Risks of Alcohol Drinking for People With Diabetes

By Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND

From pasta salad to grilled burgers to ice cream cones, summer BBQs and other gatherings often present challenges for people with diabetes. Clients may know about counting carbohydrates, watching portion sizes, and limiting saturated fats, but many are poorly informed about the effects of alcohol. While drinking alcohol may have a few perks related to heart health, drinking can have unpredictable effects on blood sugar levels for people with diabetes, especially among those taking certain hypoglycemic medications.

Alcohol Absorption and Metabolism
How quickly alcohol is absorbed depends on several factors, including the rate of gastric emptying, the presence or absence of food in the stomach, and the speed and amount of alcohol consumption.1 Alcohol, which is toxic to the body, can’t be stored and must be removed quickly. Medications, sex, age, health status, drinking regularity, time of day, and other genetic and environmental factors influence the rate of elimination. About 10% of alcohol ingested is excreted in the breath, urine, and sweat. Most of what remains is oxidized by the liver, which can result in perilous effects on blood sugar stability.

Alcohol and Diabetes
The liver contributes to blood glucose regulation by storing carbohydrate in the form of glycogen and releasing glucose—by glycogenolysis or gluconeogenesis—to the blood when levels are low. However, alcohol oxidation can override the liver’s role to store and release glucose. All people with type 1 diabetes are at risk of hypoglycemia after drinking, and many people with type 2 diabetes—especially those taking diabetes medications that have the side effect of low blood sugar—also are at risk.

How to Advise Clients
Due to these adverse effects, it’s important for RDs to discuss with clients the federal guidelines about drinking. The 2020–2025 Dietary Guidelines for Americans advises adults who choose to drink to drink moderately, which is defined as no more than one standard drink per day for women and no more than two drinks per day for men.2 Explain to clients that a standard drink is a specific amount of alcohol and that cocktails with multiple shots and large wine glasses provide more than one single drink. With the recent surge of canned cocktails, many consumers drink a single can without realizing they may be consuming multiple standard drinks.

To help clients assess the amount they drink, send them to the Standard Drink Calculator supported by the Distilled Spirits Council or a similar calculator on the website of the National Institute on Alcohol Abuse and Alcoholism. With either interactive calculator, clients can enter the volume of the container and the alcohol by volume, which is listed in small print as %ABV or proof. The output is the number of standard drinks per container.

In addition, dietitians should recommend clients with diabetes take the following steps:

• Heed warnings of hypoglycemia. Any medication that has hypoglycemia as a side effect can cause severe low blood sugar for several hours and into the next day after drinking alcohol. If clients take insulin or secretagogues, such as glyburide or glipizide, they must use extra caution. Tell them the liver can’t multitask well and prioritizes ridding the body of alcohol over managing their blood sugar levels.

• Don’t drink on an empty stomach. Having food in the stomach slows alcohol absorption. Eat carbohydrate-containing solid foods. Carbohydrates in liquid form, such as cola or cranberry juice, are processed rapidly and won’t be available to prevent hypoglycemia later in the day or evening.

• Self-monitor blood glucose more frequently. Consider these and other times: an hour or two after drinking, before driving, at bedtime, in the middle of the night, and the following day. Wearing a continuous glucose monitor is ideal for this purpose.

• Discuss the safety and desirability of alcohol consumption with their health care providers.

• Avoid drinking alone. Let their companions know they may develop life-threatening hypoglycemia, and explain that signs and symptoms of hypoglycemia resemble the signs of intoxication.

• Carry glucose gel or tablets. A glucagon injection may not reverse alcohol-induced hypoglycemia because the liver is inefficient at releasing glucose while processing alcohol.

• Be aware of alcohol’s effects. Alcohol weakens inhibitions and good decision making, which can lead to poor food choices, overeating, and serious consequences to their health.

People with diabetes often can enjoy alcohol in moderation without serious consequences, but they must be well-informed about the definition of moderation and the steps to take to avoid serious hypoglycemia.

— Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND, is the author of Prediabetes: A Complete Guide 2nd Edition and the creator of the digital course Prediabetes Turnaround. Learn more at jillweisenberger.com.

References
1. Cederbaum AI. Alcohol metabolism. Clin Liver Dis. 2012;16(4):667-685.

2. US Department of Agriculture; Health and Human Services. Dietary Guidelines for Americans, 2020–2025. https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf. Published December 2020.

What Is a Standard Drink?