Diabetes and Lipid Clinic of Alaska

 

 


Alcohol and Diabetes

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

Consuming alcohol is not a wise choice for everyone. There are some health conditions and medications that are not compatible with alcohol. Normally, people with diabetes can safely consume moderate amounts of alcohol under certain conditions. Diabetes patients should consume alcohol only when:

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

A patient should not exceed the recommended guideline of one drink per day for a woman and two drinks per day for a man. One drink is defined as:

  • One 12 ounce (355 milliliter [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 who decide to consume alcohol must prepare themselves and the people around them for the risk of hypoglycemia (low blood glucose). This risk is greatest for people taking insulin or anti-diabetic agents. The risk of hypoglycemia is significantly less in people with type 2 diabetes who control it with exercise and meal planning alone.

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

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 gender, weight, build and metabolism.

Through a process called oxidation, alcohol is detoxified and removed from the blood. The higher the blood alcohol concentration (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. That means that 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 alcohol tolerance level and the presence of other medications in the body at the time of consumption. The amount and type of food in the stomach before alcohol consumption 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 potiential effects. It is extremely important for patients to discuss alcohol with their physician. Certain medications do not mix well with alcohol, and alcohol can make some medical conditions worse. Patients should only consume alcohol if their physician has agreed that it is safe.

As with the general population, alcohol should also be avoided by people with diabetes who are pregnant or trying to become pregnant. Diabetes patients should also avoid alcohol if they suffer frequent episodes of hypoglycemia and/or hypoglycemia unawareness. Patients with certain medical conditions (e.g., pancreatitis, liver disease, alcoholism) should also not consume alcohol.

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. So 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, people with diabetes (and all people for that matter) should consume no more than two drinks per day for a man and one drink per day for a woman. 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 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 in 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 physician approval, drinking light to moderate amounts of alcohol may have a number of health benefits. In those without diabetes, light to moderate drinking (no more than one drink per day for a woman and two drinks per day for a man) has been linked to a decreased risk of type 2 diabetes, heart disease and stroke. Moderate drinking also raises HDL (“good”) cholesterol levels, and has been linked to increased insulin sensitivity.

A recent study 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 light drinking (less than two drinks per week) can lead to nerve damage.

  • Gastric disorders. Alcohol can increase the discomfort of gastric problems such as diarrhea or constipation.  
  • Retinopathy. Heavy drinking (three or more drinks a day) can lead to the development of retinopathy or make the condition worse.

  • 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 avoid alcohol completely because it may raise levels even higher.
  • Nephropathy. Even a minor rise in blood pressure can worsen kidney disease. Alcohol can increase a person’s blood pressure.

  • 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”) and/or impaired blood flow through the liver itself.
  • Pancreatitis. Any amount of alcohol may aggravate pancreatitis (inflammation of the pancreas).

  • Heart conditions. Heart attack is heart muscle damage due to lack of oxygen, usually resulting from artery disease. Periods of heavy drinking may cause disturbances in heart rhythm (arrhythmia) in some people. If the person has underlying coronary artery disease, there may be at increased risk for a heart attack once the rapid and abnormal alcohol–induced rhythm develops.

Alcohol can negatively affect a patient’s meal plan. Two light beers equal about 200 calories. These calories are considered “empty” calories 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 per gram. For patients following an exchange diet, alcohol is normally counted as fat servings. Generally, one drink equals 2 fat exchanges or 90 calories. Since 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 into glucose when blood sugar levels begin to drop. It then releases the glucose into the blood in order 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 or brain damage.

  • Alcohol can hinder treatment for hypoglycemia. The signs of hypoglycemia are very similar to the signs of intoxication. Both can result in confusion and lack of coordination. The patient and/or the people around the person with diabetes may dismiss the signs of low glucose as intoxication. Without the proper 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.

    People 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 any glucose. The patient will need to be treated with a carbohydrate, or if unconscious, with a glucose injection administered by a health care 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 levels.

  • Alcohol consumption can lead to hyperglycemia. Although it 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. A physician may recommend not combining alcohol with these medications in order to avoid low glucose.

  • Alcohol can affect a person’s motivation and thought process. A person consuming alcohol may forget to monitor their glucose level or think it is acceptable to skip a self–test. It is important for diabetics to keep a clear mind. They will need to think well enough to monitor their glucose levels, 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 8 to 12 hours after consumption.

In addition, people at risk for developing diabetes should be aware that alcohol 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. Diabetic individuals who are going to drink should:

  • Drink moderately (one drink per day for a woman, two drinks per day for a man). Do not drink alcohol during pregnancy.

  • Drink only when glucose (blood sugar) levels are under control. Patients should test glucose levels before they consume alcohol. People should not drink if their levels are low.

  • Consume alcohol with food. Drinking alcohol on an empty stomach can lower glucose levels. Because alcohol cannot be used by the body as a source of glucose, the body will require food. Patients can avoid hypoglycemia by having their drink with a meal or large snack.

  • Do not omit food from a meal plan to make room for alcohol. 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. All alcohol must be included as an addition to a person’s meal plan.

  • Choose alcoholic beverages and mixers that are lower in alcohol, carbohydrates, calories and sugar. 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 and wine coolers that are high in sugar and carbohydrates.

  • Make drinks last longer. Patients can make “spritzers” by combining wine with mixers including club soda, sparkling water or diet soda. People should also 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.

  • 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. Since 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 levels 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 level every 2 hours for 8 hours. Patients with low glucose may need to treat it more than once as time goes on since 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.

  • 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 should 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 should be eaten in addition to the extra snack. The snack should be consumed even if the person’s glucose level is within or above their target glucose range. This can prevent overnight hypoglycemia.

  • Do not combine exercise with alcohol. Mixing exercise with alcohol consumption can increase a person’s risk of low glucose levels. Physical activity lowers blood sugar levels by encouraging the transfer of glucose from the blood to the cells, where it is used for energy. Patients should avoid dancing while drinking, or following participation in a sporting activity with an alcoholic beverage

Please consult with the medical professionals at the Diabetes and Lipid Clinic of Alaska before consuming alcohol.

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