Alcohol and Diabetes


Is it okay to drink alcohol if you have diabetes? Ginger Vieira explains how alcohol can affect your blood sugar.


Enjoying the occasional glass of wine or pint of beer as a person with diabetes shouldn’t be off-limits, but it’s important to know the effect alcoholic beverages can have on your blood sugar. And it isn’t as simple as counting carbohydrates either. Whether you plan on having 2 drinks or 7, it’s critical to know what alcohol can do to your blood sugar because not knowing can risk your life. 

Let’s take a closer look at what you need to know when it comes to drinking alcohol safely as a person with type 1 or type 2 diabetes. 

What happens when you drink alcohol

No matter how good it might taste, that drink is a poison. Even if that wine is made with organic grapes or that beer was brewed with the highest quality whole grains, it still contains a poison by the time it reaches your lips: alcohol.

When alcohol is present in the body, your liver takes its job very seriously by working to eliminate that alcohol you’ve consumed as quickly as possible. 

While it’s wonderful that your liver jumps into action so quickly to take good care of you, it can come with tricky consequences for those of us with diabetes who take insulin or non-insulin medications that lower blood sugar.

Your liver is working so hard to rid your body of that poisonous alcohol, your stomach actually stops (or slows down) the rate of digestion for the food in your belly.

What can happen when you eat a big meal with alcohol

Picture this: you just ate dinner which included 60 grams of carbohydrates and 3 glasses of wine. You took 6 units for the meal along with 1 unit to cover the 15 grams of carbohydrates from a total of 3 glasses of wine.

But, at the time your insulin is kicking in, your stomach isn’t actually digesting your meal at the rate it normally would. Instead, more of your body’s energy is going towards your liver so it can process and eliminate all of that alcohol. 

This means your insulin dose is going to start dropping your blood sugar quickly, putting you at a higher risk of serious hypoglycemia. 

Drinking high-carb alcoholic beverages

This is where it gets more complicated -- whether or not you eat a meal with your drinks -- because while wine is fairly low-carb, many other delicious drinks are not. 

What if you are an insulin-user drinking Cosmopolitans or a margarita containing sugar-laden sour mix?

Now you’re trying to dose insulin for the sugar in your beverage while also estimating how delayed the impact of the sugar may be due to the presence of alcohol in your bloodstream.

Drinking low-carb alcoholic beverages

And what if your drink contained zero sugar and you didn’t eat any food with it? You can still experience low blood sugars because it can interfere with your liver’s normal glycogen (glucose) output. This is why it’s actually recommended that you eat something when you drink!

The more alcohol you drink, the more likely you’ll experience a low blood sugar in the 6 to 8 hours after you started drinking.

Drinking alcohol safely as a person with diabetes

For a person with diabetes -- especially all people with type 1 diabetes and those with type 2 who take insulin -- one night of too much alcohol can easily become life-threatening or fatal.

On top of the regular risks that everybody needs to keep in mind, there are two particular consequences of alcohol that people with diabetes need to be extremely cautious about experiencing. 

If possible, these two situations should be avoided entirely. But like anyone else, it can take a few nights of “too much” to learn our limits. As a person with diabetes, it’s important to learn your limits with alcohol quickly, and then respect those limits.

Drinking alcohol to the point of “blacking out”

We’ve already discussed the effect alcohol can have on your blood sugar hours after drinking, but what if you’re “blackout drunk” and unable to wake-up to the symptoms of low blood sugar, and unable to think logically and care for yourself?

Getting blackout drunk is extremely dangerous for a person with diabetes. You could forget to take your insulin, forget to re-attach your insulin pump, forget to dose for food eaten, not notice symptoms of high or low blood sugars.

This degree of excessive drinking is extremely dangerous.

It’s important to teach your friends how to support you if you do become blackout drunk. You should never let someone with diabetes just “sleep it off” because no one knows if that person’s blood sugar is safe or not.

Think about teaching your friends when they should call an ambulance, or even when they should encourage you to stop drinking, to check your blood sugar, and to drink some water.

It’s also important to note that someone this drunk will likely start vomiting at some point, too. Which brings us to danger #2: drinking alcohol to the point of vomiting.

Drinking alcohol to the point of vomiting

You may recall the dangers of a stomach bug or flu for someone who takes insulin -- you dose insulin for a meal, and then puke up the food before it’s been digested, leaving you with a load of insulin in your bloodstream and no extra sugar from food for it to absorb.

This can lead to severe low blood sugars.

On the flip side, repeatedly vomiting quickly leads to dehydration -- even more so if your bloodstream is flooded with alcohol.

Dehydration for someone with type 1 diabetes can quickly put you into a state of diabetic ketoacidosis which can quickly become fatal if you try to “tough it out” at home. Severe dehydration can lead to extremely high blood sugars that will not come down without intravenous fluids.

Repeated vomiting for people with type 1 diabetes or type 2s who take insulin should warrant an immediate trip to the emergency room for intravenous fluids and potentially having your stomach pumped.

This is another important conversation to have with your friends: if you start vomiting due to alcohol poisoning, it’s likely time to call an ambulance.

What about emergency glucagon kits?

It’s always wise to carry an emergency glucagon kit in your purse if you’re planning on doing a lot of drinking, but what if you’re the only person at the party who knows how to use it?

As the awesome Will Dubois explains at DiabetesMine, your emergency glucagon kit won’t work very well to treat severe low blood sugars when you’re drunk. 

