The Centers for Disease Control and Prevention (CDC) reports that 11.6 percent of people in the United States have diabetes, including 29.7 million diagnosed cases and 8.7 million undiagnosed cases. The National Health Interview Survey (NHIS) shows that around 46 percent of the people diagnosed with diabetes also drink alcohol. When deciding whether to drink alcohol with diabetes, it is important to understand how alcohol affects the body, how to manage consumption safely, and the potential risks involved.
When deciding whether to drink alcohol with diabetes, it is important to understand how alcohol affects the body, how to manage consumption safely, and the potential risks involved.
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Alcohol Consumption and Food
When in the fed state (the time after eating while the body absorbs what is eaten), the impact that alcohol has on blood sugar levels will depend on the amount of alcohol that has been consumed.
Acute alcohol consumption, or the consumption of large amounts of alcohol in a short period, does not lead to drastic changes in blood sugar levels for people with type 1 and type 2 diabetes. In some studies, the consumption of alcohol in the fed state allows for blood sugar levels to decrease slightly when they would typically tend to rise after eating.
Long-term alcohol consumption can be defined as drinking large amounts of alcohol over a more consistent period. For women, this would be consuming four or more beverages on any day or eight beverages per week. For men, this would be consuming five or more beverages or fifteen beverages per week. Long-term alcohol consumption can lead to more adverse effects on the body. Drinking alcohol long-term can lead to hyperglycemia, or a high blood sugar level, for people that are well-nourished with diabetes. Being well-nourished with diabetes relates to diet, with meals that incorporate more fruits, vegetables, and whole grains while avoiding foods with extra carbohydrates, calories, and fat. For individuals with diabetes who are not well-nourished or have a lower-quality diet, hypoglycemia, or a low blood sugar level, can be a resulting impact of consuming alcohol.
A study was conducted that compared people with type 2 diabetes who were “habitual drinkers,” or people who consumed 3-4 alcoholic beverages per day, people with type 2 diabetes who did not consume alcohol, and a control group of people that did not drink or have diabetes. The A1C levels (which measure average blood glucose over the past 2-3 months) were highest in the group of habitual drinkers compared to the other groups.
Recent research shows that heavy alcohol use can have the ability to increase the risk of middle-aged adults developing type 2 diabetes. Two groups of middle-aged adults (ages 50-64) were placed into a “heavy drinkers” and “non-heavy drinkers” group, with their placement being determined by the U.S. Alcohol Use Disorders Identification Test. After analyzing blood samples from both groups, the heavy drinkers had higher fasting blood sugar levels, indicating a potential adverse effect of alcohol on blood sugar regulation in middle-aged populations. While liver and kidney function stayed relatively the same, the research suggests that excessive alcohol consumption may result in organ failure, the development of type 2 diabetes, and the development of other diseases as well.
Alcohol Consumption in the Fasting State
The fasting state, or the state in which all food has been digested and stored, can lead to instances of low blood sugar, known as hypoglycemia. This effect can be seen in people with and without diabetes after drinking alcohol on an empty stomach.
Alcohol-induced hypoglycemia occurs because the liver prioritizes breaking down alcohol over regulating blood sugar. The liver helps stabilize blood sugar by storing and releasing carbohydrates, but it also processes toxins, like alcohol, that enter the body. Since the liver can’t perform both tasks at once, it focuses on detoxifying the alcohol, which leads to a decrease in blood sugar levels.
One of the main risks of alcohol-induced hypoglycemia is hypoglycemic unawareness, a condition in which someone with diabetes cannot recognize an episode of low blood sugar.
General warning symptoms of low blood sugar include:
- Shakiness
- Weakness
- Slurring of speech
- Confusion
- Heart palpitations
While a person with diabetes can normally tell when they are experiencing low blood sugar, alcohol consumption can make it difficult to recognize these symptoms.
Other Complications of Alcohol Usage with Diabetes
Ketoacidosis: A condition that causes excess acids to stay in the blood. In people with and without diabetes who consume heavy amounts of alcohol (approximately 16 standard drinks per day), alcoholic ketoacidosis can occur. This can lead to various health effects, including:
- Nausea
- Vomiting
- Coma
- Death
Cardiovascular Disease: Alcohol can raise the amount of fat in the blood (known as triglycerides), which puts people at a greater risk for cardiovascular disease.
Peripheral Neuropathy: A condition in which the nerves responsible for controlling muscle function and transmitting sensations (such as touch) between the spinal cord, brain, and the rest of the body become damaged.
- Diabetes and alcohol consumption are the two most common causes of peripheral neuropathy.
Studies showed that men with diabetes who consumed three to four alcoholic beverages every night had a higher risk of peripheral neuropathy compared to men with diabetes who drank less.
