Alcohol and Diabetes

Alcohol and Diabetes

Summary

Though moderate consumption of alcohol may have health benefits for some people, excessive use can lead to many health conditions or worsen complications that patients already face.

Drinking alcohol is not a wise choice for everyone. Some conditions and medications are not compatible with alcohol. Many people with diabetes can safely consume moderate amounts of alcohol under certain conditions. Diabetes patients should consume alcohol only when:

  • Their physician has decided it is safe for them
  • Their diabetes is under control
  • They are aware of how alcohol can affect them and their diabetes
  • They have eaten first

Patients should not exceed their physician’s guidelines for consumption. The general recommended daily maximum is one drink for a woman and two drinks for a man.

Alcohol can increase the risk of diabetic complications including neuropathy, retinopathy and sexual dysfunction. It interferes with glucagon, an emergency treatment for severe hypoglycemia. Some patients may be instructed to abstain from alcohol, such as those with hypoglycemia unawareness or gastroparesis.

Patients who decide to consume alcohol must prepare themselves and the people around them for the risk of hypoglycemia. This risk is greatest for people taking insulin or antidiabetic agents.

Patients trying to control their weight will also have to incorporate the additional calories from the alcohol into their meal plan.

For nondiabetics, heavy use of alcohol is a risk factor for diabetes as well as other diseases. Yet some research indicates that modest consumption of alcohol may help prevent diabetes and some other conditions, such as heart disease.

About alcohol & diabetes

Many people do not think of alcohol as a drug. However, alcohol is a drug that affects the body in various ways, depending on the dose. Blood alcohol concentration (BAC) is the amount of alcohol present in a person’s bloodstream. It is determined by the speed of consumption as well as the drinker’s weight, sex, build and metabolism.

As the BAC increases, the brain and spinal cord (central nervous system) show progressively less activity. A BAC of 50 mg/dL (milligrams per deciliter) of blood, for example, usually leads to a state of mild intoxication. A BAC of 100 to 150 leads to slurring, loss of balance and other signs of intoxication in most people. Coma is likely at a BAC of 350, and death will probably occur at 500.

Through a process called oxidation, alcohol is detoxified and removed from the blood. The higher the BAC, the longer this process takes and the longer normal bodily function and activity are affected. Alcohol is metabolized (broken down) from the body more slowly than it is absorbed. The more an individual drinks, the harder the metabolism works to break it down so the body can absorb it before intoxication and even poisoning can occur.

The effects of alcohol are also influenced by an individual’s mental and emotional state, individual tolerance for alcohol and the presence of other medications in the body at the time of consumption. The amount and type of food in the stomach before drinking alcohol is also a factor in the rate of absorption into and elimination from the body.

When deciding whether or not to drink, people should consider the potential effects alcohol may have on their health. For people with diabetes, this decision is especially important.

Occasionally drinking alcohol is normally acceptable as long as the patient’s diabetes is under control and the patient is aware of alcohol’s potential effects. It is extremely important for patients to discuss alcohol with their physician. Certain medications do not mix well with alcohol, and alcohol can worsen some medical conditions. Patients should consume alcohol only if their physician has agreed that it is safe.

As with the general population, diabetic women should avoid alcohol during pregnancy or when trying to become pregnant. Diabetes patients should also avoid alcohol if they suffer frequent episodes of hypoglycemia or hypoglycemia unawareness. Patients with certain medical conditions including pancreatitis, liver disease and, of course, alcoholism also should not consume alcohol.

A diabetic complication that may rule out use of alcohol is a gastroparesis, a form of autonomic neuropathy that affects the stomach. Furthermore, alcohol can worsen or increase the risk of developing diabetic neuropathy and other complications, including diabetic retinopathy, lipid problems and erectile dysfunction, according to the American Diabetes Association.

It is primarily the liver’s job to break down alcohol in the body. It takes the liver about one hour to metabolize 1/2 ounce (15 milliliters [ml]) of alcohol. For an average man, the body would require about two hours to metabolize 1 ounce (30 ml) of alcohol, the typical amount in one drink. When a person consumes alcohol at a faster rate than the liver can break it down, the alcohol moves through the blood to other areas of the body.

As a general guideline, men should consume no more than two drinks a day and women no more than one drink a day. Women are allotted less alcohol because they metabolize it at a slower rate. One drink is defined as:

  • One 12-ounce (355-ml) bottle of beer or wine cooler
  • One 5-ounce (148-ml) glass of wine
  • 1.5 ounces (44-ml) of 80-proof distilled spirits

Patients are advised not to exceed this recommendation – or an amount specified by their physician – because doing so can quickly lead to hypoglycemia. Because alcohol cannot be used by the body as a source of glucose (blood sugar), it should be consumed with a meal or large snack.

