People with diabetes often assume alcohol is off limits. Not so! For most people, keeping an eye on how much and what you drink will help avoid the alcohol-related pitfalls of low glucose levels, weight gain and high blood pressure.
Before having an alcoholic drink, ask yourself three questions recommended by the American Diabetes Association (ADA):
- Is my diabetes under control?
- Does my health care provider agree that I can consume alcohol?
- Do I know how alcohol can affect me and my diabetes?
"If you answer 'yes' to all three questions, it's probably OK to have a drink," says Jon Tilburt, M.D., an internist at The Johns Hopkins School of Medicine. "But make sure you know the potential effects of alcohol as well as your personal limitations."
What happens when you drink?
Normally, when blood glucose levels drop, the liver converts the body's stored carbohydrate into glucose. Sent into the bloodstream, this glucose helps avoid or slow down a low blood glucose reaction (hypoglycemia).
This process is interrupted when alcohol enters your system. The liver's first priority is to clear the alcohol from your blood quickly, and it will not put more glucose into the bloodstream until it has detoxified the alcohol. As blood glucose levels fall, you can quickly become hypoglycemic
Treat hypoglycemia quickly
Because alcohol's effects on glucose can last up to 12 hours, you may want to test your blood glucose before going to bed. If it is at a safe level—between 100 and 140 mg/dL—you should be fine. If it's lower, eat a snack—half a sandwich, yogurt, cold cereal, cheese and crackers, apple and peanut butter—to raise it.
To help prevent low glucose levels when drinking alcohol, eat a carbohydrate-containing meal or snack with your beverage.
Hypoglycemia can mimic effects of alcohol
Some early warning signs of low blood glucose levels, such as dizziness, disorientation and sleepiness, can mimic drunken behavior, Tilburt cautions. This could cause others to mistake your hypoglycemic symptoms for the effects of alcohol, and they may not realize they need to seek help. Make sure your friends know that low blood glucose and drunken behavior share common features. You also may want to wear a bracelet or other ID tag identifying you as having diabetes.
Good drink choices
The ADA recommends no more than one alcoholic drink per day for women and no more than two drinks per day for men. One drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor. Light beers or dry wines are good choices because they have less alcohol and fewer calories. If you enjoy mixed drinks, use diet soft drinks, water or seltzer as your mixers. Avoid drinks high in sugar like sweet wines or sugary mixed drinks like piña coladas or wine coolers.
You can exchange the calories from alcohol for those you would otherwise get from a serving of fat. But, Tilburt stresses, never substitute alcohol for a meal.
If you drink alcohol regularly, Tilburt recommends you tell your doctor or diabetes educator during your check-up and before diabetes medication is prescribed, especially if your drinking pattern has changed recently.
When to avoid alcohol
"Having one drink at a party is not a problem for most people," Tilburt says, "but certain people should avoid alcohol entirely, especially if they already suffer from some of the complications of diabetes."
If you have nerve damage in your arms and legs (peripheral neuropathy), alcohol could increase the burning or tingling sensation in your hands and feet. People with eye damage (diabetic retinopathy), uncontrolled high blood pressure, high triglycerides or kidney damage also should be extra cautious, Tilburt says, as alcohol may worsen these conditions. Alcohol can increase your risk of high blood pressure, a leading cause of kidney disease. If you have high blood pressure, alcohol can interfere with your hypertensive medicines and make it harder to control your blood pressure.
Be aware that combining alcohol with some oral diabetes medications, especially chlorpropamide (Diabinese®), can cause flushing of the face, arms and neck. You may notice other common subtle symptoms as well, such as lightheadedness, difficulty with balance or stomach irritation; if so, avoid further alcohol until you discuss it with your health care provider. Generally, as long as the symptoms are not life threatening, it is OK to continue cautious alcohol consumption with careful blood glucose monitoring, Tilburt says.
Alcohol and heart health
Some studies have linked light to moderate alcohol consumption with a lower risk of cardiovascular disease, something everyone with diabetes worries about. But Tilburt and other researchers aren't entirely convinced. "If you don't drink, don't start. The potential cardiovascular benefits are not great enough to warrant it," he says. One thing is certain: drinking too much alcohol will erase any potential benefits as well as worsen diabetes-related complications like nerve damage and kidney and eye disease.
The bottom line when it comes to drinking is this, Tilburt says: "There's no substitute for modest portions and control. Sip, don't guzzle your drink. Savor it."
| Top tips if you drink alcohol |
- Limit alcohol to one drink per day for women and two drinks per day for men if your diabetes is well controlled. If you haven't achieved good control, don't drink.
- Choose lower-calorie light beers, dry wines or drinks mixed with diet soft drinks, tonic water or seltzer.
- Tell your doctor or diabetes educator if you drink alcohol regularly or if your drinking habits have recently changed.
- Always eat a meal or snack when you drink to ward off hypoglycemia. Test glucose before going to bed if you've had a drink that evening. If it's too low, eat a snack.
- You can exchange the calories from alcohol for those you would otherwise get from a serving of fat. But never substitute alcohol for a meal.
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