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 amHave you made a continuation a part 2 on this subject yet?
Posted by Arend | Sep 25, 2010 at 10:10 pmI’ve recently moved to Korea and started drinking the fermented rice wine called Makoli. I’ve been noticing fasting levels in the low 100’s after a night of drinking roughly 2 cups. At one point I’d forgotten to take my 850mg Metformin and still showed a low fasting level the next day. My pills usually get me at around 120-130 fasting. Without my pills my levels are around 170. The Makoli has worked better to reducing my fasting levels than my pills. Other forms of alcohol do not have the same effect as Makoli. I think that something about the fermentation helps. I have not replaced my meds with Makoli, but I have surely cut back on the amount of pills that I take.
Posted by Diane | May 03, 2011 at 8:23 pmWhy is it that brandy makes a Diabetic person have a diffrent mood swing, I witnessed a Diabetic that i live with today who will stay up all night long, not want to do anything to help out, and lots more.. I also watched as he would drink whisky and be in a great mood, but I recently had brandy in the house, after he drank half the container, I woke up, and he had a mood swing, and charged me as well as hit me in the face, what is it that would cause this, He has not acted out this way sence he became a Diabetic. Also, why is it he now will start eating more and more each day, and alot of it is junk food, and not only this, he trys to hide the fack that he is eating this way… will someone please send me a email on how to find this information please, and thank you..
Posted by Tony | May 11, 2011 at 2:57 amHi Tony,
I’m sorry that you’ve had to go through this. To me, it sounds like the alcohol itself (and not whether it’s brandy or whiskey) is affecting your friend’s blood glucose. Alcohol can lower blood glucose too much, possibly leading to those mood swings that you’ve seen in your friend. Also, high or low blood glucose can lead to someone with diabetes eating more than usual, which could explain the “junk food.” Does your friend check his blood glucose with a meter? Is he willing to do so? It’s also quite possible that your friend is depressed. Would he be willing to see his doctor or a mental health counselor? Is there a family member of your friend’s who you could talk to? Letting him know that you’re there to help, not judge, him is often the first step.
Posted by acampbell | May 11, 2011 at 10:50 amExcellent discussion on the ramifications of a drink and the liver but misses a point.
I also have stopped drinking during day and evening due to impact of booze on the liver and performance of metformin.
Careful watching on cgm has revealed that alcohol metablizing by liver shuts off the good effects of metformin so that once booze done; liver really starts releasing glucose in large amounts as metformin effects get shut down.; liver switched from fasting to make sugar mode.
So, today; I might sip a little wine - minimal effects and only have a hard dring in early am when liver floating around doing not much, metformin mostly gone from blood and gut empty - least impact. Rest of day; no hard booze.
It has paid off as I have not had a liver dump during day or evening for weeks now nor out of the ball park glucose readings.
Posted by jim snell | May 11, 2011 at 11:16 amI am type 1 diabetic and an alcoholic. I drink approximately 70 beers per week. All of my blood work seems to be okay. I am concerned that one day life will collapse. I feel that I can not quit drinking and I do have to rely on insulin. Thoughts Please.
Posted by mame | Aug 25, 2011 at 9:18 amHi mame,
The immediate concern is the possible effect that alcohol has on your blood glucose, given that you take insulin. You don’t mention whether you are seeking help for your alcoholism (which I would strongly encourage), but in order to keep safe, I’d recommend that you check your blood glucose frequently, not skip meals, and always carry treatment for low blood glucose with you at all times.
Posted by acampbell | Aug 25, 2011 at 4:32 pmJust wondering my husband of 12 years who is diabetic and is suppose to be taken pills and overweight. My question is if he is not taking his medication and testing his sugar and under stress and goes out and gets drunk and then all of a sudden snaps but not on a person can the diabeties have anything to do with that?
Posted by Kerry | Jan 26, 2012 at 2:47 amHi Kerry,
I’m not quite sure what you mean by “snaps,” but I’m assuming you mean that he gets angry? In any case, I suspect that his reaction is due to the alcohol, and not because his blood glucose is too high or too low. It’s unlikely that his blood glucose is dropping too low because he’s not taking his diabetes medicine. In order to “test” this, see what happens after he eats a large meal. Does he “snap” when this happens? The bigger issue is that it sounds like he could use some help dealing with stress and his diabetes. Is he willing to do this?