The risk of alcohol causing low glucose is greatest for people taking insulin or antidiabetic agents because these medications are already working to reduce glucose levels. The risk of hypoglycemia is significantly less in people with type 2 diabetes who control the disease with exercise and meal planning alone.

Potential benefits of moderate alcohol use

For people with the approval of their physician, drinking light to moderate amounts of alcohol may have a number of health benefits. Some research has linked light to moderate drinking, particularly red wine (no more than one drink a day for women, two for men) to a decreased risk of type 2 diabetes, heart disease, stroke and some cancers, such as lymphoma.

Such findings are not without controversy. In 2006, researchers reviewed 54 studies touting cardiovascular benefits of light drinking and found that only seven of them distinguished between people who abstained from alcohol by choice and those who might have stopped drinking because of health concerns. Higher death rates found in nondrinkers could be due to the poor health of those who recently had to stop drinking, the analysis concluded.

However, authorities such as the Harvard School of Public Health say moderate drinking can help prevent diabetes. And two recent European studies, one involving nearly 370,000 people for an average of 12 years, support this assertion.

Moderate drinking also raises levels of HDL (“good”) cholesterol and has been linked to increased insulin sensitivity. In 2005, data from the third National Health and Nutritional Examination Survey (NHANES) indicated that moderate drinking may reduce the risk of metabolic syndrome.

Recent research suggests that a drink or two a day may help cut the risk of artery disease among people with type 2 diabetes. The study found that light to moderate drinkers showed less artery stiffness compared with either nondrinkers or heavy drinkers. Arterial stiffness increases as the blood vessel disease atherosclerosis progresses, and it can lead to heart attack or stroke.

Exactly why moderate drinking was linked to less artery stiffness is unclear. It may be associated with the increase of HDL cholesterol. At this point, medical experts do not recommend that nondrinkers begin drinking alcohol for better health.

Potential risks of alcohol use

People with diabetes who have their physician’s approval to consume alcohol should remain aware of how alcohol can affect their body. Patients should be aware of the following factors:

Alcohol can worsen some medical conditions. Individuals with diabetes who suffer from certain conditions may be advised to avoid alcohol completely. These conditions include:

  • High blood pressure. Heavy (more than three drinks a day) and regular use of alcohol can increase a person’s blood pressure.
  • Neuropathy. Alcohol is toxic to nerves and can make nerve damage worse. Heavy or regular consumption of alcohol can increase the pain, burning, numbness and tingling associated with nerve damage. There is also evidence that even light drinking (less than two drinks a week) can lead to nerve damage.
  • High triglyceride levels. Alcohol can affect how the liver clears fat from the blood. It can also encourage the liver to produce additional triglycerides. Even light drinking (fewer than two drinks a week) can increase a person’s triglyceride levels. Patients with a very high serum triglyceride level (around 500 milligrams per deciliter or more) should abstain from alcohol because it may raise levels even higher.
  • Retinopathy. Heavy drinking (three or more drinks a day) can lead to the development of retinopathy or worsen the condition.
  • Nephropathy. Even a minor rise in blood pressure can worsen kidney disease. Alcohol can increase a person’s blood pressure, a concern for people with renal damage.
  • Liver disease. Over time, large amounts of alcohol can contribute to the buildup of toxins and other harmful materials in the liver, causing permanent damage. In patients with liver disease, consuming alcohol can worsen the damage to the liver and lead to cirrhosis, a condition characterized by scarring, fat clogs (also known as “fatty liver”) or impaired blood flow through the liver itself.
  • Pancreatitis. Any amount of alcohol may aggravate pancreatitis (inflammation of the pancreas). Pancreatitis is a risk factor for developing secondary diabetes.
  • Heart conditions. Periods of heavy drinking may cause disturbances in heart rhythm (arrhythmia) in some people. If the person has coronary artery disease, there may be at increased risk for a heart attack once the rapid and abnormal alcohol-induced rhythm develops.
  • Certain cancers. Research has linked alcohol to increased risk of cancer of the lips, mouth, esophagus, larynx, breasts, liver, colon and possibly the pancreas and lungs.
  • Gastric disorders. Alcohol can increase the discomfort of gastric problems such as diarrhea or constipation.

Alcohol can negatively affect a patient’s meal plan. Two light beers equal about 200 calories. These calories are considered “empty” because they do not provide any nutrients. For patients following a meal plan, the calories in alcohol will have to be counted as part of their daily intake. Alcohol contains 7 calories a gram. For patients following an exchange diet, alcohol is normally counted as fat servings. Generally, one drink equals 2 fat exchanges or 90 calories. Because regular beer also contains about 15 grams of carbohydrate, it is counted as one carbohydrate serving and half of a fat serving.

