Diabetes and Alcohol: What You Need to Know

If you are meeting a friend for a drink after work or attending a holiday party where alcohol is being offered, is it a health risk or a benefit?  The medical and nutrition literature reports that moderate consumption of alcohol can offer some health benefits, particularly for your heart. The Dietary Guidelines for Americans 2005 defines drinking in moderation as no more than one drink per day for women or two drinks per day for men. One drink, by definition, is a 12-ounce beer, eight-ounce glass of malt liquor, five ounces of wine, or 1.5 ounces of hard liquor.  Moderate alcohol consumption may reduce the risk of having a heart attack or stroke, lower the risk of developing gallstones, and prevent the development of type 2 diabetes in people with pre-diabetes. Studies show  that those benefiting from moderate consumption are middle-aged and older adults.  It is not recommended, however, that anyone begin drinking or drink more frequently on the basis of health considerations.

Drinking more than the recommendation is harmful to your health.  Excessive alcohol consumption increases the risk of adverse health consequences.  Over time, excess alcohol can cause cirrhosis of the liver and heart damage, increase the risk for cancer and pancreatitis, and increase the occurrence of injuries due to impairment.  Alcohol consumption must be evaluated in reference to any health conditions or prior history of alcohol abuse. Many prescription medications are contraindicated with even moderate intake of alcohol.  In cases of a medical condition, regardless of medication, alcohol consumption should be discussed with a healthcare provider. 

People with diabetes can consume alcohol in moderation if they are prepared and regularly monitor their blood glucose. Take into consideration the medication used to control your diabetes and the timing of your meals.  Alcohol should be consumed along with a meal or substantial snack of at least 15 grams of carbohydrates. Whether you have diabetes or not, avoiding sweet wines and sugary mixers is a healthy choice.  Drinking alcohol adds extra caloric intake, and drinking calorie-free beverages, especially in addition to alcohol, is best for people with diabetes. 

Alcohol does have common interactions with prescription and nonprescription medications taken by people with diabetes. Medications to lower blood glucose, blood pressure, or cholesterol are commonly affected by drinking alcohol.  Within minutes of consuming a drink, alcohol moves into the bloodstream and is metabolized by the liver.  For most people, it takes the liver two hours to metabolize one drink of alcohol.  When you drink fast or in excess, the liver cannot keep up and alcohol begins to reach other parts of your body, including the brain.  Excessive amounts of alcohol compromise the liver, which impairs its ability to regulate your blood glucose levels. 

Abiding by safety recommendations for alcohol consumption for people with diabetes will reduce risk of injury or even death.  People with diabetes should monitor blood glucose prior to drinking and before going to bed to ensure safe blood glucose level of 100 to 140 mg/dL.  Regardless of alcohol consumption, people with diabetes should wear medical identification and be prepared with low glucose treatment. Alcohol can have an adverse affect on oral and insulin medications for diabetes. Studies did not reveal adverse effects among those having one to two drinks per day while taking a sulfonylurea or thiazolidinedione.  For those having type 2 diabetes, however, the FDA issued a black box warning to avoid excessive alcohol intake while taking metformin.  Metformin. like alcohol, is metabolized by the liverresulting in fluctuating blood glucose levels.

Moderate and excessive alcohol consumption affects blood glucose levels causing hypoglycemia or hyperglycemia.  Hyperglycemia usually occurs with moderate consumption of alcohol.  Of greater concern is hypoglycemia, which occurs with excessive alcohol intake without food. Hypoglycemia can occur immediately or up to eight to 12 hours after drinking alcohol, leading to sleepiness, light-headedness, and confusion. Furthermore if you drink too much, you may fail to recognize the symptoms of hypoglycemia.  Therefore, monitoring your blood glucose is critical to detect falling glucose levels before severe hypoglycemia occurs. 

The treatment for alcohol-induced hypoglycemia is ingestion of a sugar-containing liquid like fruit juice, regular soda, or honey, or taking glucose tablets.  Wearing a medical ID bracelet is essential in cases when a person has hypoglycemia and appears to others to be intoxicated from drinking alcohol.  The symptoms of drinking in excess and low glucose levels are similar and very dangerous, especially when taking insulin.  Though moderate consumption of alcohol among persons with diabetes appears to have no acute effect on glycemic control, discuss any concerns with your doctor.  

Adopting a lifestyle of healthy eating and being active improves blood glucose control and overall well-being.  Maintaining a healthy weight can reverse the risk for heart disease and diabetes.  For weight management, moderate alcohol consumption can fit into a healthy meal plan.  Alcohol does not provide any essential nutrients needed by the body. Over-indulgence in alcohol adds excessive caloric intake and can lead to weight gain.  The caloric intake from alcohol can be substituted for a snack or extra portion of carbohydrate at a meal. An excess of 500 calories each day causes an average of one to two pounds of weight gain within a week.  Often calories consumed in liquid form are unnoticed, yet they contribute more than 50 percent of the daily recommended amount of calories for many Americans.  According to the standard drink measurement, the average caloric, carbohydrate, and alcohol content of each alcoholic beverage is listed in Table 1.  

Table 1




Alcohol (ABV)

12 oz beer




12 oz light beer




5 oz red wine




5 oz white wine




1.5 oz liquor




The average person consumes about 150 to 300 calories per day from alcohol when drinking in moderation.  Over time, this additional caloric intake will cause weight gain unless activity is increased and meals are appropriately portioned. 

The assertion that drinking a glass of red wine can improve heart health is a common headline in healthcare news.  The most health benefit, however, is found in the older adult population when drinking in moderation.  Alcoholic beverage consumption can be apart of a balanced meal plan with minor substitution.  A lifestyle of eating a variety of foods, staying active, and having one to two drinks per day is known to reduce health risks.  If you already drink alcohol, choose a drink low in calories and carbohydrates, while avoiding sugar sweetened mixers.  People with diabetes can maintain good glucose control and reduce the risk of injury by being cautious and prepared for hypoglycemia when consuming alcohol.  

Table 2


Tips About Drinking and Diabetes

●         Avoid sweet wines and sugar sweetened mixers

●         Always eat food when drinking alcohol

●         Always test your blood sugar after drinking

●         Never have more than one drink if you plan to drive

●         Always wear a medical identification bracelet

●         Always carry treatment for hypoglycemia

●         Avoid alcohol if you:

○         •  Have a history of severe hypoglycemia

○         • Have hypoglycemic unawareness

○         • Have diabetic neuropathy

Author Information:

Savanna M. Cummings RD, LDN, CDEClinical Dietitian
Department of Endocrinology
The Brody School of Medicine at East Carolina University


Dietary Guidelines for Americans 2005. Chapter 9: Alcohol. USDA.  http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf

Howard, Andrea A. et al.  Effect of Alcohol Consumption on Diabetes Mellitus A Systematic Review. 2004. American College of Physicians. 211-224.