The relationship between type 2 diabetes and alcohol is complex. When people with this condition drink alcohol, it comes with risks. However, it does not mean people with type 2 diabetes cannot drink alcohol. The risks depend on how much alcohol a person consumes, as well as the type.

Diabetes is very common. According to the National Diabetes Statistics Report 2020, 34.2 million people in the United States had diabetes in 2018. The percentage of the population with diabetes increases according to age, reaching 26.8% in adults aged 65 and older.

Moderate alcohol consumption does not raise the risk of type 2 diabetes; however, heavy consumption might.

Overall, alcohol consumption leads to less predictable blood sugar levels, and this can be a risk.

Keep reading to learn more about how alcohol affects people with diabetes, including types of alcohol and how alcohol may cause hypoglycemia, or low blood sugar levels.

Learn more about hypoglycemia here.

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Alcohol does not cause diabetes. However, according to American Diabetes Association (ADA), heavy consumption and zero consumption increase the risk. The ADA also states that a drink or two may improve insulin sensitivity and sugar management.

A 2015 meta-analysis reviewed 38 cohort studies to determine whether alcohol is a risk factor for diabetes. It found moderate consumption appeared to offer some protection against the condition in women and Asian populations, while heavy consumption raised the risk in almost all groups.

Because even moderate alcohol consumption can adversely many aspects of health, the negatives seem to outweigh the positives. More research must continue into this area.

Learn more about how alcohol affects blood sugar levels in diabetes.

The ADA does not forbid a person with diabetes from consuming alcohol, but they do not advise it either. If someone with diabetes chooses to drink alcohol, the ADA recommends limiting consumption to a moderate intake. This translates to one drink per day for females and up to two per day for males.

However, the ADA adds that if an individual with diabetes does not already drink, this does not mean they should start.

Below are some detrimental effects of alcohol on diabetes:

  • It hinders blood sugar control: An intake of more than three drinks per day raises blood sugar.
  • It makes blood sugar levels less predictable: Because of alcohol’s effect on the body and its interactions with medication and other factors, consumption leads to unpredictable blood sugar levels.
  • It promotes weight gain: The calories in alcohol can add up and cause weight gain, a risk factor for diabetes.
  • It increases the risk of diabetes complications: Heavy alcohol consumption increases the risk of heart disease, high blood pressure, nerve damage, and eye problems, all of which are complications of the condition.
  • Consumption with metformin poses a risk: Consuming excess alcohol while taking the common diabetes drug metformin can raise the likelihood of a rare but dangerous condition called lactic acidosis. Symptoms include:
    • slow heart rate
    • weakness
    • shortness of breath

Doctors advise some people with diabetes to abstain from alcohol for reasons unrelated to their blood sugar. The Department of Veterans Affairs (DVA) warns that individuals with diabetes may have other conditions that alcohol could affect. In addition, certain non-diabetic medications do not mix well with alcohol.

Because alcohol is highly addictive and research links heavy consumption to an array of adverse health effects, avoiding the beverage is the healthiest choice for anyone.

The bottom line is that any person with diabetes who wishes to consume alcohol should first discuss it with a doctor.

Learn more about the risks of chronic heavy drinking here.

The below information can help someone adhere to the one-drink-per-day limit for females and the two-drinks-per-day limit for males.

These amounts comprise one standard drink:

  • 5 ounces (oz) wine
  • one 12-oz beer
  • 1.5 oz of 80-proof spirits, such as rum, gin, or vodka
  • 8 oz malt liquor

When individuals calculate how much alcohol they can consume while staying within the recommended guidelines, they should know that some common alcoholic beverages contain more than one standard ‘serving’ of a drink. For example:

  • A margarita contains 2 servings.
  • A martini contains 1.4 servings.
  • A 9-oz pina colada contains 2 servings.
  • A Long Island iced tea contains 4 servings.
  • A 40-oz regular beer contains over 3 servings.
  • A 40-oz malt liquor contains 5 servings.
  • A 6-oz bourbon and water contains 1.5 servings.

A person should avoid sweetened liquor or alcohol mixed with sodas or punch.

Learn more about how alcohol affects health here.

The biggest concern associated with alcohol for someone with diabetes involves the risk of hypoglycemia, which is low blood sugar. Hypoglycemia is when blood sugar falls below 70 mg/dL.

Alcohol consumption can decrease blood sugar, as can some diabetes medications. If these decreases occur at the same time, it can cause hypoglycemia.

This happens because the liver stores carbohydrates and releases them into the blood between meals and overnight to stabilizes blood sugar. The liver is also responsible for breaking down alcohol so the kidneys can flush it out of the body.

The problem is that the liver cannot perform both functions at the same time. When a person consumes alcohol, the liver begins to break it down. When it is busy doing this, it does not release stored carbohydrates to maintain blood sugar, meaning that blood sugar levels can drop to dangerous levels.

Exercise can also increase the risk of hypoglycemia when coupled with other factors, such as drinking alcohol. Doctors strongly encourage people with diabetes to engage in regular physical activity because it reduces blood sugar. However, exercising, drinking alcohol, and taking blood sugar-lowering medication could cause hypoglycemia.

Symptoms of hypoglycemia include:

  • drowsiness
  • slurred speech
  • confusion
  • difficulty walking

The risk of hypoglycemia is why experts advise people with diabetes not to drink alcohol if their blood sugar is already low. If a person chooses to drink, they should always eat at the same time and include carbohydrates, such as fruits, vegetables, or grains, in their meal.

They should also keep a closer watch on their blood sugar so they can quickly react if levels fall too low.

Learn more about testing glucose levels here.

The CDC list the below risk factors for developing type 2 diabetes:

  • aged 45 or older
  • prediabetes, a condition that involves slightly elevated blood sugar
  • overweight
  • physically active less than 3 times per week
  • having a brother, sister, or parent with the disease
  • having diabetes during pregnancy or having given birth to a baby weighing more than 9 pounds
  • being of Hispanic, Latino American, African American, Asian American, American Indian, or Alaska Native descent

Learn more about the risk factors for type 2 diabetes here.

Type 2 diabetes and alcohol is not always a beneficial combination. While moderate alcohol consumption lowers blood sugar, heavy consumption is harmful to diabetes and other aspects of health.

The ADA neither forbids nor advises people to drink alcohol. However, the organization recommends that females with diabetes limit their consumption to one drink per day and males limit their consumption to two drinks per day.

If someone chooses to consume alcohol, they should have food with it and keep a close watch on their blood sugar.

Most importantly, if individuals wish to engage in moderate drinking, they should first discuss it with their doctor.