In addition, people will also have to count the calories added to their drink in the form of juice, fruit, syrups and other additives. People with diabetes should not omit food from their meal plan in exchange for alcohol. Doing so can increase a person’s risk of hypoglycemia.

Other conditions alcohol can cause or worsen include the following:

  • Alcohol can increase the risk of hypoglycemia. Normally, the liver changes stored carbohydrate (glycogen) into glucose when blood sugar levels begin to drop. It then releases the glucose into the blood to prevent or delay a low glucose reaction. However, when alcohol is in the body the liver concentrates on clearing the alcohol from the blood instead of creating glucose because alcohol is a toxin. This can quickly result in very low glucose levels, especially when there is no food in the stomach. Severe hypoglycemia can result in convulsions, unconsciousness, brain damage or a potentially fatal diabetic coma.
  • Alcohol can hinder treatment for hypoglycemia. The signs of hypoglycemia are similar to the signs of intoxication. Both can result in confusion and lack of coordination. The patient and the people around the person with diabetes may dismiss the signs of low glucose as intoxication. Without treatment, the glucose level could drop lower and the patient could lose consciousness. The loss of consciousness could also be mistakenly attributed to the consumption of too much alcohol.

    Hypoglycemic patients who cannot swallow or are unconscious normally require an immediate injection of glucagon. However, glucagon shots do not help severely low glucose caused by alcohol consumption because glucagon works by getting the liver to release more glucose. When alcohol is in the body, the liver will not release glucose. The patient will need to be treated with other means, such as consumption of sugar or, if unconscious, with a glucose injection administered by a healthcare professional.
  • Alcohol can increase hypoglycemia unawareness. Alcohol affects the brain and can cause a person not to feel or notice the normal symptoms associated with low glucose.
  • Consumption of alcohol can lead to hyperglycemia. Although this does not occur very often, drinking alcohol can lead to high glucose levels. This can be attributed to an increased consumption of carbohydrates. Carbohydrates can be found in alcoholic beverages such as beer and in mixers such as juice. Alcohol also stimulates the appetite, which can lead to an increase in food consumption. 
  • Mixing diabetes medications and alcohol can increase the risk of hypoglycemia. Insulin and antidiabetic agents (e.g., sulfonylureas and meglitinides) work to lower the level of glucose in a person’s blood. To avoid low glucose, a physician may recommend not combining alcohol with these medications.
  • Alcohol can affect a person’s motivation and thought process. People consuming alcohol may forget to perform glucose monitoring or ketone testing, or think it is acceptable to skip a self-test. It is important for diabetic individuals to keep a clear mind. They will need to think well enough to monitor their glucose, remember to take their medication and know how to react if they have dropped too low.
  • Heavy drinking can make diabetes harder to control. Heavy drinking (more than three drinks a day) over time can damage the liver. As the liver becomes damaged it will not be able to make glucose as efficiently. As a result, a person’s diabetes may become harder to manage.
  • Alcohol affects the body’s ability to overcome hypoglycemia. Alcohol can continue to affect glucose levels for eight to 12 hours after consumption.

In addition, people at risk for developing diabetes should be aware that alcohol abuse can increase a person’s risk of developing the disease. Heavy consumption of alcohol can result in pancreatitis. The pancreas is an organ that releases insulin to help the body turn glucose into energy. Pancreatitis can cause permanent damage to the pancreas. It can also impair the organ’s ability to release insulin, which can lead to diabetes. 

Safety tips for diabetes & alcohol use

Patients who have their physician’s approval to consume alcohol will need to take certain steps to drink safely. Recommendations a physician may make to a diabetic patient who is going to drink:

