Balancing diabetes and alcohol can be a tricky endeavor. Even in a non-diabetic, not only does alcohol affect certain people differently, different types of alcohol have very different effects on the very same person!
When you add diabetes to a night of drinking, things can get complicated, and even potentially dangerous.
For people with type 1 and type 2 diabetes who take insulin or other diabetes medications that lower blood sugar levels, drinking alcohol needs to be done thoughtfully.
In this article, we’re going to look at how alcohol affects blood sugar levels, when it can become especially dangerous, and how to drink alcohol safely as a person with diabetes.
How does alcohol affect your blood sugar?
The reason diabetes and alcohol is such a complicated combination is because your body essentially views alcohol as a poison that the liver must process immediately.
“Because the liver is busy dealing with processing the alcohol you drank, your body stops digesting and breaking down the food you ate,” explains Lisa Harris, CDE and RN at Rush University Medical Center in Chicago, IL.
“This means you have a much higher risk of having a low blood sugar even hours after eating and drinking, because you took insulin for food that isn’t being fully digested while alcohol is present.”
This is particularly true for people with type 1 or type 2 diabetes who are taking insulin or a medication that lowers blood glucose. For type 2 patients who are taking medications like metformin–which simply reduces the amount of glucose released from the liver, rather than increasing your insulin production–it’s unlikely that alcohol would cause low blood sugars.
“Imagine you take insulin for pizza, and you have 5 or more drinks,” explains Harris. “You could experience constantly recurring lows, lastly for even 12 hours, because your body stops breaking down the food you’re eating, and is much more focused on processing the alcohol and getting it out of your body.”
Meanwhile, however, many alcoholic drinks also contain a great deal of sugar. Some beers, dessert wines, cocktails like Cosmopolitans, and other liquor-based drinks with mixers like soda, juice or sour mix are all high in sugar. Trying to determine how much insulin you may need to dose for the sugar in your beverage while also anticipating a possibly sharp dip in your blood sugar hours after drinking is not easy or straight-forward.
Grams of carbohydrate in common alcoholic beverages
“It’s not that people with diabetes can’t drink at all,” says Harris. “I’d certainly rather my patients have a glass of dry wine or low-carb beer than a soda.”
And when it comes to guessing the carb-content in an alcoholic beverage, Harris says people too often make false assumptions.
“Wine, for example, whether it’s red or white doesn’t matter. It’s not the color that impacts the carb-content, but the level of fermentation because fermentation turns the sugar into alcohol. So that’s why the carbs in wine won’t impact your blood sugar as much that same carbohydrate amount from a glass of actual grape juice.”
Let’s take a look at the carbohydrate content of common alcoholic beverages, according to the Calorie King.
Red wines, per 5 fl oz/147 ml glass
- Merlot 3.7 grams
- Pinot noir 3.4 grams
- Shiraz Syrah 3.8 grams
- Zinfandel 4.2 grams
- Cabernet sauvignon 3.6 grams
White wines, per 5 fl oz/147 ml glass
- Chardonnay 3.8 grams
- Pinot grigio 4 grams
- Sauvignon blanc 2.7 grams
- Moscato 11.4 grams
- Dry riesling 5.5 grams
- Most dessert wines 15 to 20 grams
Sweet Liqueurs, per 1 fl oz/37 ml
- Amaretto sour 12 grams
- Bailey’s 7 grams
- Blue curacao 13 grams
- Cointreau 7 grams
- Creme de menthe 14 grams
- Grand Marnier 6 grams
- Kahlua 15 grams
- Southern Comfort 3 grams
- Samba 18 grams
- Find more here…
Beer, per 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
- Find more here…
Spirits, per 1 fl oz/37 ml
Most spirits (vodka, rum, whiskey, tequila) actually contain 0 grams of carbohydrates. Some flavored varieties, like Smirnoff Strawberry, still only contain fewer than 3 or 4 grams of carbohydrates, which is generally not a quantity you’d actually want to cover with insulin.
Mixers: Remember, the only mixers that don’t contain carbohydrates are club soda (aka. seltzer) and diet soda. Most other mixers, including tonic and sour mix, contain at least 20 to over 40 grams carbohydrates per 8 ounces.
Diabetes and alcohol is especially dangerous when…
Due to the unpredictable effects of alcohol on your blood sugar and insulin needs, there are two worst-case scenarios for a person with diabetes when consuming alcohol.
When you drink so much that you become unconscious or “blackout drunk”
While you’re unconscious, your blood sugar could begin to plummet as a result of the alcohol, having not eaten enough, and all of the other everyday causes of low blood sugar (like dancing wildly at a club with friends…while drinking). At this point, you’re not going to wake-up to the symptoms of a low blood sugar or be able to consume carbohydrates.
