With the holidays upon us, a question that often comes up for those with diabetes is, “Can I drink alcohol?” It’s a perfectly reasonable question — after all, with the merriment of the season, it’s only natural that you might wonder if you, too, can join in and imbibe! The good news is that most people who have diabetes can drink alcohol. But there are some caveats and recommendations to heed in order for you to stay safe.
Understanding alcohol’s effects
You may have had a glass of wine or beer without giving too much thought to it. Interestingly, alcohol is classified as a sedative-hypnotic drug, which is a drug that depresses or slows the body’s functions. That’s because alcohol works on the central nervous system. However, alcohol can affect every organ system in the body.
When you drink alcohol, some of it is quickly absorbed into the small blood vessels in the mouth and tongue. The rest of it reaches the stomach, where about 20% moves into the bloodstream. Depending on the amount of food in the stomach, some of the alcohol stays in the stomach where it’s broken down by enzymes. If your stomach is empty, the majority of alcohol is absorbed through the small intestine into the blood.
Once in the blood, alcohol travels to all parts of the body including the kidneys, liver, pancreas, brain, lungs and skin. In pregnant women, alcohol passes from the placenta to the baby. The liver is the “gatekeeper” in that it’s charged with breaking down 90% of alcohol into water and carbon dioxide at a rate of about one standard drink per hour (the rest is excreted in the urine, through the lungs, and through the skin).
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Gender differences in alcohol’s effects
Alcohol can affect people differently — some people become the life of the party after a drink or two; others seem to withdraw and become quiet. Part of this is due to how alcohol is processed, or metabolized. Men have more and a faster-acting form of an enzyme called alcohol dehydrogenase (ADH) in their stomachs and livers than women; this reduces the amount of alcohol absorbed by 30%. Women have no ADH in their stomachs and the form of ADH in their livers is less active. This leads to a higher blood alcohol concentration (BAC) compared with men and helps to explain why women can become more intoxicated than men when consuming the same amount of alcohol.
Effects of alcohol on blood sugar
Not surprisingly, alcohol can affect blood glucose levels. On the one hand, drinking alcohol (especially on an empty stomach) can cause a drop in blood glucose. There are a couple of reasons why. First, alcohol stops the liver from releasing glucose into the blood. That’s usually a good thing if you have diabetes, but it’s not so good if you’ve had a couple of drinks and haven’t eaten anything for a while. Second, the liver’s priority is to break down alcohol so that it’s harmless. While it’s busy doing superhero work, it isn’t paying too much attention to what’s happening to your blood sugar. Also, if someone drinks a lot on a regular basis, glucose stores in the liver are quickly depleted, and if blood sugar levels drop, the liver is basically powerless to release glucose to help — the well has gone dry, so to speak.
If you take insulin, or certain types of diabetes pills called sulfonylureas (for example, glyburide, glipizide or glimepiride) or meglitinides (for example, repaglinide or nateglinide) your risk of low blood sugar (hypoglycemia) is greater from drinking alcohol compared to someone who takes other medications such as metformin, sitagliptin or dapagliflozin. That’s because, with insulin or a sulfonylurea, you automatically are at risk of hypoglycemia.
Is alcohol harmful or helpful?
The pros and cons of drinking alcohol continue to be debated. There’s no real argument that drinking too much alcohol can lead to serious consequences. Short term, these include:
• Loss of coordination, leading to injury
• Poor judgment
• Difficulty concentrating
• Higher blood pressure
• Loss of consciousness
• Harm to an unborn child
Longer term, excessive alcohol intake can lead to:
• Heart disease
• High blood pressure
• Liver disease
• Cancer of the liver, breast, head and neck, esophagus, colon and rectum
• Weight gain
• Higher blood glucose and A1C levels
• Worsening of diabetic neuropathy
• Diabetic retinopathy
Yet a “moderate” amount of alcohol (more on that in a moment) may provide health benefits, such as a lower risk of:
Alcohol can increase HDL (“good”) cholesterol and may improve insulin sensitivity in some people. However, while alcohol may provide a handful of health benefits, it’s never a good idea to start drinking alcohol — or increase your intake of alcohol, for that matter — in order to reap those benefits. There are other, safer steps that you can take to lower your risk of health problems without relying on alcohol.
What does “drinking in moderation” mean?
One of the best pieces of advice when it comes to alcohol is to talk with your healthcare provider. He or she should take into consideration a number of factors, such as how well your diabetes is managed, the presence and risk of diabetes complications, other health conditions you may have, any family history of alcohol abuse, and medications that you take. Women who are pregnant, planning a pregnancy or who are breastfeeding will likely be advised to abstain from drinking alcohol altogether.
