Can I Drink Alcohol If I Have Type 2 Diabetes?

A Guide to Imbibing Safely

Moderate alcohol consumption is believed to have health benefits for some people, such as raising good cholesterol (HDL) levels and lowering the risk of cardiovascular disease, but does that evidence hold up for patients with type 2 diabetes?

Research shows moderate drinking and diabetes often can safely mix. In fact, some studies show moderate drinking can have positive health effects on people with type 2 diabetes. Red wine is especially beneficial.

The important word here is "moderate": Excessive alcohol drinking can increase the risk of conditions such as heart disease and metabolic syndrome. What's more, drinking too much can be a cause of type 2 diabetes by leading to weight gain and insulin resistance. 

Defining Moderation

According to federal guidelines:

  • One drink per day for women and two drinks per day for men
  • One alcoholic drink-equivalent is defined as containing 14 grams (0.6 fl oz) of pure alcohol. The following are reference beverages that are one alcoholic drink-equivalent: 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol). (vodka, whiskey, gin, etc.)
  • Excessive or binge drinking is defined as more than five alcoholic beverages in a two-hour time span for men and four for women.

If you have type 2 diabetes, in order to have your beer or pinot and drink it too without creating further health problems, it's important to understand how drinking affects your body and to know which types of alcohol, and how much, are likely to be safest for you.

Effects of Alcohol on Type 2 Diabetes

For people with type 2 diabetes, isolated episodes of drinking alcohol over the short term may slightly increase insulin production, which in turn lowers blood sugar. This is why some studies have found that one drink with a meal may have temporary benefits for a person who has their diabetes solidly under control.

That being said, the American Diabetes Association recommends people with diabetes know how to recognize and manage delayed hypoglycemia (low blood sugar) when drinking alcohol, especially if they use insulin or other medications that can cause blood sugars to drop.

Because drinking can lower blood sugar, a phenomenon called hypoglycemia unawareness can easily occur. This typically happens when people who tightly control their blood sugar levels with insulin fail to notice the symptoms of hypoglycemia or may not recognize that the symptoms they're experiencing are due to low blood sugar. 

Glucagon kits, widely used for hypoglycemia in type 1 diabetes, do not work if someone has alcohol in their system. Eating food will help to correct this problem.

Long-term alcohol use may be more dangerous for people with diabetes, as it may result in increased blood sugar levels (hyperglycemia). Regular consumption has been shown to lead to increased insulin resistance, which may further destroy glycemic control in those with the disease, as well as poor adherence to general treatment guidelines. 

What to Drink and Not to Drink

Aside from strict moderation, for people with type 2 diabetes the key to drinking safely is to choose alcoholic beverages that are low in sugar and carbs. Some, such as dry wines, champagne, and distilled alcohol, are naturally lower in sugar than other offerings as long as they're imbibed straight up or with a sugar-free mixer. Beer, although also low in sugar, tends to be higher in carbs. Dessert wines such as port live up to their names by being relatively sweet.

Comparing Carbs and Sugar in Alcoholic Beverages
Alcohol Sugar Carbs
2 ounces port wine 20g 7g
12 ounces spiked seltzer 5g 5g
5 ounces white wine 1.4g 4g
5 ounces red wine 0.9g 4g
12 ounces light beer 0.3g 6g
12 ounces beer 0g 13g
1.5 ounces distilled spirits 0g 0g

It’s wise to steer clear of spiked cider and hard lemonade, which are both high in carbs and added sugars. Opt instead, for a spiked or hard seltzer or club soda or plain seltzer water with a squeeze of lime.

The same logic holds true for mixed drinks made with juice, added sugar, and syrups.

Margarita vs. Straight Tequila

  • A frozen margarita (made with 2 ounces tequila, 1 ounce triple sec, 1 ounce lime juice, and 3 cups fresh/frozen fruit): 187 calories and 42g sugar.
  • Tequila on the rocks with a twist of lime (made with 1.5 ounces tequila): 100 calories, 0g sugar.

Savings: 87 calories and 42g sugar.

How to Drink Safely

When you're planning to imbibe alcohol, take steps to keep your blood sugar under control.

Identify yourself: Before heading out to a bar or restaurant where you plan to have a drink, put on your medical ID bracelet so if an emergency arises medical personnel will know you have diabetes.

Hydrate: For each alcoholic beverage you drink, down one glass of water or seltzer—this will help you stay well hydrated and consume less alcohol.

Drink with food: Do not drink on an empty stomach. Have a snack or meal as you sip or immediately beforehand to reduce your risk of hypoglycemia. Choose foods that have some carbohydrates, so that you have some glucose in your system and therefore are at lower risk of having low blood sugar.

If you are following a fixed carbohydrate meal plan you may need to eat a little extra when drinking. Because drinking alcohol can stimulate your appetite, be mindful that you do not replace food with alcohol and do not count alcohol as part of your carbohydrate choices.

BYO snacks: There's no guarantee those offered at the bar or on the menu will be sufficient in the event your blood sugar drops while you're out. Have with you some sort carb, such as a piece of fruit, whole grain crackers, or a meal replacement bar, keeping in mind that in the event your glucose drops to <70mg/dL, you'll need to down 15g of fast-acting carbohydrates: three or four glucose tablets, 4 ounces of juice (one small juice box), or five pieces of hard candy (not chocolate).

Test your blood sugar: Consuming alcohol can cause blood sugar levels to drop as many as 24 hours afterwards. Check your blood sugar before heading to bed. According to the American Diabetes Association, you should be in a healthy range of between 80 mg/dL and 130 mg/dL before bed. If it's low, follow your physician's recommendations, such as taking in extra calories to counteract the drop.

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