Today is Cinqo de Mayo, which commemorates the Mexican Army’s victory over the French Empire at the Battle of Puebla, on May 5, 1862, under the leadership of General Ignacio Zaragoza. Even if this is not your holiday, you can expect to see/hear lots of celebration around you. As a public service to my D community, here’s some great advice and information about How to Safely Consume Alcohol with Diabetes by Cheryl Alkon for diaTribe.org, 3 May 2021.
What happens in the body when you drink? Your liver works to create glucose when your blood sugar levels are low, but it also processes any alcohol present in your body, says Sandra Arevalo, a certified diabetes care and education specialist and spokesperson for the Academy of Nutrition and Dietetics. More specifically, “Alcohol gets broken down by your liver. The liver is also in charge of making sugar when your blood sugar levels are low, by converting stored glycogen into glucose, and releasing that glucose into your bloodstream. When you drink, your liver is busy processing the alcohol and has a hard time producing glucose,” she said.
This process “puts people with diabetes at high risk of low blood sugar when they drink,” Arevalo said. “If you are on basal insulin, you may not make enough glucose for the amount of basal insulin you have taken, and you may suffer a hypoglycemic episode.” This applies primarily to people with type 1 diabetes, but people with type 2 diabetes are still at risk for low blood glucose levels when they drink.
What’s in a drink? That’s a tricky question. What you are drinking and how much of it you choose to drink can make a big difference. Like most things with diabetes, there aren’t simple answers.
According to the CDC, moderate drinking is defined as two drinks or less per day for men, or one drink or less per day for women. The US Dietary Guidelines Advisory Committee recommends one drink or fewer per day for people of any gender. It is illegal for people under 21 to drink alcohol in the United States.
What does the CDC classify as “a drink?” One drink contains 14 grams, or 0.6 ounces, of pure alcohol, which normally equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of hard liquor or spirits such as gin, rum, vodka or whiskey.
What influences your intoxication? Several factors – including diabetes medications, food, and exercise – can all make things even more complicated, said Carrie S. Swift, a dietician and spokesperson with the Association of Diabetes Care & Education Specialists. “Overall, alcohol intake leads to less predictable blood glucose whether you have type 1 or type 2 diabetes,” she said. But “the impact of alcohol on blood glucose isn’t always the same.”
This can be caused by:
- Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates, and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
- Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels – “are more likely to cause low blood glucose when alcohol is consumed,” said Swift. Insulin and alcohol work similarly whether you have type 1 or type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. “Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away,” she said. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications, Swift added.
- Food: “If you drink on an empty stomach, you are more likely to experience hypoglycemia,” said Swift. Yet, eating while drinking “may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.”
- Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia.
Read more: How to Safely Consume Alcohol with Diabetes
In case you missed it a few months back, you can watch a fun and somewhat controversial video, Alcohol and Diabetes: Do They Mix? by Drs. Steve Edelman and Jeremy Pettus, both endocrinologists and both T1Ds.