Diabetes and Alcohol Use 101: What’s Safe? (How Much to Drink)
Key takeaways:
Alcohol consumption isn’t a causal factor for T1DM and gestational diabetes. However, it may play a contributing role in the development of T2DM.
Blood sugar levels may rise or fall in response to alcohol consumption.
However, people with diabetes commonly experience hypoglycemia post-alcohol consumption as 1) the liver prioritizes alcohol breakdown, 2) alcohol makes accurate carb counting tricky, and 3) alcohol can interact with diabetes medication.
There’s no “best alcohol for people with diabetes to drink”. Instead, the two key principles to follow are to choose drinks that are free of or low in carbs and to drink in moderation.
Is alcohol strictly off-limits when you have diabetes? Not necessarily.
While alcohol will affect your blood sugar levels, being strategic with what and how much you drink can minimize the impact. But before diving into the specifics (e.g., Red, or white wine?), let’s explore the relationship between alcohol and diabetes — starting with …
Can alcohol cause diabetes?
To answer this question, we must first recognize the three main types of diabetes:
Type 1 diabetes (T1DM): Caused by immune-mediated destruction of insulin producing beta cells in the pancreas (i.e., it’s an autoimmune disease). T1DM has a strong genetic predisposition.
Type 2 diabetes (T2DM): Caused by a combination of insulin resistance and defective insulin secretion by pancreatic beta cells. There is no single cause of T2DM; instead, what contributes to its prevalence is likely a complex interaction between genetic, metabolic, and environmental factors.
Gestational diabetes (GDM): A type of diabetes that happens during pregnancy. While researchers still aren’t sure of GDM’s cause, a leading theory is that the hormones secreted from the placenta prevent the body from using the insulin as it should, disrupting blood glucose balance. (Warning: there is no safe amount or type of alcohol use during pregnancy!)
So, does alcohol cause diabetes? As highlighted above, the answer is a straightforward no for T1DM and GDM. However, things get a little more complicated when it comes to T2DM.
Alcohol and type 2 diabetes
Despite the lack of a direct causal link between alcohol and T2DM, the former could certainly increase your risk of developing the latter by contributing to:
Overweight/obesity: Aside from fat, ethanol has the highest energy density, providing seven calories per gram. This means alcohol use carries the potential of promoting a positive energy balance (i.e., you eat more calories than your body burns), creating the conditions of overweight or obesity — known risk factors for T2DM.
Insulin resistance: Research consistently highlights a link between binge and/or chronic heavy alcohol consumption and insulin resistance.
Chronic pancreatitis: A 2023 study published in Alcohol and Alcoholism found an association between daily alcohol intake, frequent binge drinking, and problematic alcohol use with increased development of pancreatitis. Chronic pancreatitis is a condition where the pancreas becomes irreversibly damaged from inflammation. This means it won’t be able to make insulin.
The relationship between alcohol and blood sugar
OK. Alcohol doesn’t directly cause diabetes (regardless of the type). But it can affect your blood sugar levels in the short term, depending on how much and what you drink.
For example, you could experience high blood sugar levels or hyperglycemia because:
Some alcoholic drinks, like cream liqueurs, dessert wines, and traditional cocktails, are packed with carbohydrates and sugars.
Alcohol consumption may stimulate the nerve cells in your brain’s hypothalamus that increase appetite — encouraging you to snack on unhealthy, carb-rich foods, such as chips, candy, and other desserts.
That said, it’s typically more common for people with diabetes to experience hypoglycemia with alcohol consumption because of the following.
The liver prioritizes alcohol breakdown
For the uninitiated, your liver helps keep blood sugar levels within the typical limits.
It stores and releases sugar according to hormonal signals from insulin and glucagon. However, it’s also responsible for breaking down toxins, like alcohol, so they’re safely removed from the body.
Unfortunately, the liver isn't great at multitasking.
So, when you drink alcohol, it’ll choose to metabolize alcohol over converting glycogen into glucose, potentially leading to hypoglycemia.
It is difficult to accurately carb count with alcohol
Different types of alcohol contain varying amounts of carbs.
This can make determining the amount of insulin you need to take extremely tricky; accidentally “over-compensating” or “over-dosing” means you’d most likely experience hypoglycemia.
Alcohol’s interaction with diabetes medications
Many diabetes medications work by increasing your body’s insulin sensitivity.
