Print Diabetes and Alcohol: Do the Two Mix? (Part 3)

Over the last two weeks, we’ve been taking a closer look at alcohol. Several of you have submitted great questions and comments about alcohol, too. The use of alcohol among people with diabetes often stirs up controversy: There are those who feel that people with diabetes shouldn’t drink at all, while others remain on the fence and believe it’s OK to have alcohol once in a while.

It’s important to point out that there are no hard and fast rules when it comes to drinking alcohol. That’s why I repeatedly state that it’s important to have this discussion with your health-care provider, as the “rules” can vary from person to person.

But, assuming that you’ve gotten the green light from your provider to carefully and safely enjoy alcohol on occasion, how do you fit it into your meal plan? How much can you drink? And what are the best choices? Let’s go through these questions one by one.

Fitting alcohol into your meal plan
Alcohol is unlike carbohydrate, protein, and fat. However, alcohol is metabolized, or handled, by the body in a manner similar to fat. This means that calories from alcohol can easily be stored as fat unless you burn them off. Alcohol contains 7 calories per gram; fat contains 9 calories per gram, and carb and protein contain 4 calories per gram. So alcohol is a prime source of calories. If you’re trying to lose or maintain your weight, you need to think about this carefully. An occasional glass of wine isn’t a problem. But if you tend to have a glass of wine every night, you need to consider that 4 ounces of wine contains about 90 calories. Over time, this can add up. You may want to cut out 90 calories somewhere else in your meal plan to balance things out and avoid that spare tire around your waist.

Remember, too, that alcohol may lead to low blood glucose in people taking insulin with a meal or those taking a sulfonylurea drug, such as glipizide, glyburide, or glimepiride. If you take any of these types of medicines, be sure to eat a carbohydrate-containing food, such as bread, pasta, rice, or fruit, with your alcohol. If you need to shave calories from somewhere else in your meal plan, you may want to think about cutting out some fat, such as margarine, oil, or salad dressing, for example.

How much to drink?
To best answer this question, it helps to know serving sizes of common alcoholic beverages. All of these are considered a serving: 5 ounces of red or white wine; 12 ounces of beer; 1½ ounces (a shot glass) of distilled spirits (such as vodka, rum, or whiskey).

Men are “allowed” more alcohol than women because men can process alcohol more efficiently. Therefore, if and when you choose to drink, the guideline for men is no more than two servings of alcohol per day; for women, no more than one serving.

Best choices
Things can be as murky as a mudslide when it comes to deciding what to drink. The “best” choices, though, are those that don’t contain too many calories or carbs: dry white or red wine or champagne; light beer; or distilled spirits. Fruity drinks, such as piña coladas, daiquiris, and margaritas contain fruit juices and therefore contain more calories and carbs. In fact, 4 ounces of a strawberry daiquiri can contain 200 calories and 30 grams of carb or more. And many people don’t stop at just one! Stouts and ales (think Guinness or Sam Adams lager) approach 200 calories per 12-ounce bottle. More of a gin and tonic or rum and coke lover? Go for diet tonic water and diet soda as your mixers. If you drink alcoholic beverages that contain a significant amount of carbohydrate, talk to your dietitian or health-care provider about how to fit these into your eating plan safely.

What about nonalcoholic beer and wine? Because these beverages contain little, if any, alcohol, you may actually need to count them as carbohydrate choices in your meal plan. Many nonalcoholic beers contain close to 15 grams of carb (equal to 1 slice of bread or 1 small piece of fruit).

In summary, there’s a lot to think about when it comes to alcohol. For some people, the safest and smartest approach to take is to not drink any alcohol. For others, the goal is to learn how to fit alcohol into your diabetes treatment plan safely—ask your health-care team if you’re not sure.

Comments:

There is solid scientific evidence that judicious amounts of alcohol may indeed prolong life, reduce cardiovascular deaths, and reduce the incidence of dementia.

Women with a personal or family history of breast cancer would be well-advised to consider total abstention from alcohol since several published studies link breast cancer with alcohol intake.

-Steve Parker, M.D.
www.AdvancedMediterraneanDiet.com/blog

Posted by: Steve Parker | Feb 14, 2008 06:32 PM

my drink of choice vodka soda just a splash
of cranberry very low carb
keith mcclelland

Posted by: keithy02 | Feb 15, 2008 07:12 AM

I agree of that the two mix together because According of many researchers drug rehabilitation is an umbrella term for process of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The obvious intent is to enable the patient to cease their previous level of abuse, for the sake of avoiding its legal, social, and physical consequences, especially in extreme abuse because every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.

