The Most Important Things To Know About Diabetes And Alcohol

Party time!

Let’s set the scene. Some snacks to nibble on, a live DJ spinning the (digital) wheels of steel, and some tasty adult beverages. In a situation like this, it can be all too easy to get caught up in the atmosphere and not think about your blood sugar. That’s totally natural - who wants to think about diabetes when you're having a good time? 

But does drinking alcohol affect your diabetes and blood sugar? Is it something to be concerned about?

Pay Attention!

Here’s the deal. If you don’t pay attention to alcohol and learn how it interacts with your diabetes, it will stop your party in one way or another, either during the dance-off or perhaps more commonly, hours later when you're sound asleep, dreaming about your smooth moves. Cruelly, that’s when you're least expecting it and when you're at your most vulnerable.

Having diabetes is no reason to avoid drinking if it’s something you'd like to do. But you should understand how it works so you can do so safely. I'm not personally a big drinker, but I've done some digging and hope to share a few bits of useful information to help keep you safe.

We're All Different, But Basics Are Basic...

We are all different, especially when it comes to our diabetes. Many people also differ in terms of how they respond to alcohol. How big of an effect alcohol has on our blood sugar levels can vary depending on gender, height and weight. 

So like everything, your mileage may vary. But with the help of a blood alcohol calculator, you can at least calculate how long your liver will be occupied with the act of processing alcohol.

There’s certainly no harm in talking about some of the basic ways alcohol affects metabolism and what it does to blood sugar. Ready?

Alcohol Inhibits Glucose Release From the Liver. So What?

The presence of alcohol in your system can cause low blood sugar. Why? Because it plays games with your liver. How? Your liver is a big reserve of sugar, and throughout the day and night, it normally releases glucose (sometimes even when we don't want it to).

But when alcohol is present, your liver changes its focus to clearing alcohol from your bloodstream and forgets all about releasing glucose. The liver is no good at multitasking.

If there’s less sugar in the blood, you'll need less insulin (or you'll need to eat more). Aha! Makes sense, right?

And The Time Delay...

Each alcoholic beverage takes between 1 to 1.5 hours to process through the liver. During that entire time, your risk for lows is increased. So if you have two drinks, you're looking at three hours. Three drinks and it could be more than four hours. Can you see how quickly the hours add up? If you're not planning way ahead, this can easily sneak up and catch you off guard during the middle of the night.

Many alcoholic beverages (beer, wine, mixed drinks, etc.) contain carbohydrates, which will quickly increase your blood sugar and usually require a bolus. But the bolus should be calculated very carefully, because although your blood sugar may go up quickly, the alcohol is also setting the stage for a fall later on.

A glass of beer, for instance, has a different impact on your blood sugar, than a shot of hard liquor. Another important thing to know is that you can experience hypos up to 12 hours after drinking alcohol.

Things To Remember:

• Be very conservative and cautious if you use insulin to lower your blood sugar when drinking, and test often.
• Have a meal or snack with carbohydrates when you consume alcohol.
• Remember to keep glucose tabs or other fast-acting glucose with you at all times.
• Dancing? Oh yeah! But remember, it counts as exercise, which also lowers blood sugar.
• Consider going to bed with a blood sugar higher than normal if you've been drinking. Keep in mind that the drop in BG is often dramatically delayed and you'll want to play it extra safe when sleeping.
• Alcohol can make it hard to notice symptoms of a low. Check your blood sugar often. Check more often than you think you need to. Have I mentioned that you should check often?
• Drunkenness and lows have similar symptoms. It makes sense for a few of your closest party buddies to know about your diabetes and how to help in case of trouble.
• Wear your medical ID at all times (you do have a medical ID, right?).

A Few More Things That Are Good to Know:

• When you've been drinking, a glucagon* rescue shot may not work! In case of a severe hypo after consuming alcohol, glucagon* might not work (no matter whether as a syringe in a hypo kit or as nasal spray) as the liver can’t release sugar reserves into the bloodstream
• I am going to repeat that - a glucagon shot may not work when your liver is busy clearing alcohol from your system!
• You might need to hear that a third time... glucagon may not save you if you pass out from a low while drunk.
• If you're a woman, you typically process alcohol a bit slower than your male counterparts.
• One gram of alcohol contains 7 kcal.

*Glucagon is a hormone that causes glucose to be released from the glycogen stores (liver). This increases the blood sugar level. However, if the glycogen storage is exhausted and the liver is occupied with breaking down the alcohol, glucose can’t be released.

There is much more to know about diabetes and alcohol, but hopefully this has been a helpful start. There seem to be precious few community-based resources out there that cover drinking with diabetes. 

And here is where we are officially obliged to advise you to discuss your specific situation with your doctor.

Sources:

Diabetes & Alcohol - UCSF

A Diabetic's Guide to Drinking - University of Southern California

Understanding Alcohol's Effects - University of Rochester Medical Center

Physiologic Response to Glucogon in Type 1 Diabetes After Alcohol Consumption

Why does alcohol affect women differently?

This article was updated in September 2020