Retinopathy: An eye disease that can be a diabetes-related complication and is one of the leading causes of blindness. When consuming alcohol heavily, the risk of developing retinopathy increases.
Medication Interactions: The consumption of alcohol while taking certain medications for diabetes can lead to further health complications, including adverse medication reactions and liver damage.
Alcohol and Carbohydrates
A common misconception is that alcohol is full of carbohydrates, which can raise blood sugar levels. The carbohydrate content in beer varies by brand, while most wines and spirits are low in carbohydrates.
To ensure the correct carbohydrate values for beer and wine, visit the brand’s website and read their nutrition facts label.
Spirits such as whiskey, gin, and vodka contain no carbohydrates, but they are often mixed with regular sodas or juices, which can be high in carbohydrates. To reduce the carbohydrate content, request diet sodas or mixers instead.
Alcohol and Carbohydrates
| Type of Alcohol | Amount of Carbohydrates (g) |
| 5 ounces of red/white table wine | 4g |
| 5 ounces of dry white wine | 15g |
| 5 ounces of bold red wine | 10g |
| 2 ounces of sweet wine (i.e. Port wine) | 32g |
| Spirits (whiskey, gin, vodka, etc.) | 0g |
| Beer | Dependent on brand |
Managing Alcohol Usage with Diabetes
Diabetes affects each person differently. Factors such as lifestyle, living and work environments, complications, and treatment plans all play a role in how someone manages their condition. Further, the consumption of alcohol is individualized and might affect each person differently.
To determine how much and how often you can safely consume alcohol with diabetes, always consult your doctor. They can provide personalized advice to keep you healthy and ensure that alcohol does not interfere with any prescribed medications.
The key to drinking with diabetes is moderation. As a general rule, women should only consume one serving of alcohol per day, and men should consume no more than two servings per day. One serving size of alcohol typically means:
- 12 ounces of beer
- 5 ounces of wine
- 1 ½ ounces of a distilled spirit
However, serving sizes of a drink can vary and it is important to check this information before consuming alcohol.
General Safety Tips for Consuming Alcohol with Diabetes
- Never drink alcohol on an empty stomach. This can lead to hypoglycemia and hypoglycemic unawareness.
- Check blood sugar levels more often after consuming alcohol. The effects of drinking alcohol can make it more difficult to recognize low blood sugar levels.
- Recognize the symptoms of low blood sugar. In the event of low blood sugar, always be prepared to:
- Carry a carbohydrate source to treat low blood sugar.
- Wear a medical ID bracelet at all times in case of an emergency.
- Stay mindful of lifestyle behaviors and daily routines.
- Keep your blood sugar stable by following a balanced diet.
- Stay active. Physical activity is important for managing diabetes as it helps lower blood sugar. However, increased exercise can lower blood sugar levels even further when consuming alcohol. Talk with your doctor regarding your risk for low blood sugar with activity, especially after consuming alcohol.
Resources
For more information, check out the resources listed below:
Healthy Snacking with Diabetes
Sources:
- American Diabetes Association. Alcohol and diabetes. Alcohol and Diabetes . https://diabetes.org/health-wellness/alcohol-and-diabetes
- American Physiological Society. (2024, April 5). Heavy alcohol use may increase type 2 diabetes risk in middle-aged adults. American Physiological Society. https://www.physiology.org/detail/news/2024/04/05/heavy-alcohol-use-may-increase-type-2-diabetes-risk-in-middle-aged-adults?SSO=Y#:~:text=Board%20of%20Directors-,Heavy%20Alcohol%20Use%20May%20Increase%20Type,Risk%20in%20Middle%2Daged%20Adults&text=Long%20Beach%2C%20Calif.,Summit%20in%20Long%20Beach%2C%20California.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
- Cirino, E. (2018). Alcohol intoxication: Acute, symptoms, treatments, signs, and more. Healthline. https://www.healthline.com/health/alcohol-intoxication
- Emanuele, N. V., Swade, T. F., & Emanuele, M. A. (1998). Consequences of alcohol use in diabetics. Alcohol health and research world, 22(3), 211–219.
- Mayo Foundation for Medical Education and Research. (2024, June 11). Diabetes diet: Create your healthy-eating plan. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295#:~:text=A%20diabetes%20diet%20simply%20means,fruits%2C%20vegetables%20and%20whole%20grains.
- University of California, San Francisco. (2012). Diabetes & alcohol. Diabetes Education Online. https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/diabetes-alcohol/
Authors: Abbie Politzer, UPIC Intern, Rural Health and Nutrition and Melissa Bales, Extension Associate, Rural Health and Nutrition