As mentioned earlier, consuming alcohol may prevent your liver from converting glycogen into glucose when your body needs it. So, when this is compounded with an increase in insulin sensitivity (induced by diabetes medication), your risk of hypoglycemia becomes that much higher.
The adverse effects of interaction between alcohol and diabetes medication aren’t simply limited to hypoglycemia.
For example, taking alcohol with metformin could increase the risk of a rare, but dangerous condition called lactic acidosis — characterized by the buildup of lactic acid in the blood. If lactic acid is not treated promptly, your organs may shut down, which can lead to death.
Symptoms of lactic acidosis include:
Nausea and vomiting
Chills or shivering
Exhaustion and fatigue
Fast, deep breathing
Slow or irregular heartbeat
Muscle cramps and body aches
Delirium and confusion
Is there a “best type of alcohol suitable for people with diabetes”?
Once again, despite alcohol’s potential adverse impact on your blood sugar levels (hyper- and hypoglycemia), you don’t have to abstain from it. Instead, just keep two key principles in mind.
First, choose alcohol free of or lower in carbohydrates and sugar.
Sugar-free alcohol options for those with diabetes are any type of distilled spirits (i.e., hard alcohol) — rum, vodka, gin, tequila, whiskey, and brandy. Wine and light varieties of beer also contain relatively low amounts of carbs. We’ll mention specifics in a bit.
Second, drink in moderation.
In reality, there’s no such thing as the “best alcohol for people with diabetes to drink”. Any amount of alcohol you drink can and will impact your blood glucose levels.
So, the important thing to do is drink in moderation. That’s one drink per day or less for women, and two drinks per day or less for men.
FYI, one drink is defined as containing 14 grams of pure alcohol, which roughly translates to:
355 ml of regular beer (5% alcohol)
148 ml of wine (12% alcohol)
44 ml of 80-proof distilled spirits (40% alcohol)
Right. Now, imagine that you’re at the bar.
You already know distilled spirits, in moderation, are advisable. Warning: be careful about the mixers you choose. Common mixers like juice, sweeteners, regular soda, and energy drinks are “carb bombs”.
To keep your distilled spirits free of or low in carbs, go for mixers like diet soda, seltzer, and diet tonic water.
Blood sugar friendly wine and beer varieties
But what if you’d prefer wine or beer? Which types should you choose?
Let’s first talk about wine varieties.
There aren't any hard-and-fast rules determining the exact sugar content of a specific type of wine, but in general, red wine has the least sugar, followed by white wine, and then dessert wines.
You can also get a rough gauge of a wine’s sugar content from its description.
If it's "dry", it contains less than 10 grams per liter of residual sugar; a "semi-sweet” wine has more than 18 grams per liter of residual sugar. And anything that’s “off dry” would fall in the middle of those limits (i.e., between 10 to 18 grams per liter of residual sugar).
Wondering about makgeolli, a traditional rice wine from Korea? It’s also relatively low in carbohydrates. Although, as always, moderation is key.
As for beer — can people with diabetes drink beer? Yes, but it’s best to choose light or low-carb beers.
Examples include Heineken® Silver, San Miguel Light, and Pure Blonde Ultra Low Carb Beer.
Alcoholic Drinks to avoid if you have diabetes
On the other hand, a specific type of alcoholic drink to avoid when you have diabetes would be most classic cocktails. Just look at the eye-watering sugar content per serving:
Pina Colada: 63 grams
Sex on the beach: 48 grams
Long Island iced tea: 40 grams
Whiskey sours: 29 grams
Mojito: 25 grams
Of course, this doesn’t mean you need to swear off all cocktails. Low-carb cocktail options you can indulge in (in moderation) include bloody mary (4.9 grams), martini (0.6 grams), and gimlet (1 gram).
Bonus tip: you could also get the bartender’s recommendations for low-carb drink options or even ask them to put a low-carb spin on your favorites.
To recap, in most cases, you can drink if you take the proper steps to be safe:
Choose drinks free of or low in carbs.
Drink in moderation.
Managing your blood glucose levels well daily*.
*This involves adhering to your treatment plan and staying consistent with healthy lifestyle habits (e.g., a well-balanced diet and regular physical activity) that’ll help keep your blood glucose levels within your target ranges.
And if you're interested in a holistic diabetes treatment program encompassing specialist medical care, appropriate diabetes medication, and lifestyle coaching, check out NOVI Magnum.