What to Know About Alcohol and Diabetes

Having diabetes doesn't mean alcohol is off-limits. We've talked to diabetes experts to find the latest advice on drinking alcoholic beverages. How many calories does a margarita have? Does a glass of wine spike blood sugar? Will a beer derail your diabetes meal plan? From wine and spirits to beer and cocktails, our diabetes drink guide tells you all you need to know about mixing diabetes and alcohol.

If You Have Diabetes,You Can Enjoy Alcohol

Can I drink alcohol? This is one of the top questions people with diabetes (PWDs) ask their health care providers after being diagnosed with diabetes. Understandable if you want to continue to enjoy alcohol as part of your lifestyle. The answer varies based on you, your health status, and the blood glucose-lowering medications you take to manage your diabetes.

In general, diabetes experts recommend that most PWDs can drink alcohol in moderation without compromising their health, blood glucose control, or safety. In fact, there may be a few health benefits of regular moderate alcohol intake. Here is expert advice on drinking alcohol with diabetes, plus up-to-date advice about how to fit alcohol into your healthy eating plan.

How Much Alcohol Is Too Much?

Adults with diabetes can drink alcohol and should follow the same guidelines as the general public: an average of up to one drink per day for women and up to two drinks per day for men (see serving sizes below). Adults, with or without diabetes, should not drink more than three or four drinks in any single day. Health care providers do not advise you start drinking if you typically abstain.

When it comes to blood sugar control, research shows a moderate amount of alcohol has minimal short- or long-term effects on blood sugar levels in people with type 1 or type 2 diabetes. However, drinking more than three drinks per day over time has been shown to make glucose control a challenge.

A serving size for one drink is:

• 12 ounces of regular or light beer
• 5 ounces of wine (any type other than sweet dessert wine)
• 1-1/2 ounces of 80-proof distilled spirits (such as scotch, gin, rum, or whiskey) (consumed alone or within a mixed drink)
• 1-1/2 ounces of liqueur

Alcoholic beverages are made from grains or fruits (starches or sugars) through the processes of fermentation and distillation, so alcohol cannot be changed into glucose. Also, alcohol is the only nutrient that doesn't require insulin to be broken down for energy -- carbohydrate, protein, and fat do.

Heart-Healthy Benefits of Alcohol

Moderate consumption of alcohol has been shown to have a few health benefits: It's associated with a 30-50 percent decrease in the risk of heart disease and a 50-80 percent decrease in the risk of death from heart disease.

Improves HDL (good) cholesterol.
"The majority of alcohol's beneficial effect is on improving HDL (good) cholesterol," says Alan Graber, M.D., Ph.D., FACE, a past president of the American Association of Clinical Endocrinologists (AACE). Studies suggest that one to two alcoholic drinks a day (beer, wine, or spirits) increases HDL an average of 12 percent. "However, the benefit of improving HDL is lost if a person gains weight," Graber says.

Improves insulin sensitivity.
A couple of recent research studies have shown that adults with diabetes might see a slight improvement in their insulin sensitivity with moderate alcohol consumption. This means the body may make more efficient use of the insulin the pancreas continues to make.
 

 

Alcohol and Blood Glucose-Lowering Medications

The biggest concern surrounding alcohol consumption is for people who take insulin and/or glucose-lowering medication, which can cause the increased risk of hypoglycemia. These include all of the insulins and pills in the sulfonylurea category, such as glyburide (Diabeta, Glynase, Micronase), glipizide (Glucotrol), and glimepiride (Amaryl); and in the glinide category, such as repaglinide (Prandin) and nateglinide (Starlix). The most commonly used glucose-lowering medications for type 2 diabetes today generally don't cause hypoglycemia.

The effects of insulin and other blood glucose-lowering medications that work by increasing your body's release of insulin, such as sulfonylureas and glinides, can also increase the risk of late-onset hypoglycemia, says endocrinologist Alan Graber.
 