______________
Rey

This is a comprehensive addiction portal focusing on topics of alcohol and drug abuse. http://www.alcoholaddiction.org

Posted by: reywahp | May 13, 2008 09:54 AM

I take Glipizide(10) and Gemfibrozil(600mg) 1/2 hr before meals and Metformin (500mg)during. Occasionally, prior, I drank (3-4 x a week) I like 1 or 2 vodka rocks before or after eating (don't drink during meals unless I have a glass of wine. Definitely, love a friday vodka (TGIF). Any advice other than quitting altogether? PS: I do exercise moderately and watch my carbs. I am a small to med eater 6'3", 200 lbs.

Posted by: Bob | Sep 25, 2009 09:35 PM

Hi Bob, In general, most people with diabetes can safely drink alcohol, but it always is worth a discussion with your physician. Two possible concerns are first, the glipizide — this is a sulfonylurea, which can lead to hypoglycemia, especially with alcohol; the second is your gemfibrozil, which can cause dizziness and blurred vision. These symptoms may be exacerbated with alcohol, and it's advised to not drink alcohol when taking this medicine. However, hypoglycemia can be prevented when drinking alcohol by always eating a source of carbohydrate when drinking and by limiting alcohol intake to no more than two servings per day. Also, careful blood glucose monitoring is helpful. I'd suggest asking your physician about the safety of drinking alcohol while taking gemfibrozil, though.

Posted by: acampbell | Sep 28, 2009 11:31 AM

Type II slowly drifting into Type I. On Lantus and off the Glip. and Met.. Glad to be off of both! Any changes with alcohol use that I need to consider and.... Enjoy a mixed drink once or twice a week. What would be the best combination. Volka & diet, Rum & diet, Blended & diet or is there no difference as we are just dealing with calories/carbs? Do some alcohol's affect the liver differently? Once the liver has finish processing the alcohol will it have a greater tendency to dump more sugar into your system at a later time due to type and amount consumed? Yes I will be discussing w/my Endo.. Would like your imput too.

Posted by: Elmi | Feb 06, 2010 04:09 PM

Hi Elmi, Having an alcoholic beverage once or twice a week is unlikely to have much of an impact on your blood glucose levels. It's possible that if your gluocse is on the low side and you haven't eaten when you do have a drink, you may be at risk for hypoglycemia. But in general, one drink usually doesn't lead to hypoglycemia. Also, there's not much of a difference between vodka, rum, or other distilled spirits in terms of their effect on glucose. (What you MIX with alcohol can have an effect if it contains carbohydrate, though). I'm not aware that the liver handles various types of alcohol differently, and I have not heard that the liver will compensate at a later time by releasing more glucose. That perhaps could happen if you went low and then the liver released glucose to compensate. (The liver would not be able to release glucose if its glycogen stores are depleted, as can happen in the case of alcoholism or someone who is malnourished, for example). But, these are good questions that perhaps your endocrinologist can answer for you.

Posted by: acampbell | Feb 09, 2010 09:02 AM

Appreciate the info. Find myself angry at this time as I find myself now drifting farther onto the type 1. How do you count carbs on alcohol (believe you do) and what is the carb count on said personality enhancements (rum, etc...)? Do understand that it is very important to mix beverages with food and never without. I admire and wonder how individuals survive socially when one is raised in a beveraged enhanced family setting. A setting where people do take it responsibly and watch over each and every individual. Yet are not afraid to kick up their heels and dance to the beat. Appreciate all advice and guidelines. Working through the muck!

Posted by: Elmi | Mar 10, 2010 02:06 AM

Hi Elmi, If you're drinking a glass of wine or beer, or perhaps a rum and Diet Coke beverage, for example, you wouldn't count the carbohydrate in these drinks — mostly because there are very few carbohydrates anyway. In fact, rum has no carbohydrate. Don't forget that alcohol can have a blood glucose-lowering effect, too. Certainly, some alcoholic beverages do contain a significant amount of carbohydrate, mostly from added ingredients, such as fruit juice, sugar, etc. And if you take premeal insulin, it may be necessary to take a little insulin to "cover" the carbohydrate in these drinks. It's always best to err on the side of caution, however. If, for example, a beverage contains 15 grams of carbohydrate and a person usually takes 2 units of insulin to cover those carbohydrate, he might instead try taking just one unit. For someone with Type 2 diabetes not on insulin, the best advice is to stick with lower-carbohydrate alcoholic drinks and if calories are a concern, count alcohol as fat servings. As always, it's important to check your glucose to see how alcohol affects you.

