Last Updated on April 3, 2021
In the United States, over 30 million people have diabetes. Another 84 million have prediabetes (meaning their blood glucose levels are higher than normal), with over 90 percent unaware of their condition.
If you’re recently diagnosed with either of these conditions, you may have many questions about diet, and which foods and beverages are safe. And if you enjoy the occasional cocktail or beer, you may be wondering about the connection between alcohol and diabetes. How much is safe to drink? Can alcohol make diabetes worse? Are some drinks safer than others?
Below, we’ll answer each of these questions, and offer some useful tips on drinking safely when you have diabetes.
Can people with diabetes drink alcohol?
The short answer is yes. However, there are significant risks. Alcohol consumption can worsen blood sugar control for diabetics, and heavy drinking can accelerate diabetes-related medical conditions. While moderate drinking is not always dangerous, people with diabetes should exercise general caution around alcohol.
How Does Alcohol Affect Diabetes?
Alcohol can affect blood sugar levels—either increasing or decreasing them depending on how recently you’ve eaten, and how much you tend to drink overall. It can also occupy your liver with other tasks that distract it from its role in regulating your blood glucose levels.
Long-term, alcohol can worsen common complications from diabetes, including nerve damage, eye disease, cardiovascular disease, and ketoacidosis. Finally, drinking to excess can increase your risk of developing diabetes in the first place.
Alcohol and Your Liver
Your liver has many jobs to do. Among them is storing glucose (blood sugar) in the form of glycogen. Typically, your liver converts glycogen to glucose when needed, helping to regulate your blood sugar levels. Your liver is also responsible for processing alcohol, which your body views as a poison. When you drink alcohol, therefore, your liver becomes occupied with eliminating it from your system.
While your liver detoxes your body of alcohol, it’s less focused on the job of releasing glucose, and this impacts your blood sugar management. For people with diabetes, this can contribute to either higher or lower blood sugar levels, depending on the situation.
Hypoglycemia and Alcohol
When you haven’t been eating recently, alcohol consumption tends to reduce blood glucose levels, resulting in hypoglycemia. This appears to be true for everyone, but it’s especially dangerous for people with diabetes. Because your body depends on glucose for its energy supply, low blood sugar can be life-threatening.
One of the biggest dangers of drinking on an empty stomach for diabetics is the similarity between symptoms of drunkenness and low blood sugar. If you’re drinking alcohol, you may not realize you have hypoglycemia until the situation becomes severe. Symptoms to look out for include:
- Blurry vision
- Lack of coordination
- Fast or irregular heartbeat
Intoxication may impact your ability to deal with these symptoms quickly enough, and make them come on faster. In extreme cases, seizures and unconsciousness are possible. And, especially for those with type 1 diabetes, full recovery can take time. Overall, it’s best not to drink alcohol without food if you are diabetic.
On the flipside, it seems that chronic alcohol use in well-nourished diabetics leads to increased blood sugar levels, or hyperglycemia.
More studies are needed, but there are several reasons why this might be the case. One possibility is that long-term, heavy drinking leads to increased insulin resistance, which can leave more glucose in the bloodstream. Another reason may be that alcohol stimulates appetite and reduces willpower, inspiring worse dietary choices and causing people to take their medicine later than they should.
Either way, chronic high blood sugar is a driving factor behind many diabetes-related illnesses. For long-term management of diabetes, it’s important to cut back on heavier alcohol consumption.
Moderate Drinking and Blood Sugar
Of course, most of the big changes in blood sugar levels discussed above are the consequence of excessive alcohol use. Moderate drinking doesn’t always have a negative impact on blood sugar levels. In some cases, it can actually improve glucose tolerance for people with diabetes.
The difference appears to be how often you drink. Regular alcohol consumption, even if it is moderate, can make it harder to control blood sugar levels and worsen long-term complications. Occasional drinking with a meal, however, can actually make it easier to manage blood sugar in that specific instance.
In other words, if you have diabetes you should avoid daily drinking. But if you want to have two glasses of wine when you go out for a nice meal, it’s probably safe so long as you take your usual precautions.
Alcohol and Diabetes Complications
Aside from worsening blood sugar control, alcohol can also make several common diabetes-related illnesses worse. These include diabetic ketoacidosis, cardiovascular disease, eye disease, and nerve damage.
- Diabetic Ketoacidosis- Ketoacidosis is caused by elevated levels of certain acids in the blood, due to high blood sugar and low insulin. Consequences can include nausea, vomiting, coma, and even death. People with type 1 diabetes are at higher risk for this, but it can also be caused or aggravated by heavy drinking.
- Cardiovascular Disease- Although moderate drinking may have a protective effect against heart disease, heavy drinking can increase your risk for various cardiovascular conditions. Cardiovascular disease is already the leading cause of death for people with type 2 diabetes. Drinking heavily may add fuel to the fire.
- Peripheral Neuropathy- Both diabetes and heavy alcohol consumption can cause damage to the nervous system, resulting in peripheral neuropathy. This commonly causes nerve pain in a person’s extremities, but it can affect other parts of the body as well. Alcohol and diabetes may actually worsen each other’s impact on this condition.
- Retinopathy- Over time, diabetes can damage the blood vessels in your retina, resulting in a loss of vision. While alcohol may not specifically cause retinopathy, it appears to cause other types of vision loss in people with type 2 diabetes, which can aggravate the issue.
Finally, alcohol can interfere with some diabetes medications, which can make both the condition and its complications harder to manage over time.
Can Alcohol Cause Diabetes?
Moderate drinking may not pose a risk, and may even lessen the likelihood of developing type 2 diabetes. Heavy drinking, however, can cause chronic inflammation of the pancreas, or pancreatitis, which in turn can reduce insulin production. Severe enough damage to the pancreas can result in diabetes.
Additionally, heavy alcohol consumption can cause type 2 diabetes by reducing your insulin sensitivity and contributing to weight gain. Overall, drinking in large quantities negatively impacts your health, and is among the significant risk factors for developing diabetes.
What Are the Best Alcoholic Drinks For Diabetics?
The best alcoholic beverages for people with diabetes are those with lower calories, such as light beer and dry wine. If you’re drinking liquor, stick with sugar-free mixers like club soda. It’s best to avoid most cocktails or craft beers, as these contain many empty calories that will increase your blood sugar.
Recommendations for Safe Consumption of Alcohol
The American Diabetes Association offers the following recommendations for drinking if you have diabetes:
- Limit your drinks: Women should stick to one drink per day maximum, while men shouldn’t have more than two.
- Drink slowly.
- Avoid consuming alcohol on an empty stomach.
- Don’t replace carbohydrates from food with alcohol.
- Stay hydrated.
- Check your blood sugar often. Alcohol can affect blood glucose levels up to 24 hours after you drink.
- Be aware that the symptoms of hypoglycemia are similar to those of drunkenness or hangovers. Wear a medical I.D. so that people know you are diabetic if you become ill.
Alcoholism and Diabetes
Regardless of whether you have diabetes or not, chronic, heavy alcohol consumption can have serious long-term health consequences. If you are diabetic and also struggling with alcohol use disorder, it is especially important to get help.
If you feel that your drinking habits are making it harder to manage your condition, Ria Health may have a solution. We use telemedicine to help you moderate or stop drinking from home. Our program gives you access to medical advice, prescription medications, recovery coaching, and digital tracking tools—all from your smartphone. You no longer need to turn your life upside down to find a healthier balance with alcohol.