In short: glucagon kits rely on your liver to dump stored glucose in order to help you recover from severe hypoglycemia -- or to prevent severe hypoglycemia, like when you’re puking repeatedly from alcohol poisoning.

But remember what we talked about earlier? When alcohol is present in your body, your liver focuses on one thing only: processing all of that alcohol. And this can take several hours for every single serving of alcohol you consumed.

Your liver will not respond normally to an injection of glucagon from your emergency kit if your body is overwhelmed by alcohol. Should you still try? Sure, it can’t hurt, but more likely, what you’ll need is a trip to the emergency room to receive glucose and other lifesaving fluids via an IV.

Drinking alcohol as a person with diabetes can be done! Lots of us do it! But you need to be smart. Because being careless can easily be fatal. 

What’s in a glass: Carbohydrate content of most common drinks

Determining the nutrition content of an alcoholic beverage can be tricky because some sweetly flavored booze contains zero calories and not-so-sweet things contain a good amount. Or wine, for example, has a reputation for red being low-carb and white being high-carb, but there are plenty of reds that contain 10 or more grams of sugar in a glass, and plenty of whites that contain a mere 3 grams per glass.

Wine 

If you’ve avoided white wine because someone told you it contains more sugar, take a minute to look more closely at what you’d actually like to order and its real carb-content.

The amount of sugar in wine isn’t about the color. Instead, it’s about the amount of fermentation. Just like the varying content of sugar in kombucha, the more fermentation a wine has endured, the more the sugar from the grapes has been broken down and turned into alcohol. 

Here’s the estimated carbohydrate content of common wine selections according to the Calorie King:

Red wines, serving: 5 fl oz 

  • Cabernet Sauvignon 3.6 grams

  • Merlot 3.7 grams

  • Pinot noir 3.4 grams

  • Shiraz Syrah 3.8 grams

  • Zinfandel 4.2 grams

White wines, serving: 5 fl oz 

  • Chardonnay 3.8 grams

  • Moscato 11.4 grams

  • Dry riesling 5.5 grams

  • Dessert wine 15 to 20 grams

  • Pinot grigio 4 grams

  • Sauvignon blanc 2.7 grams

Sweet Liqueurs (not to be confused with liquors!)

This is where the sugar is. Liqueurs are generally used to sweeten a drink and give it a fun flavor. But beware, liqueurs contain a good wallop of sugar in only 1 fluid ounce, so pay attention to how many drinks you have and how many servings of liqueurs are in each drink.

Sweet Liqueurs, serving: 1 fl oz

  • Amaretto 19 grams

  • Bailey’s 7.4 grams

  • Blue curacao 7 grams

  • Cointreau 7.4 grams

  • Creme de menthe 22 grams

  • Grand Marnier 6.4 grams

  • Kahlua 14.7 grams

  • More liqueurs

Beer

Now beer is a real hodge-podge of carbohydrate content because there are truly no consistent parameters to rely on. Some cheap beer contains very few carbs, while some very high-quality beer contains the same amount as a cheap beer!

Let’s take a look at a few common options...

Beer, serving: 12 fl. oz/1 bottle

  • Budweiser American Ale 18 grams

  • Blue Moon 13 grams

  • Bud Light 6.6 grams

  • Miller Lite 3.2 grams

  • Coors Lite 5 grams

  • Stella Artois 12.8 grams

  • More beer options

Liquor, serving per 1 fl oz

Technically, your basic liquor options -- tequila, rum, whiskey, vodka, etc. -- are actually completely void of carbohydrates. 0 grams of carbohydrates!

Do keep in mind that flavored versions -- like pre-mixed Smirnoff flavors and Bacardi Razz -- can contain anywhere from 2 to 8 grams of carbohydrate.

And of course, there are “mixers” like soda, sour mix, tonic, and juice. Unless you’re drinking a diet soda, all of these mixers contain an average of 30 grams of carbs per serving or more. The sugar from these mixers will absolutely spike your blood sugar if you don’t cover at least some of the grams with insulin.

Why not cover all the carbs just like you would with food? Again, this comes back to trying to anticipate the combination of total carbohydrates consumed from beverages and food, total insulin dosed, and how much alcohol you consumed. 

The more alcohol you consume, the more likely you’ll experience a sharp drop in your blood sugar in the 4 to 8 hours after you began drinking.

Dosing insulin when you’re drinking alcohol

The annoying thing is that we’re all different. One glass of wine can cause a significant drop in your blood sugar 6 hours after drinking but have little to no effect on my blood sugar. So that means it’s important to do a little self-study when you’re drinking.

How does 1 glass of wine affect your blood sugar if you don’t take any insulin for those carbs?

How does it affect you when you drink on an empty stomach versus with food?

These are just a few of the variables you’ll want to pay attention to when you’re drinking and taking insulin. 

Some people find that eating 10 or 15 grams of carbohydrates right before they go to bed -- without covering those carbs with insulin -- helps to prevent that drop in your blood sugar. 

Start small and think wisely about how much you’re drinking. This isn’t a lecture about your health, it’s about making sure you are still alive in the morning. It’s serious. It’s real. It’s something you should engage in with great responsibility and respect for your personal limits. 


The information in this article is not medical or nutritional advice. If you have questions about how alcohol fits into your diabetes management, please consult with a medical professional or nutritionist.




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