoglycemia, or a hypo, is when you don’t have enough glucose in your bloodstream so your BG 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.
Emergency glucagon treatment might not work if…
Remember that tidbit about how alcohol interferes with your liver’s normal release of glycogen? If you have consumed a lot of alcohol and you’re experiencing a severe low blood sugar, your “emergency glucagon” treatment might not be effective because it relies on your liver!
Emergency glucagon kits work because glucagon is a hormone that tells your liver to release a large amount of stored glycogen. If your liver is overwhelmed with processing the alcohol in your system, it isn’t going to respond normally to the presence of emergency glucagon.
This is another reason why it’s important as a person with diabetes to be very mindful of how much alcohol you consume.
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 blood sugar. The Joslin Diabetes Center indicates hyperglycemia occurs with a blood sugar above 8.9 mmol/L160 mg/dL.
Whether you have Type 1 or Type 2 diabetes, it’s important to count your carbs and monitor your blood sugar while drinking. (Remember, hard alcohol by itself has zero carbs and will not raise your blood sugar but still can put you at risk for low blood sugar that can occur hours after hard liquor ingestion).
Some effects from high blood sugar are being thirsty, tired, needing to go to the bathroom frequently, and in more severe cases, DKA (diabetic ketoacidosis) can develop where you have nausea/vomiting, confusion, or coma. It is important to remember that it’s possible to be in DKA with a normal blood sugar. Always check for ketones if you suspect DKA.
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 judgement, behavioral changes
- Slurred speech
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 both Type 1 or 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 blood sugar levels, 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.
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.
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 on this page before going out so that they know how to help you.
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.
Know your alcohol.
Keep track of how much you are drinking, the alcohol content, the sugar/carb content, and pace yourself. Come into the night prepared: check out our article about different types of alcohol and recommendations on how much is safe to drink at a time.
Check, check, check your blood!
Check your blood sugar frequently! Before you drink, while you are drinking, and in the hours after you drink. Do not drink if your blood sugar is low. Before you go to bed and after you wake up. Alcohol does funky things to your BGLs.
Bring your blood testing kit, glucose tabs, a snack, etc. And remember: glucagon might not help an alcohol-induced hypo: here’s why.