This puts you at severe risk for seizures or death because your friends think you’re just sleeping when you’re actually blackout drunk and suffering from severe hypoglycemia at the same time.
On the flip-side, you may become so drunk that you forget to take your evening long-acting insulin dose or you forget to dose insulin for the pizza and cake you ate a party. Then, while still unconscious, your blood sugar is rising to dangerously high levels, putting you at risk for diabetic ketoacidosis, coma, or death.
When you begin vomiting due to binge-drinking and alcohol poisoning
If you’re taking insulin or a medication that lowers blood sugar levels, and you start to vomit due a night of binge-drinking (or even an ordinary stomach virus), your body faces a dangerous mix of severe dehydration, inability to consume glucose to treat or prevent hypoglycemia, and either diabetic ketoacidosis or severe hypoglycemia.
When you start to vomit due to excessive alcohol consumption, it’s critical that you tell the friends you’re drinking with to help you test your blood sugar immediately, and potentially call 911 to get intravenous fluids and glucose if you’re unable to consume food or juice without puking again.
Severe dehydration in a person with diabetes can quickly lead to kidney failure if you are continuously vomiting, and unable to keep even plain water down. This is a sign that you need to get to an emergency room quickly by calling 911 or having a sober friend drive you.
Why your glucagon kit might not help while drinking
When you’ve started puking due to alcohol poisoning, you might think a glucagon kit would be the next best option to prevent a trip to the emergency room. Unfortunately, when alcohol is present, an injection of emergency glucagon isn’t going to be as effective as usual, explains a study published in the Endocrinology Advisor.
Should you still teach your friends (and yourself) how to administer emergency glucagon to use if you’re struggling with severe hypoglycemia and vomiting while drinking? Absolutely. But keep in mind that it isn’t going to raise your blood sugar nearly as quickly as it would when you are sober.
Tip: After properly mixing the ingredients per the instructions on your glucagon kit, you can use an insulin syringe to withdraw 10, 20, 30 units of glucagon and inject it into muscle or fat, signaling your liver to dump glucose and prevent seizures or death. It’s much easier to inject yourself using an insulin syringe than the terrifyingly large needle that comes with the kit. If someone else is administering your glucagon, they can also use a syringe.
How alcohol impacts your health with diabetes
Even if you don’t to the point of being drunk and vomiting, it’s still important to understand the way a couple of daily alcoholic drinks affect your overall health as a person with diabetes.
It contributes to type 2 diabetes and weight-struggles
“If you have type 2 diabetes, you have some level of metabolic disease, and adding the sugar and calories from alcohol to your regular diet is only going to contribute to your metabolic disease,” explains Harris.
For those already struggling with high triglycerides, the regular consumption of alcohol can significantly worsen your levels. Even just one or two drinks per night are 7 to 14 drinks per week and more than 40 drinks per month.
It’s harder to make good choices
“When you’re drinking, it’s simply harder to use good judgment and make good choices,” adds Harris. You’re more likely to choose cookies or vegetables, or more likely to eat far more cookies than your body can handle.
Even the morning after a night of drinking, you can find yourself craving greasy, heavy foods. It’s also pretty unlikely you’ll want to exercise that day, too. Even regularly drinking just one or two glasses of wine a night can have a large impact on your motivation to exercise the next day.
It wears on your entire body.
Regular drinking is not only going to make your blood sugars more difficult to control, it’s going to wear on your liver and your kidneys, both of which are already under greater stress if your blood sugars are higher than ideal.
If you already have diagnosed retinopathy in your eyes, regular drinking can worsen the health of the nerves and blood vessels in your eyes.
The long-term effects of regular alcohol consumption are well documented, but for people with diabetes, anything wears on us more noticeably because our body is already experiencing higher levels of inflammation along with blood vessel and nerve damage due to non-diabetic blood sugar levels.
The American Diabetes Association recommends that people living with diabetes follow the general guidelines for alcohol consumption:
- Men: No more than 2 drinks per day on average
- Women: No more than 1 drink per day on average
If you have kidney disease or liver issues…
If you’ve already been diagnosed with conditions relating to your kidney or liver function, Harris says alcohol truly is something you should avoid entirely.
The National Kidney Foundation says that while one drink on rare occasion for a person with existing kidney disease isn’t necessarily life-threatening, it isn’t going to help either. And they are very clear that “excessive drinking”–defined by more than four drinks daily–can absolutely worsen your kidney disease and be a life-threatening habit.
How to drink alcohol with diabetes safely
At the end of the day, no one expects you to abstain from alcohol for the rest of your life just because you’ve been diagnosed with type 1 or type 2 diabetes. And unless you have other health conditions that call for avoiding alcohol, there’s no reason why you can’t enjoy a refreshing glass of wine or unique microbrew now and then.
