A nice glass of Chianti…a cold beer on a hot summer day…celebrating with a flute of champagne. There are so many ways that alcohol is integrated into both everyday life and special occasions. Granted, not everyone drinks alcohol, but many people do. And when it comes to the question, "Can I drink alcohol if I have diabetes?" the answer is about as clear as that for "Is a low-carb diet good for diabetes?" In other words, the answer really is "It depends!"
It’s important to mention right off the bat that there are certainly many reasons why people should not drink alcohol. Some may be related to diabetes and some may be related to other reasons. Therefore, it’s important to discuss this issue with your health-care provider if you have any doubts or concerns. And if you’re newly diagnosed with diabetes or starting on a new medicine, it’s worthwhile bringing up the topic if your provider doesn’t.
While you’d be hard-pressed to find any health organization actually recommending that you drink alcohol, you might take some comfort in knowing that the American Diabetes Association, the American Heart Association, and even the American Cancer Society agree that drinking alcohol in moderation is certainly not off-limits to most people.
But back to diabetes and alcohol. What’s the concern here? And why should some people with diabetes not drink alcohol? To answer these questions, it’s helpful to understand a little bit about how alcohol is processed in the body.
The body treats alcohol as a drug, not as a food product. This means that, when you drink any type of alcoholic beverage, your liver kicks into high gear, preparing itself to “detoxify” the body of this “poison” (I’m using these words for dramatic effect). Essentially, the liver has to metabolize, or break down, alcohol into less harmful substances. This takes, on average, about two hours. While the liver is truly a miracle organ, it can only do so much multitasking at one time. And handling alcohol is its number one priority. So, this means that while your liver is busy reigning in the effects of that green apple martini, it may not pick up on the fact that your blood glucose levels are starting to wind their way down.
In most cases, your liver is able to release glucose when blood glucose levels start to drop in an effort to prevent low blood glucose (hypoglycemia). But with alcohol on board, this may not happen. Now, it’s no big deal if you have diabetes and you control your blood glucose with a healthy eating plan and physical activity alone. Hypoglycemia isn’t going to occur if you don’t take medicine. However, if you take certain types of diabetes pills called sulfonylureas, such as glipizide or glimepiride, or if you take insulin, your chances of developing low blood glucose rise considerably. Your chances are even higher if you’ve been drinking on an empty stomach (think cocktails before supper); if you grab a beer or wine cooler after a few runs down the ski slopes (exercise is already lowering your blood glucose levels); or if your blood glucose levels are already on their way down (too much medicine and/or not enough food).
Alcohol is a little sneaky, too, because it’s not always predictable. When the topic of alcohol and hypoglycemia came up in one of the classes I was teaching a few years ago, an astute gentleman quipped, “Well, why don’t I just drink alcohol instead of taking my Glucotrol?”
The question was actually a good one (although we’d never recommend using alcohol in that way). But what he didn’t realize, at the time, is that alcohol is not always so predictable. Some people metabolize alcohol more slowly than others. And alcohol metabolism can depend on factors such as the amount of alcohol consumed and over what time period; body size; type and amount of food eaten along with alcohol; and level of physical activity. It’s therefore not unusual to hear stories from people (often college students) who, after having had a bit too much to drink, “went low” in the middle of the night or even the next morning after a night of partying.
Well, out of time and space for this week. We’ll continue our in-depth look at alcohol and diabetes next week. Cheers!
I was told by the first Dr. that I was involved with my diabetes that I should not drink wine, brandy, rum and most beers. She said that those alcohol drinks have the worst kind of sugar for diabetics. She said the expensive bourbon whiskeys have a different sugar composition which is not as detrimental to the diabetics glucose levels. Is her analysis supported by any research?
Posted by daonegriz | Jan 24, 2008 at 9:07 amHi daonegriz,
I’m not aware of research claiming that bourbon has a different sugar composition. In general, however, brandy, rum and other distilled spirits have practically no carbohydrate (the exception would be something like a cherry-flavored brandy, for example). Wine and beer can vary in their carb content; sweeter dessert wines can have up to 15 grams of carb per 4 ounces, and a stout beer can contain 15 grams of carb per 12 ounce bottle. Unless you’re drinking these or mixed drinks, such as pina coladas, most alcoholic beverages tend to lower glucose levels. If you drink alcohol, check your glucose levels to find out how it affects you.