When to Say ‘Yes’ or ‘No’ to Alcohol

When to say ‘yes’ to alcohol: "If a person with diabetes chooses to drink alcohol, they should also know what effect alcohol may have on their blood glucose control and the management of their diabetes, and how to drink safely," Graber says.

When to say 'no' to alcohol: Drinking alcohol isn't recommended for PWDs who:
• are not yet of legal age to consume alcohol.
• take prescription or over-the-counter medications that can interact with alcohol.
• have uncontrolled blood sugar. 
• have a history of alcohol abuse or dependence.
• take metformin (Glucophage) and have difficulty restricting alcohol intake to more than a moderate amount, including a history of binge drinking. If so, talk to your provider about not using metformin.
• have a condition that prohibits consuming alcohol: liver disease, pancreatitis, advanced neuropathy (nerve problems from diabetes), or severe hypertriglyceridemia (elevated triglycerides).
• plan to drive or operate machinery, which could cause injury to one's self and others.
• are pregnant (due to the general recommendations and warnings about alcohol consumption and pregnancy).
• are breastfeeding.

Trying to lose weight?
Most PWDs can enjoy moderate alcohol consumption. However, the amount of alcohol should be considered additional calories within a healthy eating plan. Healthful foods should not be omitted to compensate for the calories from alcohol. Each serving of alcohol contains about 100-150 calories, and they can add up quickly. Consider keeping alcohol consumption to a couple times a week or less if weight loss is in your diabetes management game plan.

Top Tips for Drinking Alcohol

Here are the top tips for drinking alcohol for people with diabetes:

Don't drink on an empty stomach. Don't skip meals when you drink alcohol, particularly if you take a blood glucose-lowering medication that could cause hypoglycemia. As a guideline, plan to eat when having a drink, and know what your blood sugar level is before you start drinking.

Limit extra calories and carbohydrate with alcohol. Avoid high-calorie and high-carbohydrate mixed drinks, such as margaritas and daiquiris. Keep the calorie and carb count of your alcohol drinks low by drinking light beer, a glass of wine, or a shot of distilled spirits on the rocks or mixed with a noncaloric beverage like water, club soda, diet tonic water, or diet soda.

Practice moderation. One way to stick to your drink limit is to not use your alcoholic beverage to quench your thirst. Have a no-calorie drink with a meal, or alternate an alcoholic drink with a nonalcoholic drink (within your alcoholic drink limit).

Test, test, test. Your blood sugar should be at a safe level (90-150 mg/dl) before you drink alcohol. If your blood sugar is less than 70 mg/dl and you take a glucose-lowering medication that can cause hypoglycemia, treat your low before you drink. The best way to learn how your body responds to alcohol is with frequent glucose checks.

Carry emergency glucose. If you're at risk of hypoglycemia, make sure you carry glucose tablets, gel, or liquid. Hypoglycemia treatments such as juice or regular soda might be available where you are consuming alcohol, but it's best to have treatments on hand.

Hypoglycemia may strike later. The potential for late-onset hypoglycemia in PWDs who take insulin happens a number of hours after consuming alcohol. Therefore, regular blood sugar checks are important, including overnight if necessary. 

Educate companions to provide an assist if needed. Alert friends and family about the signs and symptoms of hypoglycemia and how these signs could differ from overconsumption of alcohol. Let them know how to check your blood sugar if you can’t and where you have your hypoglycemia treatments. If you are unconscious and experiencing severe hypoglycemia, encourage them to call 911 and to stay with you until emergency personnel arrive.

Wear diabetes ID. Signs and symptoms of hypoglycemia can be similar to the effects of excess alcohol consumption. People who don't know you, such as law enforcement personnel, might attribute these signs and symptoms to intoxication and not realize you have diabetes. This can prevent you from getting the rapid care you need. Wear a diabetes ID to help people quickly identify that your blood sugar is low and provide you with the proper care.

