Alcohol and Type 2 Diabetes: Proceed With Caution

If you have type 2 diabetes, knowing the risks and benefits of drinking alcohol can help you make informed decisions.

If you have type 2 diabetes, having an alcoholic drink is probably fine—as long as your blood sugar is under control, you don't have any complications 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 (ADA).

Understanding how alcohol affects your type 2 diabetes is critical in making informed health decisions.

Heart Disease Risk

According to the Centers for Disease Control and Prevention (CDC), having diabetes doubles your risk of heart disease. So, it's especially important to take care of your heart health. How does alcohol fit into this?

Although early research suggested moderate alcohol intake may reduce the risk of heart disease in people with type 2 diabetes, later evidence challenged this idea.

In a 2020 study published in the Journal of the American Heart Association, researchers found that while light drinking had no effect on blood pressure, moderate and heavy drinking did.

Using data from the ACCORD—Action to Control Cardiovascular Risk in Diabetes—trial, researchers analyzed 10,200 eligible participants with type 2 diabetes. They found that light (1-7 drinks per week) alcohol consumption was not associated with an increase in blood pressure.

However, moderate (8-14 drinks/week) and heavy (>15 drinks/week) were both associated with elevated blood pressures and varying stages of hypertension in people with type 2 diabetes.

Findings from this large cohort study suggest an association between moderate (and heavy) alcohol consumption and hypertension in those with type 2 diabetes, increasing their cardiovascular risk, the study claims.

Also, in a 2018 study published in the journal Diabetes & Metabolic Syndrome, researchers found that in participants with diabetes, cardiometabolic index (CMI—the product of waist-to-height ratio and triglycerides-to-HDL cholesterol ratio that ranks your risk for cardiovascular disease) was better in light-to-moderate drinkers compared to both non-drinkers and heavy drinkers. Heavy drinkers had the worst CMI.

Nerve Damage

People with diabetes are more likely to experience nerve damage called diabetic neuropathy, especially if their blood sugars are not well-controlled, per the CDC. In addition to long-running high blood sugars, being over the age of 40 or having high blood pressure or high cholesterol in addition to diabetes also increases your risk of diabetic neuropathy.

Symptoms include pain and numbness in your feet and issues with your internal organs, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Chronic excessive alcohol consumption alone can also cause nerve damage, creating a condition called alcoholic neuropathy, per StatPearls. If you already have nerve damage from diabetes, adding alcohol to the mix could make it worse. And if you don't already have diabetic neuropathy, alcohol might cause it, according to 2021 research published in the journal Diabetes Therapy.

Blood Sugar

Blood sugar management is a priority for people with diabetes. And while it might seem counterintuitive that alcohol could help manage blood sugar, according to the ADA, it may.

"A daily cocktail or two may improve blood sugar (blood glucose) management and insulin sensitivity. If you have one or more drinks a day, you may find that your A1C is lower than during times you weren't drinking," according to the ADA. (Note, again, that the ADA is referring to light-to-moderate drinking.)

One of the liver's jobs is to store glucose from carbohydrates you've eaten and then release the glucose into the bloodstream when needed so it can be used for energy. But when you drink, and the liver is processing alcohol, it takes a break from its glucose-releasing duties to break down the alcohol (it's not very good at multi-tasking).

Since the liver is not releasing glucose into the bloodstream, this tends to lower the blood sugars while drinking, especially if you're not eating while drinking (eating while drinking will help keep your blood sugars up—the food you're eating will be used for energy since the liver is busy dealing with the alcohol).

However, if you over-imbibe, don't eat while drinking, or are taking a medication that manages your blood sugars, combined with the alcohol, it can lower your blood sugar too much, causing hypoglycemia.

Hypoglycemia in people with diabetes can be dangerous. Per the ADA, signs, and symptoms of hypoglycemia include:

  • Feeling shaky
  • Being nervous or anxious
  • Sweating, chills, and clamminess
  • Irritability or impatience
  • Confusion
  • Fast heartbeat
  • Feeling lightheaded or dizzy
  • Hunger
  • Nausea
  • Color draining from the skin (pallor)
  • Feeling sleepy
  • Feeling weak or having no energy
  • Blurred/impaired vision
  • Tingling or numbness in the lips, tongue, or cheeks
  • Headaches
  • Coordination problems, clumsiness
  • Nightmares or crying out during sleep
  • Seizures

Whether you're drinking or not, if you have any of these symptoms, check your blood glucose. If it's below 70 mg/dL, you're hypoglycemic. If you can't test your blood glucose, then treat the hypoglycemia anyway with some form of sugar that will get into your system quickly.

According to the ADA, this can include glucose tablets or gel; 4 oz. of fruit juice or soda (regular, not diet); 1 tablespoon of honey, sugar, or corn syrup; or hard candies, jelly beans, or gum drops.

The ADA recommends the 15-15 Rule: 15 grams of carbohydrate every 15 minutes until your blood glucose is back up to at least 70 mg/dL.

On the flip side, alcohol can sometimes raise blood sugar. If you're choosing cocktails that are mixed with juice, mixers, or sugary sodas, this can raise your blood sugar levels, especially if you overdo it.

So, Is It OK To Drink?

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, according to ADA.

It's important to note that studies tend to lean toward more benefits coming from light drinking, which would be no more than seven drinks a week. Chronic heavy drinking and binge drinking should be avoided.

And the size of that drink matters: 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, according to the National Institute of Health (NIH).

People with diabetes who choose to drink need to take extra care to keep food, medications, alcohol, and blood sugars in balance. To accomplish this, Janis Roszler, RD, PhD, a certified diabetes educator in Miami, offered these recommendations:

  • Mix alcoholic drinks with water or calorie-free diet sodas instead of sugary 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 in place to avoid overeating and over-drinking in social situations. Alcohol can make you more relaxed and may lead you to make poor decisions.
  • Don't drink on an empty stomach because alcohol can have a 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.

Hypoglycemia can mimic drunkenness, so wearing a diabetes identification necklace or bracelet is important. "If you become hypoglycemic and there is alcohol on your breath, police or paramedics may mistake your condition for being drunk and you may not get the care you need," said Dr. Roszler.

Individualizing Your Care

If you do choose to drink, it's important to test your blood glucose levels 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 to lower your blood glucose. Remember, alcohol itself will lower blood glucose levels, and when added to medications that also lower levels, it can bring you too low.

The decision to include alcohol in your life with type 2 diabetes is a personal one. If you decide you want to drink, talk with your healthcare provider or diabetes educator about how to safely weigh the risks and benefits.

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