Posted by acampbell | Jan 25, 2008 at 8:05 amAnd I always thought that alcohol when consumed would turn to sugar therefore increasing your blood glucose. I refuse to drink alcohol in any manner. As a diabetic that tries to control my blood glucose without insulin its important to not consume products you know will effect your glucose levels. I have friends that believe its alright to consume alcohol. One now had no foot and is missing fingers. Not good.
Posted by wkmmarfa | Jan 26, 2008 at 9:26 amHi wkmmarfa,
Posted by acampbell | Jan 28, 2008 at 12:19 pmMany people with diabetes don’t drink alcohol. And it’s wise for people who have difficulty controlling their glucose levels to stay away from alcohol. However, there are people who enjoy having a glass of wine or beer; since alcohol tends to lower glucose levels, it’s important for those who choose to drink to learn how alcohol affects them - this means checking more frequently with a meter. Learning how to safely fit alcohol into one’s lifestyle is possible and should be done under the guidance of a health-care provider.
thhiss doeesntt hellp
Posted by broownn' | Feb 05, 2009 at 10:25 amaaaaaaaat all . liike
onne of my [u]bestfriiends[/u]
mightt have diabeetiies .
andd ii wannuhh knnow if shhe
can still drinkk.
Hi broownn,
I’m sorry this posting wasn’t helpful, but the point is, when it comes to alcohol and diabetes, that each person needs to discuss the issue with his or her physician. Most people with diabetes can drink alcohol, but certain medicines can interact with it, and if a person has other medical issues, it might not be such as good idea. So, she needs to talk with her physician about this.
Posted by acampbell | Feb 09, 2009 at 4:08 pmI went through a period of about eight years where I did’nt excercise at all and never watched what I ate(I’m 61 now). My blood sugar test came in at 155. I now work out on a rowing machine for twenty minutes a day and now eat more carefully and the last blood test came in at 110. So this combo does work and I do drink red wine and bourbon 3-4 times per week.
Posted by Evernew | Aug 02, 2009 at 12:21 amhi there thanks for different ideas and experiences
Posted by anil kumar | Aug 24, 2009 at 7:12 amits really difficult to figure out how things will effect your levels. one thing i do not understand
is what is good using medicine or doing exercise. when i go for a run I can drop my blood sugar from 13 to 5 . my question is ,is this OK to cut down BSL from that high to that low
as I diagnosed with type 2 in June 2009 so being new there are so many confusions around my head.need some more information on Formine
Hi Anil,
Posted by acampbell | Aug 24, 2009 at 4:08 pmWell, the good news is that both your diabetes medicine and your exercise are helping to lower your blood glucose! You don’t mention what type of medicine you take, but because you experience such a drop in your glucose with exercise, I’d suggest you talk with your physician about perhaps lowering your dose so that you don’t have too low of a glucose after exercising. For most people with type 2 diabetes, a combination of healthy eating, regular exercise and often, medication is what works best to control glucose levels.
I drink vodka, pretty much every evening. I am also takng Metformn and another drug to lower my cholesterol levels. I’m concerned about developing lactic acidosis, and other problems because of the drugs I’m taking. Are there other drugs with less propencity to cause LA? Although I’ve slacked on my exercise regime for about 1 month now, I also exercise for 45 minutes about 4 times a week. I’m hoping I can get off diabetic meds altogether. My last blood results indicate that my LDL’s are lowering as well as my sugar levels. I’m starting to worry about the Metformin however, after reading more extensively, the side affects.
Posted by PK | Dec 18, 2009 at 3:54 pmI treat alcohol like coke(cola). It’s just not really part of my world. I’ve never heard of any harm comming to anyone from not dinking. I have type 1. I don’t really miss it, not like a loaf of good french bread, anyway.
Posted by FUSZEK | Dec 19, 2009 at 11:59 amHi PK,
Metformin is in a class of drugs that are more likely to cause lactic acidosis than other diabetes medicines. However, this doesn’t necessarily mean that you should switch to another class of drugs, since alcohol can cause different interactions, depending on the drug. For example, alcohol can increase the likelihood of hypoglycemia if taken with sulfonylureas or insulin. I’d suggest having a conversation with your physician or pharmacist, letting them know how much vodka you drink, the pros and cons of staying on metformin, and discussing, if warranted, other options for medicine.
