Drinking With Diabetes
Avoiding alcohol? The latest research says you might not have to
If you never or rarely drink alcohol, you’ve got lots of company. In fact, people with diabetes imbibe half as much as other adults. Why? Maybe their doctors cautioned them that drinking and diabetes don’t mix. Perhaps some have health conditions that are incompatible with alcohol. Or maybe they’re just concerned about all those calories—and carbs.
But is the occasional cocktail or glass of wine really so bad? After all, a daily drink does have its benefits. “There are more than 100 prospective studies that associate light to moderate drinking with a reduced risk of conditions such as heart attack, stroke, peripheral vascular disease, cardiac death, and gout,” says Jennifer LeBlanc, BSN, RN, CDE, director of care and education at the Joslin Diabetes Center in Boston. “Plus, it’s relaxing. And we know that any kind of stress reduction is good for people with diabetes.” Still, diabetes can make happy hour pretty confusing. Here’s what you need to know about drinking and how to do it safely.
The Benefits of Imbibing
You’ve probably heard that alcohol is good for your heart. But that’s an oversimplification. Take a look at the numbers and you’ll find that only moderate drinkers have less cardiovascular disease. On the opposite ends of the spectrum, both abstainers and heavier drinkers have a greater risk. Case in point: A study of 11,140 people with diabetes published in 2014 in the journal Diabetes Care found that those who drank moderately were significantly less likely to experience or die from heart disease than teetotalers or heavy drinkers.
But what exactly is moderate drinking? According to the Dietary Guidelines for Americans, published by the U.S. Department of Health and Human Services, it’s one drink a day for women and up to two per day for men. However, that “drink” is a lot smaller than you might suspect, just 5 ounces of wine, a 12-ounce beer, or 1½ ounces of 80-proof spirits (see “Size Matters” below).
A daily cocktail or two may also improve glucose management. While experts still haven’t nailed down the precise mechanism, they think that modest consumption improves insulin sensitivity. When Kaiser Permanente researchers asked 38,564 people with diabetes about their drinking habits, they found that those who sipped one or more drinks a day had lower A1C levels than those who abstained. (But if you don’t drink regularly, this doesn’t mean you should start. After all, other aspects of moderate drinkers’ lives may be behind the link.) However, after three daily drinks, A1C began to rise, a finding that’s consistent with other reports linking heavy consumption to higher blood glucose and A1C. Some experts suspect that too much alcohol decreases insulin sensitivity, but others have a different theory. “While there are likely a number of factors that play into these findings, research indicates that individuals who consume more alcohol tend to be less adherent to their medications and monitor their blood sugar less frequently,” says Nicole White, PharmD, CDE, a certified diabetes educator and associate professor of pharmacy at Creighton University in Omaha, Nebraska.
Risk Versus Reward
Despite the potential health perks of imbibing, there are some cautions as well. The biggest concern is hypoglycemia. While a glass of wine with dinner probably isn’t a big deal, a mojito on an empty stomach at happy hour is.
Blame it on your liver. This organ stabilizes glucose levels by storing carbohydrates and releasing them into the bloodstream between meals and overnight. It’s also the body’s detoxification center, breaking down toxins like alcohol so the kidneys can easily flush them away.
Trouble is, it’s not great at multitasking. “When you drink alcohol, the liver prioritizes the metabolism of the alcohol over the maintenance of blood sugar, putting you at risk for hypoglycemia,” says White. “This risk is increased if you are drinking alcohol and not consuming food or are using insulin or another medication that stimulates insulin secretion, such as glipizide, glyburide, or glimepiride.”
Because many of the symptoms of hypoglycemia—such as slurred speech, drowsiness, confusion, or difficulty walking—mirror those of intoxication, it can be difficult to tell the two apart. And if you have a tendency toward hypoglycemia unawareness, a condition in which you don’t recognize you’re going low, drinking becomes especially dicey.
Timing may also be an issue, as hypoglycemia can strike hours after your last drink, especially if you’ve been exercising. “Physical activity increases insulin sensitivity for as long as eight to 10 hours,” says Alison Evert, MS, RD, CDE, coordinator of diabetes education programs at the University of Washington Medical Center in Seattle. “So if you go get a couple of beers after a run, it might result in unexpected lows in the middle of the night.”
Carbohydrate (and Calorie) Confusion
There’s another reason imbibing can be challenging. Unlike protein, fat, or carbohydrate, alcohol doesn’t require insulin to provide energy to the body. Yet many people automatically assume that alcoholic drinks are loaded with carbs, not realizing that wine and spirits are practically carbohydrate free, with only a trace of carbohydrate in spirits and roughly 4 grams of carb in a 5-ounce glass of wine. The exception: sweet dessert wines, which pack 14 grams of carb per tiny 3½-ounce glass.
“The calorie and carbohydrate content of alcohol is something that people have a hard time wrapping their heads around,” says Evert. “If your blood glucose is high after a meal with a glass of wine, it’s probably not the wine but something else in the meal.” More common culprits are regular (not light) beer, with 13 grams of carbohydrate per 12-ounce bottle, and mixed drinks. Margaritas and wine coolers, for instance, can each easily pack 30 grams of carb.
High-carb drinks may sound like the smart option when you’re at risk for hypoglycemia, but it’s a bit more complicated than that. Liquid sugars are quickly absorbed by the body, LeBlanc says, so those carbs won’t be much help in preventing or treating a low that may occur hours after you drink. Food, on the other hand, is digested gradually, so it provides better protection against lows.
“Things get really tricky with mixed drinks,” says LeBlanc. “You can’t really ask a bartender how many carbs are in your cosmo.” If you’re on insulin, that can make it difficult to pin down the correct dose.
With all the focus on carbs, it’s easy to forget that alcohol also has calories. Given that drinking can make you lose track of what you’re eating, calories (and pounds) can add up quickly. Being tipsy has another downside, making it easy to mix up your medications or to forget to take them entirely.
What does all of this mean for you? “Like so many things related to diabetes, drinking is individualized,” says LeBlanc. “People don’t always like to talk about their drinking habits with their health care practitioners, but they should. We actually have a lot of tips and tricks that can help.”
Drink sizes vary. That can make it difficult to get a grip on how many carbs and calories you’re consuming. Here are the details on some common drinks.
Rum + diet cola
(1.5 ounces rum)
Less than 1 gram carbohydrate
Scotch + club soda
(1.5 ounces scotch)
Less than 1 gram carbohydrate
(2.25 ounces vodka or gin and 0.25 ounces vermouth)
Less than 1 gram carbohydrate
100 calories 4 grams carbohydrate
Red or white wine
120 to 125 calories 4 grams carbohydrate
(1.5 ounces vodka)
120 calories 5 grams carbohydrate
100 calories 6 grams carbohydrate