Alcohol and diabetes
Diane Kress
Written by Diane Kress

For many years, alcohol consumption for those with type 2 diabetes was considered a “no- no.”

Alcoholic beverages had been labeled high in empty calories and loaded with sugar.  Alcohol was black listed for hastening diabetes complications and adding to weight- related medical issues. For the most part, those with diabetes were advised to abstain from drinking alcohol.

Time, research, and knowledge marches on.  With physician approval, based on a patient’s individual medical history, controlled alcohol consumption is typically allowed for those with reasonably controlled diabetes.

How many alcohol containing drinks per day is considered controlled consumption?

Occasional mild alcohol consumption does not have a marked negative effect on blood glucose. The recommendations for alcohol consumption are the same for those with or without a diagnosis of diabetes: women should consider one alcohol containing drink per day and men should not exceed a maximum of two drinks in a day.

What size is considered a serving of alcohol?

  • 1.5 ounces of distilled spirits such as gin, vodka, rum, Scotch, or whiskey
  • 5 ounces of most wines or champagne
  • 12 ounces of lite beer.

 But isnt alcohol all carbohydrate?  

It’s true that the base ingredient in alcoholic beverages is carbohydrate…but the story does not end there.

  • Wine = grapes
  • Vodka = potatoes or grain
  • Gin = juniper berries
  • Whiskey = corn or rye
  • Beer = wheat
  • Scotch = malt
  • Bourbon = corn
  • Tequila = agave
  • Rum = sugar cane

If alcohol is made from carbohydrate, it will wreak havoc on blood glucose, right?

Surprisingly, in the process of manufacturing alcohol; through either distillation or fermentation, the majority of the wine, spirits, or beer’s chemistry changes from carbohydrate to alcohol. Alcohol does not follow the metabolic pathway of carbohydrate; it follows the metabolic pathway of fat. Just as fat does not have a great impact on blood sugar rise, neither does alcohol.  So, most wines are not considered to be carbohydrate.  Neither is rum, whiskey, gin, or Scotch!

My blood sugar wont skyrocket after having alcohol?

It’s not the alcohol that will cause your blood sugar to rise after a drink or two. It’s the high carbohydrate content in the sweetened mixers, juice, or regular soda used to make sweetened drinks like margaritas, cosmopolitans, daiquiris, and flavored martinis. If you have diabetes, don’t mix alcohol with sweetened mixers, juice, or regular soda.

If you have diabetes and take medication to control blood glucose be aware that alcohol can cause a temporary decrease in blood sugar. When alcohol is consumed, the liver must take a break from releasing glycogen (sugar) into the bloodstream and take on the role of detoxing alcohol from the blood. During this detox time, your blood sugar may actually drop!  Many people have tested their blood sugar after having a few drinks (wine, spirits, light beer) and are shocked to see normal or low blood sugar before going to bed. This is because the liver is still busy in the detox mode.

But…once the liver is through cleansing alcohol from the blood, it will resume its normal self-feeding function and release glycogen stores into the blood. As blood sugar might be lower than normal at this time, the liver dumps extra stored sugar to bring the level up quickly. This is why your blood glucose may be normal at bedtime (after a drink or two), but elevated the morning after a night of alcohol consumption.

What should I eat before or during a night of drinks?

 Because alcohol can play roller coaster with your blood sugar, it is recommended to avoid the sweetened alcoholic beverages and eat some carbohydrate and protein before or while you drink. A small amount of cheese and crackers, fruit and cheese, pretzels and dip are good choices in the course of a night when alcohol is consumed to support blood sugar during the time the liver is cleansing alcohol from the blood.

I take insulin to control my blood glucose. Do I have to be concerned with low blood sugar?

If you have diabetes and are on medication to lower your blood sugar (oral medication or insulin), make sure to carry something to treat hypoglycemia.  3-4 glucose tablets can treat hypoglycemia (blood sugar under 70mg/dL).

You should check your blood sugar before you have a drink or two and then make certain to recheck it if you feel symptoms of low blood sugar (shaking, dizziness, cold sweat, mood swings) and definitely before you even consider driving.

Also, if you take medication for blood sugar control, don’t mix alcohol and exercise. Playing basketball and drinking a few beers will increase your chance of becoming hypoglycemic.

What can be done to help prevent or treat hypoglycemia caused by alcohol?

For the average person, it takes two hours to metabolize one drink. If you drink alcohol faster than your body can metabolize it, like two drinks in two hours, excess alcohol will accumulate in the bloodstream and reach your brain.

The symptoms of getting tipsy (a little drunk) and the symptoms of hypoglycemia can mimic each other. Whether you are tipsy or hypoglycemic, you don’t belong behind the wheel of a car.

It’s important for emergency personnel to be aware that you have diabetes as they may overlook hypoglycemia if they feel you are intoxicated.  If you are going to drink alcohol and you take medication that lowers blood sugar (like insulin, Prandin, Glyburide, Januvia, Glipizide, etc) you should wear a medical ID and/or keep medical ID in your wallet next to your license.

Especially if you are on medication for diabetes, don’t drive for several hours after drinking alcohol as your blood glucose may drop without you realizing it. If you have waited awhile and are going to drive, check your blood sugar first. (Blood glucose should be 100-120mg/dL when you get behind the wheel to drive). Just like anyone else, it’s best to have a designated driver or cab bring you home after drinking.

Don’t forget to check your blood sugar before you go to bed for the night. It should be 100-120 at bedtime. If it is lower, eat a snack of carbohydrate and protein.

Alcohol is a diuretic?

Alcohol is a diuretic and causes you to lose more fluid than you drink. If you drink a rum and diet Coke, or vodka and a sugar free energy drink, both the alcohol from the liquor and the caffeine from the cola or energy drink will cause you to lose more fluid than you take in. Remember to drink water before drinking, between drinks, and after drinking to prevent dehydration.  Those with blood sugar issues must be careful to remain hydrated.

What are some good drink choices for those with diabetes?

If you are a beer drinker, choose light beer. It is lower in alcohol, calories, and carbohydrate.

Most red and white wine as well as champagne is low in alcohol and very low in carbohydrate. Adding sparkling water to wine makes a wine spritzer and cuts the alcohol in half.

If you prefer mixed drinks, choose calorie-free mixers like diet soda, club soda, diet tonic water, carb free mixers, coffee, unsweetened tea, or sparkling water. Flavor infusers like Mio™ or Propel fitness water drops ™ can also be added to spirits to impart flavors like pomegranate or strawberry for flavored vodka martinis.

You might also squeeze some fresh lemon or lime to lend zest and flavor to water and mixed drinks.

Alcohol is a part of adult life. It is present at parties, celebrations, dining out, visiting friends, and a day at the beach, or tail gating before the big game. Those with metabolic issues, especially those with diabetes who take medication that lowers blood sugar, must know how to deal with blood sugar fluctuations caused by alcohol. If you choose to drink, drink smart! And remember to check with your doctor or health care provider to see if an occasional alcohol containing beverage is safe for you!


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About the author

Diane Kress

Diane Kress

New York Times bestselling author, Diane Kress, RD, CDE, is a registered dietitian and certified diabetes educator with more than thirty years experience specializing in weight reduction, metabolic syndrome, and type 2 diabetes. She owns and directs her private practice; The Nutrition Center of Morristown and currently works out of Naples, Florida.

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