Alcohol and Diabetes
Diabetes mellitus is a disorder of the endocrine system. It causes the blood levels of insulin to become too high or too low. Insulin is a hormone produced by the pancreas to help convert blood sugar into energy.
Type 2 diabetes (which is also called adult-onset diabetes) results from the body’s inability to process insulin effectively. Almost 90 percent of all people with diabetes have Type 2. Being overweight and having a family history of diabetes are the strongest predictors of Type 2 diabetes.
Lifestyle patterns may also play a role in the development of the disease. This includes being inactive, the types and amounts of foods the persons eats, and having higher levels of alcohol consumption.
Diabetes affects approximately 1.8 million
adults in the Canada. Ten
Canadians aged 65+ have the disease, compared to 3% of those aged 35 to 64. With the aging of the Canadian population, the number of
cases of Type 2 diabetes are projected to increase. The
rate of Type 2 diabetes is
3 to 5 times higher in native communities than
in the general population. (1) Diabetes is
manageable chronic (long term) disease. However when people have poorly
controlled blood sugar (glucose) levels, they are at much higher risk of several
diabetes-related complications. This includes the risk of heart attack or
stroke, kidney disease, and the risk of amputation because of poor blood
circulation to the legs and feet.
Does Alcohol Affect the Development
Diabetes affects approximately 1.8 million adults in the Canada. Ten percent of Canadians aged 65+ have the disease, compared to 3% of those aged 35 to 64. With the aging of the Canadian population, the number of cases of Type 2 diabetes are projected to increase. The rate of Type 2 diabetes is 3 to 5 times higher in native communities than in the general population. (1)
Diabetes is manageable chronic (long term) disease. However when people have poorly controlled blood sugar (glucose) levels, they are at much higher risk of several diabetes-related complications. This includes the risk of heart attack or stroke, kidney disease, and the risk of amputation because of poor blood circulation to the legs and feet.
Does Alcohol Affect the Development of Diabetes?
There is some evidence to suggest that people who drink moderate amounts of alcohol have a reduced risk of developing diabetes. In 1995 Harvard University researchers reported in the British Medical Journal that men who consumed two drinks per day had a 40% reduced risk of developing diabetes compared to non-drinkers. (2)
Coronary heart disease is a common complication of diabetes. A 1999 research article in the July 21 Issue of the Journal of the American Medical Association suggests that people with Type 2 diabetes who consumed alcohol in low to to moderate amounts had a reduced risk of death due to coronary heart disease. In the study, researchers compared people who never drank alcohol with people who reported drinking light to moderate amounts of alcohol (up to two drinks per day). When the data were analyzed, the results suggest that such alcohol consumption might lower risk of death from coronary heart disease by as much as 80 percent. (3) As with all research of this nature, it is important to consider whether there are other social, economic, health, or lifestyle differences that distinguish the people who are drinkers from those who are never-drinkers.
Other research suggests that the ties between alcohol and diabetes may be more complex. A Japanese study looking alcohol and the risk of diabetes, compared men with different body masses. It discovered a bit of a paradox. Lean men had a higher risk of developing Type 2 diabetes if they were heavy drinkers. Heavier men, in contrast, had a greater risk of developing Type 2 diabetes if they were moderate drinkers. (4)
National diabetes associations stress the importance of individuals and physicians working together to make decisions regarding alcohol consumption, whether or not the patient has diabetes.
People who have difficulty limiting themselves to light to moderate drinking should not be encouraged to drink.
Guidelines for People Who Have Diabetes
Alcohol + Diabetes is a new resource from the Canadian Diabetes Association (CDA) which is designed to assist both clients and educators when they discuss the subject of alcohol and diabetes management. The tool outlines the questions that people should ask before deciding whether to drink, as well as techniques for managing blood glucose before, during, and after drinking.
People with diabetes always need to consider:
McKinley Health Services in the United States has an interesting handout on its website called "Alcohol, Diabetes and You". It describes how alcohol affects a person who has diabetes, and how alcohol affects blood glucose. It gives "safe sipping tips", carbohydrate grams and exchanges. The information is reprinted from the American Diabetes Association and the American Diabetics Association.