Posted by acampbell | Dec 21, 2009 at 2:59 pmHi, I actually live in South Korea and have had type 1 since 2005. I generally stay away from strong alcohol but drink the local rice wine ‘makkoli’ around 3-4 times a week (alcohol content is around 5-6 %). I do this for two reasons 1/it tastes good 2/it has no refined sugars as most commercial beers have (stout less so)
The hospital I get my insulin from here generally has the same attitude as my doctors in England (generally alcohol is O.K provided it’s only 2-4 units a day max) while the Korean clinic (which comes from a homoepathic Korean tradition in medicine that is closer to Chinese medicine and traditions of acupuncture) advise me against alcohol of any kind.
I’m now in a bit of a quandary and have been cutting back on any alcohol intake over the last month or so because of this. Any observations on these two different views wd certainly be appreciated.
Posted by Andrew | Dec 28, 2009 at 2:48 amHello - I am a Type 1 Diabetic and I am an alcoholic. I drink on average about 6-12 24oz beers per day. I keep my blood sugar under 250 for the most part. I have been having large amounts of ketones, usually in the morning and then when I have a beer it tends to go away to about a trace or small. I am getting concerned about DKA, but like I said…my Blood Sugar is usually below 250 (180 avg). My question is this…Could it be Alcoholic Ketoacidosis? Why do the Ketones come and go? Should I still go to the doctor when ketones are high? Do ketones leave the blood or just keep building up? I hope this was ok to post here. Any Help would be great! Thanks!
Robert
PS. I have begun to quit drinking alcohol…hope this works for the ketones!
Posted by Robert | Dec 28, 2009 at 5:01 amHi Robert,
My guess is that you could have alcoholic ketoacidosis, given that your blood glucose isn’t that high, from what you report. Ketones form when the body breaks down fat for fuel. This can happen in the absence of insulin (I’m assuming you’re taking your insulin) or if one isn’t eating enough carbohydrate (or enough calories for proper nutrition). There may be other symptoms associated with alcoholic ketoacidosis (and DKA, for that matter), including abdominal pain, dehydration, feeling sluggish, loss of appetite, confusion, and dizziness, to name a few. However, since I’m not a physician and can’t diagnose you, I’d strongly suggest you call your doctor, as you may need medical treatment, including IV fluids. In the meantime, congratulations on quitting the alcohol — that will help!
Posted by acampbell | Dec 29, 2009 at 9:34 amHi Andrew,
The decision to drink alcohol depends on a number of factors, including your diabetes control and other possible health issues. You mention that you drink makkoli 3-4 times per week but you don’t mention how much. Guidelines in the US for people with diabetes are up to 2 drinks (1.5 ounces of hard alcohol) per day for men, up to one drink per day for women. And there is evidence that drinking alcohol can lower your risk of a heart attack, stroke, and heart disease. However, if your A1C is above 7, if your blood triglycerides are above 150, if you’re overweight, if you have liver/kidney disease, etc., you may want to reconsider how often and how much you drink. So, my advice is to evaluate any possible risk factors you may have. It certainly doesn’t hurt to cut back on your alcohol intake, which you’ve begun to do.
Posted by acampbell | Dec 29, 2009 at 10:30 amthanks for yr advice. Amount of alcohol? 1-2 bottles (I think these bottles are around British pint-size each which would mean 2 units of alcohol each, or just over? don’t know ounces tho) 3-4 times a week generally, although recently less frequently.
Blood? The odd high of 2-250 in the evenings 2-3 times monthly. I’ve begun to look into natural remedies that have the same effects on the blood as insulin (grapefruit, crushed fenugreek?)
I also exercise daily (walk/jog/bike) to keep my circulation in order.
I guess I got in touch because of the advice from the Korean clinic. It’s the first time I’d heard the diabetes=no drinks prognosis
Posted by Andrew | Jan 05, 2010 at 7:54 amHi Andrew,
Probably the safest thing to do is to cut back on your alcohol intake, perhaps to 1 bottle 3–4 times per week — it certainly won’t hurt. Again, it would be more of an issue if you had other health problems or even frequent hypoglycemia due to alcohol intake. It’s likely that the Korean clinic is taking a “purist,” wholistic approach to alcoholic (meaning, don’t drink it) and I’d guess they also likely restrict intake of other things, too, such as sugar, red meat, etc. By the way, it’s possible that fenugreek could affect your blood glucose and doubtful that grapefruit will do much.
Posted by acampbell | Jan 06, 2010 at 9:05 am