  • Drink moderately. A general guideline, which an individual’s physician may alter, is one drink a day for women and two drinks a day for men.
  • Drink only when glucose (blood sugar) is under control. Patients should test glucose before they consume alcohol. People should not drink if their levels are low or they are experiencing unstable diabetes.
  • Consume alcohol with food. Drinking alcohol on an empty stomach can lower glucose levels. Because the body cannot use alcohol as a source of glucose, it will require food. Patients can avoid hypoglycemia by having their drink with a meal or large snack. Diabetic individuals taking insulin, sulfonylureas or meglitinides should not consume alcohol without food.
  • Do not omit food from a meal plan to make room for alcohol. People with diabetes should not sacrifice nutrition in exchange for alcohol. Doing so can increase a person’s risk of hypoglycemia. All alcohol must be included as an addition to a person’s meal plan.
  • Choose alcoholic beverages and mixers that are lower in alcohol, calories, and sugar and other, carbohydrates. Dry wines and light beer are better choices for people with diabetes because they are lower in calories, carbohydrates and alcohol. Patients should also select sugar-free mixers including diet soda, diet tonic, club soda, seltzer and water.  People should avoid sweet wines, sweet vermouth, heavy beers and wine coolers that are high in sugar and carbohydrates. So-called energy drinks, which have recently become popular mixers, are typically high in sugar, may provide a false sense of increased alertness and should be avoided.
  • Make drinks last longer. Patients can make spritzers by combining wine with mixers including club soda, sparkling water or diet soda. People can sip their drinks slowly to make them last.
  • Choose nonalcoholic or alcohol-free beverages. Nonalcoholic beer, alcohol-free wine, and “virgin” drinks are smart choices for people who enjoy the taste of alcoholic beverages. Red wine that has had the alcohol removed may benefit people with coronary artery disease, recent research suggests.
  • Wear a medical identification bracelet or necklace at all times. Patients can also carry a medical identification card in their wallet to alert people of their diabetes. Because the signs of low glucose levels and intoxication can be similar, people need to be able to identify a patient as diabetic.
  • Educate other people about hypoglycemia. People with diabetes should inform their drinking companions about their medical condition. They should discuss the symptoms of low glucose as well as treatment methods.
  • Discuss combining alcohol and medication with a physician. Patients should get their physician’s approval before combining alcohol with their medications. Patients who consume alcohol several times a week or more should discuss alcohol with their physician when being prescribed medication.
  • Know the amount of alcohol in a drink. Patients should be aware of the proof of the alcohol they are drinking. People should also know the level of alcohol in their drink, or “strength” of their drink.
  • Test glucose levels. Glucose monitoring can help a patient avoid hypoglycemia when drinking. People who are drinking alcohol should test their glucose as recommended by their physician, typically every two hours to eight hours. Patients with low glucose may need to treat it more than once as time goes on because alcohol can affect glucose levels for several hours. Patients should also test before going to bed and again at around 2 or 3 a.m. Detecting and treating dropping glucose levels can help a person avoid overnight lows, as well as hypoglycemia in the morning.
  • Carry a fast-acting carbohydrate snack, glucose tablets or glucose gel. Patients should always be prepared to treat low glucose.
  • Have an emergency plan. A physician-directed plan for emergencies such as severe hypoglycemia or diabetic coma may include treatments such as an injection of glucagon. It is important to note, however, that glucaon does not treat hypoglycemia that is caused by drinking alcohol.
  • Test glucose levels before driving. A person with diabetes who has consumed alcohol may risk low glucose levels. As a result, people with diabetes should always test glucose levels before getting behind the wheel of a car. Patients whose glucose levels are low should eat something and/or have someone else drive.
  • Eat a snack before going to bed. Patients may be advised by their physician to eat 10 to 15 grams of carbohydrate for each serving of alcohol consumed before going to sleep. For patients who normally eat a bedtime snack, the usual snack is eaten in addition to the extra snack. Patients may be advised to eat the snack even if their glucose level is within or above their target range. This can prevent overnight hypoglycemia and the Somogyi effect.
  • Do not combine exercise with alcohol. Mixing exercise with alcohol consumption can increase a person’s risk of hypoglycemia. Physical activity lowers blood sugar by encouraging the transfer of glucose from the blood to the cells, where it is used for energy. Patients may need to avoid dancing while drinking or having an alcoholic beverage after participating in sports.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about alcohol and diabetes:

  1. Is it safe for me to drink alcohol? If so, how much?
  2. Are there particular situations in which I should not drink alcohol, such as unusual glucose levels?
  3. Is it important for me to eat before or while drinking alcohol?
  4. Do I need to carry the instant glucose solutions with me if I plan on having a drink?
  5. Should my emergency plan for severe hypoglycemia or diabetic coma include glucagon? When should glucagon not be used? Should I wear a medical ID bracelet?
  6. Do I need to test my blood glucose when I have a drink?
  7. Must I limit or avoid exercise when having a drink?
  8. After I have an alcoholic drink, should I eat an extra snack before bedtime?
  9. Does alcohol interfere with my insulin, antidiabetic agents or other medications?
  10. Can improvements in diet and exercise make it safer for me to drink alcohol?
  11. Can moderate consumption of red wine or other drinks have health benefits for me, such as reduced risk of heart disease or cancer?
  12. Does alcohol increase my risk of diabetic kidney disease, eye disease, nerve damage or other complications?
  13. How can I tell if alcohol is causing a problem with my diabetes?
  14. What do you recommend if I am having trouble controlling my drinking?
  15. For my loved ones who don’t have diabetes, can light drinking reduce their risk? Does heavy drinking increase their risk of diabetes?
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