The Canadian Diabetes Association notes that
"moderate alcohol consumption is acceptable for people with diabetes whose blood glucose and blood fats are well controlled. All people with diabetes should discuss alcohol consumption with their dietician. Such individuals could consume up to five percent of total daily calories (or two drinks per day), whichever is less."
The Canadian Diabetes Association also notes that people using insulin should be aware they can develop delayed hypoglycemia up to 14 hours after alcohol consumption.
WebMaster's Note: Please note both of these sources provide general guidelines to adults (which means the guidelines have not been adjusted for age). That information may need to be carefully considered and may need to be modified for older adults in light of the fact that an older person's body metabolizes alcohol more slowly. Some older persons may have other health problems in addition to the diabetes.
How Many Calories Are There in Alcohol?
The Canadian Diabetes Association gives some caloric breakdowns of common alcoholic beverages based on Canadian alcohol beverage standards:
|1 regular beer||
|1 light beer||
|45 mL (1.5 oz) whisky, rum, scotch
|100 mL (3.5 oz) red/ dry white wine||
Here are some examples:
People who have diabetes may want to be careful with those pre-mixed, ready-to-serve cocktails because of the hidden sugar or carbohydrates. For example, an 8 ounce serving of Rum Island Island Tea (TM) contains 12.5% alcohol and has 32 gm. of carbohydrates.
Note: Sweeter or higher alcohol varieties of liqueurs do not necessarily have more carbohydrates. Coffee liqueurs and Amaretto appear to contain the most grams of carbohydrates.
What Are the Concerns about Alcohol for Older People Who Have Diabetes?
Consuming more than two standard drinks a day* can become a health concern for any adult with diabetes, but being older involves some additional consideration:
1. Older people can have a harder time telling when their blood glucose is low. Like all people who have diabetes, the aim is to have the best blood glucose control possible.(5)
2. Any person who has diabetes and is drinking more than moderate amounts
may be neglecting his or her diet. The person may not be eating or not getting proper nutrition. The person may not be drinking enough non-alcoholic fluids to avoid becoming dehydrated. (6)
may be or can become overweight because of a sedentary lifestyle. Often in this situation, the person is consuming a lot of empty calories from the alcohol, and not eating well planned meals. (6) Either way, lack of proper nutrition can throw the blood glucose levels out of control.
may not be taking the oral medications properly or taking advantage of other monitoring supports, such as outpatient follow up visits. (6)
3. A person who is drinking may be experiencing low blood glucose. Other people may mistake this as intoxication, and they may not act in time to help the person.
4. When a person's diabetes is not being well controlled, the person can develop peripheral neuropathy, which in turn impairs their mobility. The neuropathy and circulatory problems associated with diabetes can lead to other complications such as amputations, further limiting mobility.
"Peripheral neuropathy begins with painful burning, tingling and aching in the toes and/or fingers that can, when advanced, change to numbness of the feet or hands occasionally associated with sudden sharp pain. Usually the pain is worse at rest, and it frequently interferes with sleep. There is no satisfactory treatment for painful diabetic neuropathy." (7)
5. There are several health problems related to diabetes, including potential vision loss and impaired mobility. These health problems can make it significantly more difficult for an older person to access many of the available diabetes resources if she or he develops an alcohol problem.
Seventy-eight per cent of people who have Type 2 diabetes will experience some degree of vision loss.
* Two standard drinks a day for men; one standard drink a day for women.
Alcoholic beverages can make your blood sugar drop. Avoid the risk of a low blood sugar by having your drink at meal time, or having snack along with the drink.
The carbohydrate content of alcoholic drinks will vary. Limit those with sugar as they will have a higher amount of carbohydrates and may therefore contribute to a high blood sugar. Avoid sweet mixers and use sugar-free products.
Signs and symptoms of low blood sugar and intoxication are similar!
If you take insulin, don't get into a situation where you may be drinking on an empty stomach and getting hypoglycemic - and your friends just think you are a little "tipsy". Make sure your companions know you have diabetes and know how to treat an insulin reaction. Always wear medical identification to alert people to the fact that you have diabetes.
It is not advised to drink if you are taking certain medications. People taking oral hypoglycemic agents (medications they take by mouth to lower their blood sugar) may have a reaction to the alcohol. Discuss this with your doctor.