If your healthcare provider gives you the green light to drink alcohol, they’ll probably advise you to drink “in moderation.” But what does that mean? According to the federal government’s Dietary Guidelines for Americans, along with the American Diabetes Association and the American Heart Association, moderation means:
• Up to one drink per day for women
• Up to two drinks per day for men
For reference, heavy drinking is defined as:
• More than three drinks in a day or more than seven drinks per week for women and for men older than 65
• More than four drinks in a day or more than 14 drinks per week for men 65 and younger
Binge drinking is four or more drinks within two hours for women and five or more drinks within two hours for men, according to the Substance Abuse and Mental Health Services Administration.
Best choices of alcoholic drinks
One drink is defined as:
• 12 ounces of beer
• 5 ounces of wine
• 1 1/2 ounces distilled spirits (gin, rum, vodka, whiskey)
Compared with most cocktails, beer (while containing some carb), wine and distilled spirits are generally better choices due to their lower carbohydrate content. And while it may seem like common sense to reach for a sugary cocktail in order to prevent hypoglycemia, the reality is that the carb in those drinks will be absorbed quickly, offering little or no protection against hypoglycemia.
To give you a sense of how much carb is in different alcoholic beverages, check out the table below.
As far as drink mixers go, think twice before you toast the New Year in with an alcoholic beverage laden with regular soda, tonic water or juice. These mixers contain a significant amount of carbohydrate and calories. Instead, choose diet soda, diet tonic water, club soda or seltzer water. Or, skip the mixers altogether and go “neat,” meaning no ice or water, or “on the rocks,” meaning with ice.
Handling hypoglycemia from alcohol
As noted above, your risk of hypoglycemia increases when you drink alcohol if you take insulin or certain types of diabetes pills (sulfonylureas and meglitinides). It’s important for everyone to be smart when it comes to drinking alcohol, but especially so if you take these particular medications. You should also keep in mind that alcohol can be somewhat unpredictable in terms of if, when and to what extent it can affect your blood glucose. So how do you stay safe while enjoying some holiday cheer? Here’s how:
Be aware of your medications.
This means knowing if your diabetes medications put you at risk for hypoglycemia. Ask your doctor, pharmacist or diabetes educator if you’re not sure. Other medications may raise your risk of lows, too — these include beta blockers, some heart arrhythmia drugs and even some dietary supplements, such as fenugreek.
Line up your wingman/wingwoman.
In other words, make sure someone you’re with knows that you have diabetes, can recognize signs and symptoms of hypoglycemia, and can help you (or get help for you) if needed. On a side note, if you’re making merry with alcohol and happen to have hypoglycemia, others may think you’ve had too much to drink — that’s because symptoms of a low can mimic signs of being intoxicated.
Wear or carry medical identification.
In the event of a medical emergency, a medical ID gives healthcare professionals a heads up that you have diabetes.
Eat when you drink.
Make sure to eat something that contains carbohydrate if you’re sipping on a libation. Doing so will help minimize the chance of hypoglycemia. It’s also a good idea to include some protein and fat in your snack or meal to help sustain your blood glucose level. And forget about substituting alcohol for carbs at your holiday feast — doing so is a recipe for low blood sugar.
Know your glucose level.
Check your blood glucose before the festivities start, midway through and then before you go to bed. Alcohol may cause hypoglycemia 12 to 24 hours later. If you use a continuous glucose monitor (CGM), pay attention to the low glucose alerts.
Be careful mixing exercise and alcohol.
If skiing, skating, or snowball fighting is part of the holiday festivities, have fun! Just don’t overdo the alcohol afterward. Exercise combined with alcohol greatly increases the risk of hypoglycemia. Keep tabs on your blood sugar by checking regularly.
Stop and treat hypoglycemia.
Any time your blood glucose is low, stop and treat the low with 15 grams of carbohydrate, such as 4 ounces of juice or regular soda or 4 glucose tablets. Make sure you have treatment for lows with you at all times.
The holidays are often a time to celebrate, and it’s easy to overindulge in both food and drink. Know your limits with alcohol, and be especially sure not to drink and drive.
More words of wisdom
More often than not, people with diabetes can enjoy alcoholic beverages in moderation (as defined above). Remember to discuss the use of alcohol with your healthcare provider to be on the safe side, especially if you take insulin, a sulfonylurea or a meglitinide. There are other reasons why alcohol may not be a good idea. These include:
• Being pregnant
• Difficulty limiting alcohol intake
• Trying to lose weight
• Having high triglycerides (blood fats)
• Having complications of diabetes, such as kidney or heart disease, eye problems or nerve damage
• Taking non-diabetes medications that may interact with alcohol
• Having other health conditions, such as liver disease
Here’s to a happy and healthy holiday season. Cheers!