Here are a few guidelines to follow when drinking alcohol with diabetes:
If it’s your first drink as a person with diabetes, start with one drink
“If it’s your first drink as a person with diabetes, just start off with one low-carb drink like a dry red or white wine or a low-carb beer (like Miller Lite), don’t take insulin for the carbs in that drink. Eat a meal with it, and take insulin for the carbohydrates in that meal.”
And of course, check your blood sugar often! Then, take notes on what happens so you have a reference for next time.
Check your blood sugar before, during, and after drinking
The more alcohol you drink, the more you should check your blood sugar during the 10 to 12 hours after drinking. “If you drink one alcoholic beverage,” explains Harris, “it’ll take your liver about 1.5 hours to process it. But if you drink two alcoholic beverages, the time it takes to process doubles to 3 hours.”
The more you drink, the more hours it takes for your body to deal with all of that alcohol.
Teach your friends and family about alcohol and diabetes management
Even if it’s your first week at college with brand-new roommates, it’s critical that the friends you’re going to parties with know they can never let you just “sleep it off” if you pass out on the couch after a lot of alcohol.
They should try to wake you up to be sure you are not “blackout drunk” and insist that you check your blood sugar and think about any medications you still need to take. If they discover that you are “blackout drunk” and unresponsive, they should call 911.
The risk of experiencing a severe low blood sugar after that much alcohol is too high to risk hoping you wake up feeling fine in the morning.
Choose drinks that are generally lower in carbohydrates
Ordering a sugar-laden cocktail is sort of asking for trouble because you’re combining a lot of fast-acting carbohydrates with liquor that’s going to potentially cause a sharp drop in your blood sugar hours after drinking.
Instead, choose dry wines (red or white), cocktails with sugar-free mixers (diet soda or club soda), lighter beers.
And avoid (or be prepared to manage insulin around) choices like dessert wines (Moscato, Zinfandel, some rose, and some rieslings), alcoholic ciders, and cocktails mixed with tonic, sour mix, juice, and soda.
Take notes on how much insulin you took for different types of alcohol
“Everybody’s a little bit different, so you can’t just copy how a friend with diabetes manages their insulin around a glass of wine,” says Harris.
For some people, one glass of wine at 9 p.m. can cause a significant drop in blood sugar at 4 a.m. And for others, nothing happens at all! It’s crucial that you approach each type of alcohol with an awareness that it might affect you differently than the last type of alcohol you drank.
Beer, for example, varies in its carb-count but those carbs are coming from a very starchy source–grain. So you may find that one bottle of beer calls for 1 unit of insulin while two glasses of pinot grigio doesn’t require any insulin.
Harris wants to remind us all again to keep track of how many drinks we’ve had, too, because the more you drink, the more work your liver has to do to process that poison. And that means more time spent with alcohol impacting your blood sugars, too.
Eat food with your drinks
Even if you’re eating an entirely low-carb meal, eating a little peanut butter or cheese or mixed nuts with a few glasses of wine can help prevent or reduce the drop in your blood sugar hours later.
Generally, eating a meal with your drinks is critical, and ideally, that meal would contain a few carbohydrates, too. For high-carb meals, you will need insulin for a large majority of those carbs. The more complicated the meal (hello lasagna or Chinese food, high in both fat and carbs), the more complicated dosing your insulin around that meal with alcohol onboard too will be.
Take your medications before you’re too tipsy!
If you normally take your long-acting insulin dose every night at 10 p.m. but you’re downtown with your friends and plan on having quite a few drinks, take your long-acting insulin as close to normal as possible without risking forgetting entirely. Taking your long-acting insulin at 8 p.m. will have essentially no noticeable impact on your blood sugars, especially if it means you made sure to take it before the night got too rowdy.
If you are vomiting from alcohol…
If you begin to vomit because of excessive alcohol consumption, it’s critical to first test your blood sugar and test your ketone level. Whether you have ketones or not, next it’s important to try drinking water to replenish the fluids you lost and prevent dehydration.
If you did have large ketones, and you’re unable to keep fluids down, you should call 911 or ask a friend to drive you to the emergency room. The only way to safely rebalance your hydration, blood sugar, and ketone levels is an intravenous bag of saline, electrolytes and possibly glucose and insulin.
Even if you don’t have ketones, repeated puking and the inability to keep water down means you need to get to the emergency room quickly. Don’t be embarrassed, don’t hesitate. Just get the help you need. It’s not a fun part of life with diabetes, but it’ll keep you alive.
