Last updated: Apr 10, 2008
Alcohol can worsen diabetes-related nerve damage.
Hoping for a beer at the ball game, or a glass of wine with dinner?

If you have type 2 diabetes, that's probably OK as long as your blood sugar is under control, you don't have any complications that are affected by alcohol (such as high blood pressure), and you know how the drink will affect your blood sugar, according to the American Diabetes Association.

An alcohol-containing drink a day might even help your heart (though if you don't already drink, most experts say that's not a reason to start).

In moderation, alcohol may cut heart disease risk
According to a study by researchers at the Harvard School of Public Health, women with type 2 diabetes who drank relatively small amounts of alcohol had a lower heart-disease risk than those who abstained. A second study found that men with diabetes had the same reduction in heart risk with a moderate alcohol intake as non-diabetic men.

In general, the recommendations for alcohol consumption for someone with type 2 diabetes are the same as anyone else: no more than two drinks per day for men and no more than one drink per day for women. (Make sure to measure: A drink serving is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor such as scotch, gin, tequila, or vodka.)

People with diabetes who choose to drink need to take extra care keeping food, medications, alcohol, and blood sugars in balance.

Janis Roszler, RD, a certified diabetes educator in Miami, Fla., recommends:

  • Mixing alcoholic drinks with water or calorie-free diet sodas instead of sugary (and calorie- and carbohydrate-laden) sodas and other mixers.
  • Once you have had your drink, switch to a non-alcoholic drink, such as sparkling water, for the rest of the evening.
  • Make sure you have an eating strategy and plan in place to avoid overeating and overdrinking in social situations. Alcohol can make you more relaxed, and may lead you to make poor food or drinking decisions.
  • Don't drink on an empty stomach because alcohol can have a very rapid blood glucose lowering effect, which is slowed if there is food in your stomach.
  • If you're going to have a drink, wear your diabetes identification bracelet or necklace.

"If you become hypoglycemic and there is alcohol on your breath, police or paramedics may mistake your condition for being drunk and may not get the care you need," says Roszler.

Alcohol may also worsen nerve damage
Some people with diabetes, though, should not consume alcoholic beverages.

Drinking can worsen nerve damage from diabetes and increase the pain, burning, tingling, and numbness that people with nerve damage often experience.

If you have complications related to your diabetes, you should be more careful about your alcohol intake. More than three drinks a day can worsen diabetic retinopathy. And even if you have fewer than two drinks per week, you can increase your risk of nerve damage (alcohol abuse can cause nerve damage, even in people without diabetes). Alcohol can also raise levels of fat called triglycerides in the blood.

Here's something else to consider: Researchers at Kaiser Permanente in California wanted to see whether there is a relationship between drinking and diabetes self-care behaviors. The team examined survey data for 65,996 adults with diabetes to determine their levels of alcohol consumption and adherence to good health habits, such as testing their blood sugar, getting their A1C levels checked, and taking their medicines.

People who drink alcohol, the study found, are less likely to follow recommended practices than those who don't drink, and the more they imbibe, the less likely they are to stick with recommended health practices.

Although the study doesn't prove that drinking causes poor health behaviors, it does suggest that drinking is a marker for poor self-care.

You'll need to test your blood sugar to gauge alcohol's effect
If you do choose to drink, there are no specific recommendations for one type of alcoholic beverage as better than another. However, the American Diabetes Association notes that light beer and dry wines tend to have less alcohol, carbohydrates, and calories.

It's important to test before and after having a drink to see the impact on your blood sugar, especially when you've first been diagnosed with diabetes or if you're taking insulin or other medicines that can cause hypoglycemia. Treat abnormal blood sugar levels as directed by your health care team.

Alcohol usually causes blood sugar to drop (while the liver is processing alcohol, it takes a break from its other role of releasing stored glucose as needed). However, alcohol can sometimes raise blood sugar.

"I do drink alcohol in very moderate amounts," says Donna Kay, 40, of Prairie Village, Kan., who was diagnosed with type 2 diabetes in 2003. She always checks her blood sugar before and after consuming alcohol. "If I'm at a dinner party, I'll duck into a bathroom," she says.

"For me," says Kay, "beer will raise my blood glucose, while a martini will cause it to fall a little. I avoid drinks with fruit juice or a lot of sugar, such as a cosmopolitan or a piña colada. "They are not worth the blood sugar spike or the calories. Also, some alcohol, such as Baileys Irish Cream, has lots and lots of added sugar—I skip the sugary stuff so I can save those carbs for something else," Kay says.

Red and white wine both have about 100 calories per five-ounce glass; sweeter red wines will have a higher calorie count because of the extra sugar from the grapes. A screwdriver (vodka and orange juice) made up of 1.5 ounces of vodka and eight ounces of orange juice would have 208 calories and 25 carbohydrate grams (all the carbohydrate is from the orange juice.)

You may have to adjust other food choices during the day to accommodate the extra calories and carbohydrates from alcoholic drinks. As a general rule, it is better not to "drink" your calories; healthy food choices should come first.