While having a drink with dinner may not be a problem, going to happy hour for a person with diabetes can be challenging. This is because alcohol can lower blood glucose, especially for people taking insulin or a medication that increases insulin secretion.
Alcohol is metabolized differently than food. It moves through the stomach to the bloodstream and small intestine quickly. Our bodies don’t store alcohol, so we need to get rid of it. The liver’s job is to break down and detoxify alcohol. Normally the liver makes and stores glucose and then releases it when needed. When the liver is busy breaking down alcohol it doesn’t release glucose, so less glucose is available in the blood. The liver can a while to break down alcohol, so glucose could be lowered up to 12 hours later, causing delayed hypoglycemia.
Moderation is Key
When it comes to drinking, recommendations for people with diabetes are the same for those without diabetes. If you choose to drink, moderation is defined as no more than one drink per day for women and two drinks per day for men.
So, what’s considered one drink? One drink is equal to:
- 12 ounces of regular beer (5% alcohol)
- 5 ounces wine (12% alcohol)
- 5 ounces liquor (80-proof liquor or 40% alcohol)
Each of these drinks is about the same amount of alcohol even though they are different in volume. Keep in mind that the amount of alcohol by volume varies by manufacturer. For example, beer can range from 3-13% alcohol. So, a higher percent alcohol beer is more than one drink.
Benefits vs. Risks
There are many research studies that show benefits to drinking in moderation. Some of the health benefits include lower risk of heart disease, dying from heart disease, and lower risk of stroke. Some of these benefits are due to alcohol raising HDL cholesterol. However, there are risks that may outweigh the benefit of having a drink.
The immediate risk for people with diabetes is hypo or hyperglycemia. Depending on the drink type and amount, glucose levels could increase or decrease. People metabolize alcohol differently so not everyone has the same glycemic response. Alcohol can increase appetite which can lead to overeating and higher glucose levels.
There are plenty of long-term risks to heavy drinking. Excessive drinking has been linked to organ damage including the liver, brain, heart, and pancreas and certain types of cancer. People who have liver disease, pancreatitis, severe neuropathy, or high triglycerides should avoid alcohol.
Have a Plan
If you choose to have a drink for happy hour, try these 5 steps to have a safe time:
- Plan to eat. Think about eating something before and while drinking alcohol. Alcohol is absorbed more rapidly without food. Include food that has carbohydrates, protein, and healthy fats to slow digestion and prevent hypoglycemia.
- Pick your drinks wisely. Order smaller drinks, lower alcohol choices, or dilute drinks with club soda. If you don’t know what’s in your drink, ask the bartender. Ask about the percent alcohol or how much alcohol is added to a mixed drink. For example, a martini may have 3 ounces of alcohol, which is equal to two drinks. It’s important to know what’s in your drink. Avoid sweet drinks such as sweet dessert wine and drinks sweetened with soda or juice.
- Stay hydrated. Start with a nonalcoholic beverage first like unsweetened seltzer water. Alcohol is a diuretic, so drink water beverage before, during, and after drinking alcohol.
- Check your glucose. Carry your glucose meter and be ready to test more frequently as needed. Consider testing before drinking to make sure you aren’t low and before bed. Remember there is a possibility of overnight hypoglycemia especially for people who take insulin. Plan for a designated driver after drinking any alcohol.
- Show and tell. It’s always a good idea to wear medical ID, but especially if you are out having a drink. Tell friends you are with about hypoglycemia symptoms and how they could help. Hypoglycemia symptoms such as blurred vision, slurred speech, and confusion can look like someone who is intoxicated. A glucagon injection for alcohol-induced hypoglycemia is not effective because the liver is still breaking down alcohol and can’t release glucose. Carry fast-acting carbohydrates like glucose tabs or gels to treat any lows.
If you have questions about alcohol, talk with your healthcare team. Alcohol can interact with certain medications causing harmful effects or causing the medication to be less effective. Alcohol can affect your health, glucose, and medications so tell your healthcare team about your intake.
by Christine McKinney, RD LDN CDE
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