Alcohol And Type 2 Diabetes | HealthMatch

Drinking alcohol is generally safe, as long as you practice moderation and your doctor hasn't advised you to stop drinking. However, diabetes complicates things. 

There are approximately 37 million diabetic people in the US,¹ with 90-95% having type 2 diabetes. It's vital to understand the influence of alcohol on type 2 diabetes. Let's look at how alcohol impacts type 2 diabetes, its risks, benefits, and more. 

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How does alcohol impact type 2 diabetes? 

First, let's look at what happens to alcohol when you consume it. Here's a breakdown of what happens when you drink a glass of wine: 

  • Your mouth absorbs a small amount of alcohol. About 75-85% is absorbed into the blood from the intestine. Having food in your stomach is crucial since it slows down the stomach-emptying process and the absorption from the small intestine.

  • When the alcohol is absorbed into your bloodstream, about 90% will be metabolized and broken down by the liver. 10% is excreted in the urine by the kidneys. 

Your blood alcohol level varies according to the condition of your liver and its size, your weight, and sex. Body fat concentration varies between men and women.

Alcohol can impact your blood glucose level, especially if you have type 2 diabetes. Your liver stores excess glucose as glycogen. When your blood sugar falls, the liver converts glycogen into glucose.

It can also produce glucose from noncarbohydrate sources in a process called (gluconeogenesis), releasing glucose into your bloodstream to bring it to normal levels. 

However, if you drink alcohol in a fasted state, your liver has to work really hard. It needs to simultaneously convert glycogen, perform gluconeogenesis, and metabolize the alcohol to rapidly remove it from the body. Therefore, it will focus on metabolizing alcohol rather than the other two mechanisms for glucose production, lowering your blood glucose.

This can cause hypoglycemia, which is low blood sugar and can be dangerous

So what are the risks of alcohol to people with type 2 diabetes? Type 2 diabetes refers to having too much blood glucose. This usually occurs when the body doesn't produce enough insulin or doesn't respond to insulin as it should: insulin resistance.

Based on various factors, alcohol can either lower your blood sugar level or increase it. Here are ways that alcohol puts you at risk if you have type 2 diabetes: 

Carbohydrates in different alcoholic drinks can raise your blood sugar 

Generally, some alcoholic drinks have higher carbohydrate levels than others. For instance, wine is lower in carbohydrates than cocktails, beers, and spirits. 

Even though some alcoholic drinks may increase your blood sugar, they cannot prevent hypoglycemia if you drink too much.

Stimulates your appetite 

Interestingly, alcohol can stimulate your appetite and contribute to unhealthy eating habits. One study² looked at this association in university students. It found that moderate drinkers were more likely than low drinkers to have increased appetite after drinking.

Nearly half of the students reported making unhealthy food choices and overeating after drinking alcohol. 

Another study conducted on mice proves this phenomenon. According to this study, alcohol stimulates your neurons, making your brain think you're starving. Therefore, you might eat foods high in carbs to compensate for "alcohol-induced hunger."

This effect could put you at risk of high blood glucose if you have type 2 diabetes. 

Weight gain 

There are different theories associated with alcohol consumption and weight gain. Some of these theories include: 

Alcohol has empty calories 

Alcohol has "empty" calories, meaning it provides the body with calories with little nutrients. For instance, a 12oz can of beer or a 125oz glass of red wine contain 155 calories. These calories don't provide you with satiety, and you will likely not deduct these calories from your daily calorie needs, so you might see weight gain. 

Effects on your liver 

The liver works as a "filter" of foreign substances entering your body, including alcohol. It also plays a vital role in metabolizing fats, proteins, and carbohydrates. Excess alcohol consumption can cause alcoholic fatty liver. This condition can damage your liver and affect the metabolization of fats and carbohydrates, which will impact your blood sugar levels and weight.

Contribution to excess belly fat 

Your body stores extra glucose that it doesn't need for energy as fat. Since alcohol can stimulate excess consumption of high-calorie foods, your body will store the excess glucose as fat. This is often around the abdominal areas, causing central obesity.

Insulin resistance and visceral obesity are some of the main characteristics associated with metabolic syndrome,³ which greatly increases the risk of cardiovascular disease and stroke

Metabolic syndrome involves:

  • High blood pressure

  • High cholesterol

  • High blood sugar levels

  • Central obesity and high waist circumference measurement

  • High body mass index (BMI)

Effects on sexual hormones 

Alcohol is long known for its effect on testosterone, particularly chronic and heavy drinking that can interrupt testosterone production. Testosterone plays a significant role in metabolism, including muscle formation and fat burning. Studies associate low testosterone with type 2 diabetes and a higher prevalence of metabolic syndrome in men. 

People with low testosterone have higher levels of insulin resistance, which can result in an increased risk of developing or worsening type 2 diabetes.