Patients share: This is how I manage diabetes and alcohol
We asked people with type 1 diabetes on Twitter how they personally manage diabetes and alcohol. Their experience and approach to alcohol is not medical advice for your own diabetes management. Here’s what they had to say:
“Winner answer: check your blood sugar. Repeat. Repeat. Repeat.” Notas Sobre T1D
“As much as I love red wine, I’ve discovered through experience that it tends to make my blood sugars plummet overnight or the next day. I stick to low-carb beer and I have smooth sailing…no highs, no lows.” Chris Miller
“After 13 years of living in Madrid, Spain, wine is just like water at dinner. And I have several glasses every night. It doesn’t affect my sugar level at all. I guess I’m lucky and a wino!” Richard Nazarewicz
“I drink IPA beers and usually see a blood sugar spike after the first one, so I bolus for 15 to 20 grams, and keep taking a look at my blood sugar as I have a second or maybe third.” Douglas
“Always cheesy chips before bed, and don’t put in any insulin for the whole evening. Would always rather be very high for one night than very low the next morning.” Christie Roberts
“One time, I was in one of those inexplicable chronic low blood sugar situations while on vacation (I think from all the extra activity). I finally made the best of it and treated the lows with Mai Tais! Others drank with me in “sympathetic support of my chronic hypos.” Donna Hill
“I always test before I go to bed. Depending on what time that is, and quantity of alcohol I consumed, I set my alarm for a few hours thereafter to check my blood sugar! I always have some chocolate and glucotabs with me just in case. This old head learned lessons from those young days of drinking and not caring really…” Shiv Gaffney
“Red wine does not affect my blood sugar. Spirits lower my blood sugar in the hours after drinking. Beer sends me up, so I run an increased basal along with loads of blood sugar checks, especially 3 a.m. and 5 a.m.” Andy Griffin
“Lots of scanning with my Freestyle Libre glucose sensor. I usually reduce my basal rate overnight. The next morning, I don’t do full bolus for breakfast.” Gayle Devlin
“Hats off to you all still being able to keep your blood sugar in target, or even going low when drinking. I tend to find I go high, and when I drink I have veggies near me. I would like to have crackers or chips, but my blood sugars go all over the place. I try to keep it to one drink with veggies or fruit.” Joel Wijey
“I avoid it, mostly. Small drink here and there, but I played with fire in college and recognize the stupidity now. One drink is social enough for me!” Brianna Wolin
“I try to limit myself to no more than two drinks, or else I tend to go low during the night.” Sportster
“I choose wine or spirits, and I leave the house with a few servings of treatments for low blood sugars. And I have a late-night kebab without a bolus to even it all out and wake up at 5.5 mmol/L.” Georgie
“I need to have lots of snacks. I like something like an Oh Henry bar or toast and peanut butter, something with sugar and fat. I’m on Tresiba, and don’t alter the dose because it just complicates my blood sugars the next day.” Shnoune
“I don’t really check while drinking, but I make sure I have a snack before hitting the sack.” Type 1 Traveller
“I tend to do a slightly reduced basal while I’m out but it depends on what I’m drinking. Malibu, for example, sends me high, but Jack Daniels and Vodka make me drop after just one drink. I always eat something at the end of the night, and I don’t always inject insulin for it. It depends on my blood sugar at the time. I do loads of tests through the night, and everyone I’m out with has a tube of glucogel, just in case. They all know what to do, and they check on me in the morning. Basically my strategy is: drink with good friends, reduce my insulin, eat some food with the drinks.” Kate Sired
“I always check my blood sugar a little more than usual and watch-out for the blood sugar drop overnight. I also always carb-up before bed. Who doesn’t love some chips on the way home right?” Type1Bri
“A glass of red wine isn’t a disruptor for me. Find what works for you and stick with it.” Jewels
“Using a CGM makes all the world of difference. I tend to stick to lower-carb alcoholic options, so I don’t have to bolus insulin for them, leaving less insulin in my system overall. I also eat some type of protein and fat snack before bed. Those seem to work for me.” Morgan Garretson
“I drink vodka waters and add sugar-free Crystal Lite. I always try to make sure I’m snacking on something as well. I have emergency snacks just in case and make sure someone else checks in on me throughout the night.” Sam Bahr
5 things to remember about alcohol & diabetes
Alcohol and diabetes can be a tricky combination, but it’s absolutely possible to enjoy drinking responsibly if you remember these guidelines:
- Check your blood sugar regularly! Before, during, and after you drink.
- Consider reducing the insulin dose of fast-acting insulin for meals while drinking to prevent low blood sugar hours after you’ve finished drinking.
- Choose low-carb drinks like dry wines, light beer, or cocktails that contain sugar-free mixers like diet soda or club soda.
- Be sure to teach your friends and family about the signs of hypoglycemia, how to help you if you’re struggling with alcohol poisoning, and that they should never let you “sleep it off” if you are unconscious and unresponsive.
- Be smart. Limit your alcohol consumption ideally to no more than 2 to 3 drinks, with a strict cut-off at 5 drinks if you do intend to drink more heavily.
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