Drinking more than a moderate amount of alcohol comes with health risks for everyone. For people with diabetes, especially those who take medications that lower blood glucose levels, the risks of any alcohol consumption are higher. If you have diabetes and choose to drink alcohol, it is important to be informed.
“Alcohol has a lot of sugar in it, and hyperglycemia, or high blood sugar, can be one result of drinking alcohol for people with diabetes,” says Zachary Bloomgarden, MD, Clinical Professor of Endocrinology, Diabetes, and Bone Disease at Mount Sinai School of Medicine. Dr. Bloomgarden adds, “Some alcoholic drinks will raise blood sugar levels more than others. If you have diabetes, you need to be aware of the amount of sugar and carbs in your drink, not just the amount of alcohol.”
Beer, for example, has a higher carbohydrate count than wine. Cocktails can be made with cola, fruit juice, or even add-ons like sweetened whipped cream, and such drinks will likely contain more carbohydrate than beer. If you would like to drink alcohol, be prepared with a couple of better alternatives, such as a glass of wine or a vodka with ice and soda water. Remember that, unlike club soda, regular tonic water is packed with sugar. (Learn more about the symptoms of hyperglycemia.)
A Surprising Risk
It might be surprising that hypoglycemia, or low blood sugar, is another risk of drinking alcohol for people with diabetes. Mariela Glandt, MD, attending physician and Medical Director of the Diabetes Medical Center at Bronx-Lebanon Hospital Center says, “It’s important to understand that regular carb counting may not suffice, when it comes to drinking alcohol. It’s not that simple, because even sugary alcoholic drinks, if consumed in excess, can actually lower blood glucose levels.” (Learn more about the risks of hypoglycemia.)
According to Dr. Glandt, here’s how alcohol can cause hypoglycemia in people with diabetes:
- Diabetes medications are designed to lower blood glucose levels by increasing the amount of insulin in the body.
- If there is too much insulin in the body, and blood sugar drops too low, the liver responds by releasing glucose into the bloodstream.
- The glucose released by the liver raises overall blood glucose levels.
- When you drink alcohol, however, the mechanism of action in which the liver releases glucose is delayed or prevented because the liver cannot raise blood glucose levels and metabolize alcohol at the same time. When this happens, hypoglycemia may occur.
Finally, in addition to hyperglycemia and hypoglycemia, drinking too much alcohol holds a few additional issues to be careful of for people with diabetes:
Compromised judgment. According to the Mayo Clinic, it takes approximately two hours for the liver to metabolize one drink. If you drink alcohol faster than your body metabolizes alcohol, the excess alcohol moves through your bloodstream to other parts of your body, particularly your brain. This is the reason people can feel fuzzy when drinking alcohol. Feeling fuzzy can compromise your judgment, and you may not recognize symptoms you may be feeling. And, says Dr. Bloomgarden, “If you are not thinking clearly, you may forget to take your medication, take an incorrect dose, or have difficulty monitoring your blood glucose levels.”
Drunk or hypoglycemic? “Drinking alcohol is not the only thing that can cause confusion in a person with diabetes. Hypoglycemia can, too,” says Dr. Bloomgarden. The symptoms of drunkenness and hypoglycemia can be similar, like dizziness, clumsiness, and disorientation. It may be possible for a friend or medical professional to mistake the symptoms of hypoglycemia for the symptoms of drunkenness. This could be dangerous, because you will not receive the proper treatment if your hypoglycemia is not identified as such. One way to avoid this situation, of course, is by not drinking alcohol. If you do choose to drink alcohol, however, consider wearing a diabetes medical ID bracelet, in addition to following the American Diabetes Association (The Association) guidelines below.
Unintended effects. Alcohol can also interfere with your diabetes medication, and can stimulate appetite, which can affect your blood glucose levels.
American Diabetes Association Tips on Drinking Alcohol
The Association suggests women with diabetes drink one or fewer alcoholic beverages a day (one alcoholic drink equals a 12-ounce beer, 5-ounce glass of wine, or 1½-ounce distilled spirits, such as vodka, whiskey, gin, etc.). Men should drink two or fewer alcoholic drinks a day. We’ve included more tips on drinking alcohol from The Association below.
- Drink only when and if blood glucose is under control. Do not omit food from your regular meal plan.
- Test blood glucose to help you decide if you should drink or not.
- Wear an I.D. that notes you have diabetes.
- Sip a drink slowly to make it last.
- Have a no-calorie beverage by your side to quench your thirst.
- Try wine spritzers to decrease the amount of wine in the drink.
- Use calorie-free drink mixers: diet soda, club soda, diet tonic water, or water.
- Drink alcohol with a snack or meal. Some good snack ideas are pretzels, popcorn, crackers, fat-free or baked chips, raw vegetables, and a low-fat yogurt dip.
- Find a registered dietitian who can help you fit alcohol into your food plan.
- Do not drive or plan to drive for several hours after you drink alcohol.
- Make sure your doctor is aware that you may choose to drink alcohol.
Find a complete list of tips from The Association here. And, remember, if you choose to drink, be informed.
Jessica Apple is the co-founder and editor-in-chief of the online diabetes lifestyle magazine A Sweet Life. Her writing has appeared in many publications, including The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review,and Tablet Magazine. Apple is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewees, and not of Sanofi US, its employees, agencies, or affiliates.
© 2013 The DX: The Diabetes Experience