Can I Drink Alcohol with Diabetes? Why Does Drinking Alcohol Cause Hypoglycemia (Low Blood Sugar)?

“Oh don’t worry, I choose low carb drinks”. That’s a common response when I ask clients with diabetes if they drink any alcohol. They are sometimes surprised to hear that I am more so concerned about potential hypoglycemia (low blood sugar).


Read on to learn about the things to keep in mind before your next happy hour or drinks on the patio.


Alcohol, Diabetes and Hypoglycemia (Low Blood Sugar) | Beyond Diabetes Nutrition - Lucy Zhang, Registered Dietitian



Do I need to avoid alcohol because I have diabetes?

Drinking is a personal choice. In most cases, alcohol in moderation is okay for individuals with diabetes. Recommended limits for alcohol are the same for people with or without diabetes. Canada’s Low-Risk Alcohol Drinking Guidelines recommend:

  • No more than 10 drinks in a week for women, with no more than 2 drinks a day most days

  • No more than 15 standard drinks in a week for men, with no more than 3 drinks a day most days

If you have high blood pressure, limit alcohol to 1 drink per day for women and 2 drinks per day for men.


Depending on what you are drinking, one drink equals:

  • Beer 12 oz. (341 ml)

  • Cider or cooler 12 oz. (341 ml)

  • Wine 5 oz. (142 ml)

  • Spirits or Hard Liquor 1.5 oz. (43 ml)


NOTE: Please speak with your healthcare provider before drinking if you have pancreatic disease, eye disease, high triglycerides, liver problems, or nerve damage. Alcohol can worsen these conditions.


Canada's Low Risk Drinking Guidelines for women and men. What is a serving size of beer, wine, cider cooler, spirits hard liquor | Canada's Low Risk Drinking Guidelines | Beyond Diabetes Nutrition



What is the risk of drinking alcohol if you have diabetes?

If you use insulin or insulin secretagogue medication, alcohol can increase your risk for low blood sugar. Insulin secretagogue medications include gliclazide (Diamicron® and Diamicron MR®), glyburide (DiaBeta®), glimepiride (Amaryl®), and repaglinide (GlucoNorm®).


In fact, alcohol intake can increase your risk of having low blood sugar for up to 24 hours after drinking. For example, if you drink in the evening, you may notice a delayed episode of low blood sugar the next morning.




Why does drinking alcohol cause hypoglycemia (low blood sugar)?

Your liver plays an important role in both regulating blood sugar and breaking down alcohol. In this case, it’s not very good at multitasking!


Our liver helps to prevent episodes of low blood sugar between meals and overnight by releasing sugar into the bloodstream. When you drink, your liver prioritizes its role as the detoxification center of the body to breakdown alcohol. This impairs its ability to regulate blood sugar.


Drinking increases risk of low blood sugar, liver prioritizes breaking down alcohol | Beyond Diabetes Nutrition - Lucy Zhang, Registered Dietitian



“I always feel when blood sugar is getting low, I should be fine”.

Some symptoms of low blood sugar can look the same as being drunk. This includes feeling light-headed, slurred speech, drowsiness, or difficulty walking. It can be hard to tell the two apart, so you may not notice the usual warning signs.


Make sure someone you are with knows you have diabetes, can recognize the signs of low blood sugar and knows how to treat it. Wear or carry some form of ID that says you have diabetes.




Should I use a sugary mixer for my alcohol to offset the potential low?

Not a great idea. Alcohol can cause dehydration. High blood sugar from sugary mixers plus dehydration can be a dangerous combination. Try mixing alcohol with sugar-free beverages (e.g. club soda, diet pop, or diet cranberry juice) to prevent blood sugar from going too high. And make sure you are drinking water to keep hydrated!


Remember that alcohol can increase the risk of low blood sugar for hours after drinking. Rather than sugary mixers that are absorbed fast, reach for carbohydrate-containing foods that are digested more gradually for better protection against lows.




5 Tips to Remember when Drinking with Diabetes

  1. Have your drink with a carbohydrate-containing meal or snack. This can help to prevent low blood sugar.

  2. Test blood sugar more often during and after drinking. Keep your glucose meter with you if you are going out and check your blood sugar before going to bed. If blood sugar is lower than usual before bed, have a carbohydrate snack before sleeping.

  3. Always have a treatment for low blood sugar with you. We are talking 15g of fast-acting sugar (E.g. 4 Dex4 tablets, 6 Life Savers, 150mL (~ ⅔ cup or 5oz.) regular pop/juice).

  4. Make sure somebody you are with knows that you have diabetes. This person should know the signs of low blood sugar and how to treat a low so they can help if needed.

  5. IMPORTANT: Glucagon (a treatment for severe low blood sugar) does not work as well when alcohol is in the system. This is because both glucagon injection and nasal glucagon rely on your liver’s ability to release sugar into the bloodstream - remember how breaking down alcohol impairs this? Make sure that someone knows to call 911 if you pass out.


How to prevent hypoglycemia (low blood sugar) when drinking | Beyond Diabetes Nutrition - Lucy Zhang, Registered Dietitian





References:

Baqsimi ™ (glucagon nasal powder) [product monograph]. Toronto: Eli Lilly Canada, Inc. 2019. https://pdf.hres.ca/dpd_pm/00053281.PDF


Canadian Diabetes Association. Building Campetency in Diabetes Education: The Essentials (5th Ed.) Toronto: Canadian Diabetes Association. 2019.


Canadian Centre on Substance Use and Addiction. Canada’s Low-Risk Alcohol Drinking Guidelines. Ottawa: Canadian Centre on Substance Use and Addiction. 2012.


Diabetes Canada. Alcohol and Diabetes. Toronto: Diabetes Canada; 2018.


Glucagon [product monograph]. Toronto: Eli Lilly Canada, Inc, 2012. https://pdf.hres.ca/dpd_pm/00017002.PDF


GlucaGen® (glucagon) [product monograph]. Mississauga: Novo Nordisk, 2016. https://pdf.hres.ca/dpd_pm/00035104.PDF


Lipsombe L, Booth G, Butalia S, et al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. Can J Diabetes 2018;42(Suppl 1):S88-S103.


McCrimmon RJ. Management of Acute and Recurrent Hypoglycaemia. In Third ed. Hypoglycaemia in Clinical Diabetes. Chichester: Wiley-Blackwell;2014: 165-183.


Turner BC, Jenkins E, Kerr D, et al. The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes. Diabetes Care 2001; 24(11):1888–93. doi:10.2337/diacare.24.11.1888.


Yale J, Paty B, Senior PA. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Hypoglycemia. Can J Diabetes. 2018;42(Suppl 1):S104-S108.


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