Posted by acampbell | Jan 26, 2012 at 11:00 amI was told that you can drink tequila as it is made from cacti and not a veggie!!
Posted by wheeler | Jan 27, 2012 at 2:55 pmAmy makes important points and I wanted to add.
As old goat 60 plus who started out years ago in fishing industry in Canada - read “drinking”; some folks when sober usually keep their inner frustrations and problems under good control.
Once a good dousing of booze, all inhibitions and control get removed and person can actually turn very nasty as the inner control gets loosend off.
As insulin not needed for alcohol breakdown in body, biggest issue is that it is hidden calories - no free ride and most important to me is it interferes with glucose/sugar control as liver’s priority is booze first - sugars - second. In addition because of this, booze also interferes with metformin operation in liver over riding the metformin and cause excessive liver glucose when the metformin is supposed to be shutting it down.
I have found that small amounts of wine generally are not an issue but hard alcohol really gets liver’s attention.
I have reduced my alcohol overall but when I have a hard liquor drink - rum, vodka etc, I do so when metformin not up to strength in blood after ingestion. I have found with small amounts - single drink and timing nothing seems being knocked out of whack. BUT be carefull - don’t push it.
I arrived at this using cgms watching all the riots on the blood stream of this 30+ years as type 2 diabetic.
Posted by jim snell | Jan 27, 2012 at 3:47 pmlast night i went out with my friends to the club and we started to drink and before going i ate at home thinking that it would help me a little so my blood glucose doesnt go down because i have read that alcohol lowers your glucose level. when i began to drink and was on my third glass i started feeling buzzed so i decided to stop and then danced and i was feeling fine and everything. when i got home i checked my blood level it was all good but i did get thirsty in the middle of the night. but i woke up with my blood glucose level just fine in the morning also so i guess it would be ok to drink as long as i plan ahead and be careful how much i have to drink. So is alcohol safe to drink for diabetics??? can we drink alcohol and nothing will happen wrong?
Posted by Melissa M | Feb 05, 2012 at 8:04 pmWell, there is still a question.
As long as ones body glucose is under control, and moderation is key, then one might conclude all is OK.
For diabetics though ( and I am talking ype 2 like myself), there are two key issues having to do with:
1. Liver’s priority to process hard alcohol first and stop sugars processing from gut which can create big low and super high. It is definitely most curious that all’s nature’s animals from lowly fruit fly to the mighty elephant can all metabolize ethyl alcohol and I am told elephants in India and africa can bust into a winery/beer operation to drink the stuff.
2. Anybody on Metformin needs to know that booze interferes with metformin affect on liver when metformin up to strength in blood and best advice is not mix the two. Booze will override met and cause liver to boom out the glucose buffer to blood stream shooting up BG levels and some believe liver damage.
Posted by jim snell | Feb 06, 2012 at 1:28 pmHi Melissa M,
As I mentioned in my posting above, it’s likely that most people with diabetes can safely drink alcohol, as long as they don’t have other medical conditions that could be a cause for concern, or take certain medications that could interact with alcohol. That being said, however, you need to be very careful when you drink alcohol, especially if you take diabetes medicines that lower blood glucose (such as insulin or certain types of diabetes pills). Alcohol can be very unpredictable, which is why we advise that you: Always eat something when you drink, limit how much you drink (for women, the guidelines are no more than one drink per day), and check your blood glucose frequently. I’m making an assumption that you take insulin (and I apologize if I’m wrong); in the situation that you described, you likely prevented hypoglycemia by eating beforehand, which is recommended. However, if you were to repeat what you did on another night, you possibly could go low, (especially since you went dancing), either soon after you got home or hours later. The key is to know how alcohol affects you, prevent hypoglycemia from occurring when you do drink, and drink in moderation so that you don’t run into issues with hypoglycemia hours later.
Posted by acampbell | Feb 06, 2012 at 2:40 pm