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Note: All drinks on the following slides were prepared using standard recipes from The New American Bartender's Guide (NAL Trade, 2002) and with nutrition information primarily from calorieking.com. The amount of ice can vary, so ice was excluded from the serving size unless otherwise specified.

Nutrition values on the following slides vary by brand (the manufacturer may be able to provide precise nutrition information), serving size, and how they're prepared. Cocktails made from packaged mixes will have higher carb and calorie values than listed.

Light Beer

Serving Size: 12 ounces Calories: 103 Carbs: 6 grams

Tip: The difference between light beer and low-carb beer is insignificant. If you are watching calories, choose a light beer that satisfies you. If you have calories to spare, enjoy a regular beer of your choice.

Margarita

Serving Size: 3.5 ounces Calories: 153 Carbs: 7 grams

Tip: Measure the serving of your favorite drinks at home so you'll be able to better estimate the servings when you're at a restaurant.

Wine

Serving Size: 5 ounces Calories: 125 Carbs: 4 grams

Examples of Red Wine: Burgundy and Merlot

Examples of White Wine: Chardonnay and Pinot Gris

Tip: No studies have found that red wine is a healthier choice than any other form of alcohol. However, it does have a unique profile of antioxidants that can be beneficial to your health if consumed in moderation.

Scotch

Serving Size: 3 ounces Calories: 221 Carbs: 0 grams

Tip: Healthy mixers for scotch, bourbon, and other spirits include water, club soda, diet soda, and diet tonic. Fruit juice is an option but adds carbs and calories.

Sparkling Wine

Serving Size: 4 ounces Calories: 78 Carbs: 1 gram

Tip: Different types of sparkling wine contain different amounts of sugar: Extra Brut contains less than 0.6 percent sugar per liter, while the sweetest type, Doux, can have up to 8 percent sugar per liter. Find the percentages online at wineliquorbeer.com. Create your own wine spritzer with a 5-ounce serving of wine along with the sparkle from club soda or diet soda, such as Sprite, 7-Up, or another lemon-lime soda. 

Regular Beer

Serving Size: 12 ounces Calories: 150 Carbs: 13 grams

Tip: If you're trying to lose weight, choose a light beer to save calories and carbs.

Martini

Serving Size: 2.25 ounces Calories: 135 Carbs: 0 grams

Tip: Whether it's a sweet or savory martini, go light on the garnish. Some olives are packed in sugar-water and can add unwanted carbs. So can oranges, strawberries, grapes, and sugary rims. 

Mojito

Serving Size: 7 ounces Calories: 298 Carbs: 12 grams

Tip: Make your mojito with a low-calorie sweetener to help save calories and carbs.

Bloody Mary

Serving Size: 10 ounces (with ice) Calories: 125 Carbs: 7 grams

Tip: Use low-sodium tomato juice when making your bloody mary.

Kahlua and Cream

Serving Size: 3 ounces Calories: 230 Carbs: 10 grams

Tip: Cut the fat in this drink by choosing 2 percent milk, low-fat milk, or almond milk instead of high-fat cream.

Strawberry Daiquiri

Serving Size: 8 ounces (with fruit and ice) Calories: 145 Carbs: 11 grams

Tip: Have fun making your own sweet cocktail. Sugar-filled drink mixes, such as daiquiris and pina coladas, may pack 25-50 grams of carb in just 4 ounces, whereas cocktails made from scratch can have significantly less carbohydrate. If you're making drinks at home, shop for sugar-free mixers (check out Baja Bob's mixers at bajabob.com) or use fresh fruit, such as strawberries.

Irish Coffee

Serving Size: 5 ounces Calories: 210 Carbs: 8 grams

Tip: Save calories by sweetening with a sugar substitute.

Egg Nog

Serving Size: 4 ounces Calories: 201 Carbs: 13 grams

Tip: Choose light egg nog to save calories, carbs, and fat.

Sherry

Serving Size: 2 ounces Calories: 91 Carbs: 8 grams

Tip: Sherry is a great drink to sip slowly and enjoy.

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