Effects on your willpower 

Alcohol usually affects people's willpower. Therefore, they will most likely make poor food choices, leading to weight gain. You might be tempted to eat processed foods, sweets, and high-fat meats. 

It's highly recommended to avoid these foods altogether if you have type 2 diabetes.

Raises your triglycerides levels

Your liver breaks down alcohol, rebuilding it as triglycerides. Therefore, if you drink alcohol, you'll raise the triglyceride levels in your blood. High triglyceride levels stimulate insulin resistance. 

Diabetes can increase your triglycerides, particularly if you aren't controlling your condition well. High triglyceride levels put you at risk of complications such as heart disease and stroke. 

Elevates your blood pressure

Type 2 diabetes means that the glucose in the bloodstream cannot properly enter your cells which use it for energy. Therefore, it will end up accumulating in your bloodstream. 

High glucose levels can decrease your blood vessels' elasticity, obstructing blood flow. As a result, this increases the risk of high blood pressure. 

So, how does alcohol put you at risk of further complications if you have type 2 diabetes? 

There are different ways that alcohol elevates your blood pressure, including:

  • Effect on the renin-angiotensin-aldosterone system, constricting the blood vessels.

  • An increase in cortisol levels, cardiac output, total peripheral resistance, and renovascular resistance eventually leads to a rise in blood pressure. 

  • Alcohol decreases baroreceptor sensitivity, which prevents the stretching of blood vessels when needed, resulting in high blood pressure.

  • Alcohol increases blood calcium levels that bind your blood vessels. Therefore, your blood vessels heighten their sensitivity to the compounds constricting them, increasing blood pressure.

Pancreatitis 

Excessive consumption of alcohol increases the risk of pancreatitis. Free radicals and other toxic by-products of alcohol metabolism damage your pancreatic acinar cells. Alcohol causes excessive secretion of the enzymes usually released into your digestive tract, and they become prematurely activated in the pancreas.

As a result, the pancreas begins "digesting" itself. 

Since the pancreas produces insulin, your blood sugar could rise to life-threatening levels. 

Is it safe for people with type 2 diabetes to drink alcohol? 

The answer for this is not a simple yes or no. Although the American Diabetes Association (ADA) doesn't restrict alcohol consumption, it doesn't advise drinking. If you choose to drink, it's advisable to drink moderately.

A drink per day for a woman and two for a man constitutes moderate alcohol consumption if you have diabetes. An example of one alcoholic beverage includes a 12oz beer and a 5oz glass of wine. It's vital to closely monitor your blood sugar levels after drinking, and don't drink alcohol on an empty stomach. 

It's safer to avoid drinking alcohol if you can. If you do not drink alcohol, you should not start drinking, especially with type 2 diabetes. 

Benefits of alcohol for type 2 diabetes 

Yes, there are risks associated with drinking alcohol if you have type 2 diabetes. However, there is also evidence for potential benefits with occasional or moderate alcohol drinking. Moderate alcohol consumption can briefly lower your blood sugar levels by inhibiting the liver from releasing glucose into your bloodstream.

This could be useful for people with type 2 diabetes aiming to reduce their high blood glucose. 

Moderate alcohol consumption has links to other health benefits, such as increasing good cholesterol levels (HDL). This can lower your risk of heart disease. 

Those who drink red wine in moderation with food can also benefit. Red wine contains antioxidants that prevent cell damage. Type 2 diabetes triggers several metabolic reactions, leading to cell death, inflammation, and cytokine secretion.

However, antioxidants in red wine might prevent cell damage. 

Still, the risks of consuming alcohol if you have type 2 diabetes outweigh the benefits. That's why doctors recommend keeping your drinking to moderate levels or quitting altogether.

Can alcohol interact with type 2 diabetes medication?

Alcohol has harmful interactions with many type 2 diabetes medications. That's why it's better to stay away from alcohol if you are taking any of these medications to avoid dangerous interactions. 

Many type 2 diabetes treatments involve a combination of different drugs, increasing the risk of multiple alcohol-related interactions. Here is a breakdown of specific interactions between alcohol and type 2 diabetes medication: 

Interaction with metformin 

Metformin treats type 2 diabetes by improving insulin sensitivity and reducing gastrointestinal glucose absorption and hepatic glucose production. 

Mixing alcohol with metformin increases the risk of a rare condition known as lactic acidosis. Metformin makes your body produce more lactic acid. With alcohol, your body can't get rid of the excess lactic acid, leading to its accumulation in the blood. 

The symptoms associated with lactic acidosis include:

  • Weakness

  • Increased sleepiness

  • Irregular heartbeat

  • Shortness of breath

  • Feeling cold

If not treated immediately, this condition can be fatal, so seek urgent medical care if you suspect lactic acidosis.

Interaction with insulin 

A combination of alcohol and insulin can lead to hypoglycemia or hyperglycemia. The level of interaction depends on the frequency of your drinking and how much you drink. 