Posted by: acampbell | Mar 12, 2010 09:03 AM

I love my sangria wine! I am concerned though about my weight and sugar count. I am a type 2 diabetic and most nights I drink quite a bit of sangria ( a red wine ) but it does appear to raise my sugar levels...what else might this habit cause?

Posted by: Deana | Mar 24, 2010 01:31 AM

Hi Deana, Sangria is a delicious blend of wine, fruit, other alcoholic spirits, and some kind of sweetener, such as honey, sugar, or fruit nectar. An 8-ounce glass contains about 140 calories and about 17 grams of carbohydrate. You don't mention how much you are drinking, but more than a glass can certainly affect your blood glucose and can contribute quite a bit of calories (which doesn't help if you're trying to lose weight). Too much alcohol may lead to health problems, including liver disease, heart disease, and an increased risk of some types of cancer. So, you might consider cutting back to, say, one wine glass per night. But again, it depends on how much you're drinking now.

Posted by: acampbell | Mar 30, 2010 03:30 PM

Final question on alcohol for me :-) Understand alcohol will lower blood levels at first. But later will it cause your sugar levels to elevate once the liver is done processing the alcohol in your system? Example you have three rum and diet cokes the previous evening. Will this cause increase sugar levels the following morning? Appreciate all the info that has been provided. Take care,

Posted by: Elmi | Apr 10, 2010 11:40 AM

Hi Elmi, It's possible that alcohol could lead to an increase in blood glucose if you were rebounding from a low blood glucose. Again, it's more likely that rum and Diet Coke would lead to low blood glucose, but theoretically, your liver could respond by putting out glucose to try and bring your blood glucose up. However, remember that your liver may be too busy trying to detoxify the alcohol in the first place, so that may not happen. You really need to check your blood glucose when you do drink alcohol and find out how it affects you. If you're having difficulty controlling glucose levels after drinking, it might be prudent to cut back a little!

Posted by: acampbell | Apr 13, 2010 08:06 AM

Thank you for your imput and that is exactly what I did :-) Take care

Posted by: Elmi | May 06, 2010 08:09 PM

Hi, I'm type 2 diabetic. I'm of normal weight and am not trying to lose any weight. Everything I read about alcohol, is about carbs and how it effects your weight. Actually, i've never been over weight, I got diabetes at the age of 25 and now i'm 27. I weight 170 and i'm 5'11. In general how do you think alcohol will effect my glucose?

Posted by: sam | Jun 14, 2010 04:20 PM

Hi Sam, The answer depends, in part, on how you're managing your diabetes. If you are taking a diabetes medicine that can lower blood glucose, then you may be at risk for low blood glucose (hypoglycemia) if you drink alcohol without eating something at the same time. If, however, you're not on any medicine or are on a different type of medicine, then the risk for hypoglycemia is very low. You mention that weight isn't a concern for you, so from a calorie perspective, drinking alcohol may not be an issue. (For the most part, alcohol doesn't contain a lot of carbohydrate unless you're having a mixed drink). Other possible health concerns that may be aggravated by alcohol are having high triglycerides (blood fats), liver disease, certain diabetes complications, and, of course, a history of alcohol abuse. But in general, alcohol is usually fine (in moderation!) for most people.

Posted by: acampbell | Jun 15, 2010 10:42 AM

Hi, I take 500mg of metformin a day. And I drink vodka and orange juice. I don't drink till i'm drunk or anything. I drink about two or three cups, you usually get from a bar.

Posted by: sam | Jun 16, 2010 06:42 PM

Hi I am a type 2 diabetic and recently had a episode that reall scared me. I usally have two or three drinks max when I socilise on weekends. I had a stressfilled event in my life recently and threw caution to the wind and had about 8-10 drinks of rum and orange juice. I woke up the following morning and could not recall how i got home and events that took place the last hours of the night.I had a episode of blackout for a couple of hours. This really scared me. Has ayone evr experienced this and should I see my Doctor? F

Posted by: Florence | Jul 24, 2010 11:12 PM

Hi Florence, I'd advise you to speak to your doctor about what happened. The fact that you passed out is certainly cause for concern, and drinking 8–10 drinks in one "sitting" due to stress is dangerous (and not the best way to respond to a stressful event!). Your doctor should be able to guide you on safe and effective stress management techniques, or perhaps refer you to a specialist. Good luck!

Posted by: acampbell | Aug 02, 2010 02:50 PM

thanks...i think i learned my lesson.if i tell my doctor she will go banannas on me! but i will not be repeating that behaviour again.

Posted by: Florence | Aug 30, 2010 11:24 AM

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