The Connection Between Alcohol and Diabetes

person with diabetes testing their blood sugar

Most people with diabetes can safely consume moderate amounts of alcohol. According to The National Institute of Diabetes and Digestive and Kidney Diseases, moderate consumption for a woman is a maximum of one alcoholic drink per day, and for a man is a maximum of two drinks per day. However, alcohol consumption is not without risk.

How Diabetes Affects Metabolism

In order to understand the link between alcohol and diabetes, it is important to understand how diabetes causes changes to normal metabolism. In people without diabetes, every meal provides energy in the form of carbohydrates. As carbohydrates are digested, they are broken down into several components, one of which is the sugar glucose.

Glucose is the most efficient form of energy that cells can use to carry out normal metabolism. After a meal, glucose is transferred from the gastrointestinal tract to the bloodstream and eventually reaches every cell in the body.

Cells cannot pick up glucose on their own. They need something that can help them transfer glucose from the bloodstream. The hormone insulin is what helps glucose move out of the blood and into a cell. If insulin is not available, cells are unable to pick up glucose. The consequence of not having insulin available is a catastrophic inability for cells to carry out normal functions, rapidly leading to death.

Type 1 and Type 2 Diabetes

People with diabetes are either unable to make insulin (type 1 diabetes) or don’t make insulin in sufficient quantities to overcome insulin-resistance (type 2 diabetes). Without medical intervention, glucose accumulates in the bloodstream (“hyperglycemia”) while cells starve for energy.

  • Type 1 diabetes: is diagnosed during childhood and is thought to be a genetic and immune disorder that causes the complete destruction of insulin-producing cells. Type 1 diabetics cannot produce any insulin, and their survival depends on their ability to administer daily insulin shots. Type 1 diabetes makes up 5-10% of diabetes cases.
  • Type 2 diabetes: is generally considered to be a disorder attributable to lifestyle choices (poor diet and lack of exercise). Most type 2 diabetes cases are diagnosed during adulthood and are caused by cells becoming resistant to an overwhelming abundance of glucose. Because high levels of circulating glucose cause the pancreas to increase insulin production, over time, insulin-producing cells become burned out and are unable to produce enough insulin to ensure that cells can get sufficient energy. Type 2 diabetes accounts for 90-95% of cases.

Can Diabetics Drink Alcohol?

Moderate alcohol consumption (one drink for women, two drinks for men) is generally safe for diabetics. Importantly, alcohol should only be consumed with a healthy meal that includes several sources of carbohydrates. Type 1 diabetes is more sensitive to alcohol than type 2, but alcohol use disorders are a major risk factor for the development of type 2 diabetes.

Effect of Alcohol on Blood Sugar Levels

The net effect of alcohol is to reduce blood sugar. This is counterintuitive, especially for carb-heavy alcohols like beer and sugary cocktails. Because alcohol is broken down into glucose, insulin production is triggered, and cells increase uptake of glucose. However, type 1 diabetics are dependent on exogenously administered insulin, so if they did not administer enough insulin, glucose accumulates in the blood while cells starve for energy.

Type 2 diabetics are able to produce some insulin, so their cells are able to continue to take in glucose, albeit at a reduced rate. Diabetics who over-consume alcohol are at risk for “hypoglycemic unawareness”, which is a state where symptoms of alcohol intoxication (dizziness, lightheadedness, and uncoordinated movements) mask the similar symptoms associated with low blood sugar (“hypoglycemia”).

For people with type 1 diabetes, hypoglycemia unawareness can be fatal, especially if they fall asleep without eating something.

Effect of Alcohol on Weight

Alcohol is a key contributor to weight gain for several reasons:

  • Many alcohols are very high in carbohydrates, including glucose, sucrose, and fructose that directly promote weight gain in people with unhealthy diets and insufficient exercise.
  • Alcohol intoxication is linked to cravings for greasy food, and lots of it (imagine the line outside of a pizza shop at 2:30 am).
  • Finally, the next-day hangover associated with a night of heavy drinking promotes overeating while reducing the likelihood of exercise.

For type 2 diabetics, alcohol is both a likely cause of their disease and a significant contributor to the persistence and worsening of the disease.

Interference with Diabetes Medication

While moderate alcohol use is generally safe with most diabetes medications, combining alcohol and type 2 diabetes medications can have adverse effects. Drugs that increase insulin production (chlorpropamide) also increase hangover symptoms.

Also, drugs that reduce insulin resistance (metformin, troglitazone) can have very dangerous interactions with alcohol that result in impaired liver function and increased risk for liver disease. Before mixing alcohol and any diabetes medication, it is imperative that you discuss the risks with your doctor.

Other Potential Health Complications

  • Peripheral neuropathy: Peripheral neuropathy is one of the most common diabetes complications and can be very painful. Peripheral neuropathy develops more quickly and has worse outcomes in diabetics who regularly drink even moderate amounts of alcohol.
  • Retinopathy: Retinopathy is sometimes known as “diabetic eye disease” because of its prevalence among people with diabetes. Frequent alcohol use is known to potentiate retinopathy development.

Preventing Alcohol and Diabetes Complications

The most reliable way to prevent alcohol-related diabetes complications is by avoiding alcohol. For many people with diabetes, moderate alcohol consumption (one drink per day for women, and two drinks per day for men) is safe.

However, it is strongly recommended that diabetics discuss alcohol use with their doctor. People who are diagnosed as adults with type 2 diabetes must be aware of potential drug-alcohol interactions if they are prescribed medications that promote insulin production or reduce insulin resistance. A healthy diet and regular exercise is the most important thing anyone can do to control their health.

People who have co-occurring diabetes and alcohol use disorders face unique challenges and complications associated with alcohol consumption. If you are concerned about your own or someone else’s alcohol use, The Recovery Village Ridgefield can help. Our multidisciplinary team of experts is equipped to manage diabetes-related complications of alcohol use while addressing the physical and psychological aspects of alcohol use disorders. Call us today to learn how we can help get you on the road to recovery.

National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetes Diet, Eating, & Physical Activity.” December 2016. Accessed August 24, 2019.

National Institute of Diabetes and Digestive and Kidney Diseases. “What is Diabetes?” December 2016. Accessed August 28, 2019.

Kim, Soo-Jeong; Kim, Dai-Jin. “Alcoholism and Diabetes Mellitus.” Diabetes & Metabolism Journal, April 2012. Accessed August 24, 2019.

Martín-Timón, Iciar; del Cañizo-Gómez, Francisco. “Mechanisms of hypoglycemia unawareness and implications in diabetic patients.” World Journal of Diabetes, July 2015. Accessed August 28, 2019.

Emanuele, Nicholas; Swade, Terrence; Emanuele, Mary Ann. “Consequences of Alcohol Use in Diabetics.” Alcohol Health and Research World, 1998. Accessed August 28, 2019.