Interaction with chlorpropamide 

A combination of alcohol and chlorpropamide can cause dangerous hypoglycemia. Symptoms include:

  • Increased thirst

  • Fatigue

  • Pale skin

  • Shakiness

  • Loss of consciousness

The drug can also cause alcohol intolerance, with symptoms including:

  • Rapid heartbeat

  • Nausea

  • Vomiting

  • Flushing

  • Headache

Diabetes and alcohol dos and don'ts 

The best solution to the risks associated with alcohol and diabetes is to significantly limit your alcohol intake or stop drinking. There's no reason to start if you don't drink, especially with diabetes.

If you drink alcohol and don't wish to stop, here are dos and don'ts to adhere to: 

Drink moderately 

Men should limit their drinking to two drinks daily, while women should drink one drink. Examples of one alcoholic beverage include a 12oz beer or a 5oz glass of wine. 

Drink alcohol only with food 

Drinking alcohol with food slows down the alcohol absorption rate in the small intestine. This avoids stressing your liver too much as it tries to metabolize alcohol, which slows down alcohol's effect on people with type 2 diabetes. 

Avoid drinking "sugary" alcoholic beverages

Sugary alcoholic beverages contain carbohydrates that can raise blood sugar. Even though alcohol on its own is a low carbohydrate, sugary drinks can significantly increase your blood glucose, which is dangerous for anyone with type 2 diabetes. 

Mix your liquor with, water, or club soda 

Mixing your alcoholic beverages with water or club soda lowers the sugar percentage in your drink. 

Identify yourself 

It's recommended to have an ID bracelet or any form of identification showing that you have diabetes. This way, bar or restaurant attendants will consider your nutritional requirements and help you in case of a diabetes-related emergency. 

Choose your drink wisely 

Some alcoholic beverages are high in carbohydrates, even when drunk straight. Most alcoholic drinks carry the risk of causing hypoglycemia. However, some have the potential to cause high blood sugar levels (hyperglycemia). 

For instance, traditional cocktails are high in sugar, so try to avoid them as much as possible. This includes daiquiris, piña coladas, and margaritas. 

It's best to abstain from dessert wines such as sherry, port, and vermouth since they are high in carbs. It's also wise to avoid liqueurs such as Kahlua and Bailey's. 

Here are some types of alcohol that are appropriate for you if you have diabetes: 

  • Beer: Low-carb beers include Miller Lite, Coors Light, Bud Lite, Busch

  • Wine: Red wine and white wine

  • Distilled spirits

  • Whiskey, gin, rum, and vodka

  • Low-carb cocktails: Martini, vodka soda, and Bloody Mary

Don't overindulge 

Practice moderation to avoid the risks associated with alcohol and type 2 diabetes.

Excessive or binge drinking refers to drinking more than a certain amount of alcoholic beverages in a single sitting. This is five for men and four for women. This type of drinking could have a detrimental effect on your health, particularly if you have diabetes.

Test your blood sugar after drinking alcohol 

If you have diabetes, check your blood sugar levels before and during the 24 hours after drinking. It's also vital to test your blood sugar before you sleep to ensure it's stable. 

There are different options available for at-home blood sugar testing. Therefore, you don't have to visit your healthcare provider every time you plan to drink or after drinking. 

Traditional home glucose monitoring 

You can easily test your blood glucose at home with a glucose monitor. It uses a testing strip to measure the glucose levels in your blood.

You obtain a blood sample with a short needle (lancet.) You put a drop of your blood on the testing strip, and the meter displays your blood glucose levels. 

These meters deliver results at varying speeds. A standard strip should show results within fifteen seconds. Some meters can calculate your average blood sugar levels over a timeline, while others can display a reading on a graph or meter. All these meters are available at your local pharmacy. 

Ensure that you follow these steps while using a traditional home glucose monitor: 

  • Wash your hands and dry them before handling the kit.

  • Cleanse the testing area with an alcohol swab, soapy water, or warm water.

  • Note and record your blood glucose level after every test. 

Continuous glucose monitor 

These devices use sensors inserted under the skin to monitor your blood glucose for a week or two before you change them. They have a transmitter that sends information wirelessly to a monitor or your smartphone. 

You'll be checking your blood glucose level every five minutes using this device. However, if you're drinking alcohol, you need to monitor your blood glucose constantly. These devices often have an alarm that warns you when your blood sugar level is too high or low. 

Before you decide on this device, talk to your doctor to determine whether it's right for you. 

The lowdown 

Alcohol and type 2 diabetes aren't a good mix. However, keeping your drinking to moderate levels can be safe. However, avoiding alcohol may be the safer choice, particularly if you have poorly controlled blood sugar or take medications that interact with alcohol. 

The most crucial factor is speaking to your doctor for further advice. They will recommend whether you can consume alcohol or if you should completely abstain.

Have you considered clinical trials for Type 2 diabetes?

We make it easy for you to participate in a clinical trial for Type 2 diabetes, and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
Peter, 64

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