Consuming alcohol is not advised for people who have diabetes if their triglycerides levels are high.
Alcohol and Diabetic Medications
A person with diabetes may be on several medications to control the disorder, and to avoid other related conditions such as high blood pressure, or high triglycerides, as well as to avoid complications such as heart disease. It is important to know if and how alcohol interacts with these medications.
ALCOHOL may interact with GLYBURIDE
Drug Digest is a non-commercial website with evidence based information where you can find out drug interactions. According to Drug Digest:
"Glyburide is used to lower blood sugar levels in people with diabetes. Based on information from several studies involving drugs similar to glyburide, alcohol may have an unpredictable effect on this type of drug. For instance, alcohol may interfere with the removal of glyburide from the body. If this happens, its blood sugar-lowering effects could be prolonged. When alcohol is used for extended periods of time, glyburide may be broken down and removed from the body at a faster rate than normal. This could make the drug less effective.
In some cases, glyburide may interfere with the breakdown of alcohol, causing harmful by-products from the alcohol to accumulate in the body. This may lead to intolerable or otherwise undesirable side effects including flushing, feeling lightheaded, nausea and vomiting, a rapid heart beat, and rapid breathing. If possible, limit the amount of alcohol that you consume to no more than one occasional drink while you are taking glyburide.
Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.
This interaction is well-documented and is considered moderate in severity."
Metformin promotes sugar uptake. The Drug Digest does not identify any interactions between alcohol and Metformin.
However, the Canadian Diabetes Association notes this diabetes medication should not be used if the person has decreased kidney or liver function, heart failure, or if person has a history of alcohol binges (drinking a large quantity of alcohol over a short period of time) or has a history of alcohol use problems.
ALCOHOL may interact with INSULIN
According to Drug Digest:
"Sugar is the main source of fuel used by the body. When there is not enough sugar to use, the liver breaks down fat and protein from the diet and from storage sites in the body so that these substances can be converted into more sugar. Insulin is responsible for moving sugar from the blood into cells all throughout the body so that it can be used as fuel. This, in turn, causes blood sugar levels to decrease.
When alcohol (ethanol) and insulin are used together, the blood sugar-lowering effect of insulin may be enhanced. This situation is especially dangerous when alcohol and insulin are used together on an empty stomach.
Alcohol may increase the release of insulin from the pancreas, causing a greater decrease in blood sugar levels. It may also prevent the liver from converting fat and protein into sugar. If you are using insulin, be sure to eat a snack or meal before you consume alcohol. You should also consider limiting the number of alcoholic beverages that you consume, monitoring your blood sugar level, and watching for signs of hypoglycemia. Ask your healthcare provider about these drugs and this potential interaction as soon as possible."
This interaction is poorly documented and is considered
major in severity.
Other common medications used by people who have diabetes may include aspirin, and cholesterol reducing drugs.
(1) Canadian Diabetes Association, www.diabetes.ca/Section_about/index.asp
(2) Rimm, Chan, Meir, Stampfer, et al. (4 March, 1995). Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men, British Medical Journal, 310, 555-559.
(3) Criqui, M. &, Golomb, B. (July 21, 1999). Should Patients With Diabetes Drink to Their Health? Journal of the American Medical Association, 282, No. 3. 279-280 Extract at :
(4) Tsumura, K., Hayashi, T., Suematsu, C. et al. (1999) Daily alcohol consumption and the risk of Type 2 diabetes in Japanese men. Diabetes Care, 22(9),1432-1437.
(5) Guidelines for the Nutritional Management of Diabetes Mellitus in the New Millennium, A Position Statement by the Canadian Diabetes Association, Reprinted from the Canadian Journal of Diabetes Care, 23 (3), 56-69, at p. 8.
See also, Clinical Guidelines, www.diabetes.ca/cpg2003/chapters.aspx
(6) See for example: Johnson, K.H., Bazargan, M., & Bing, E.G. (2000). Alcohol a consumption and compliance among inner city minority patients with type 2 Diabetes Mellitus. Archives of Family Medicine, 9 (10), 964-70.
(7) Ask the Podiatrist,... www.diabetes.ca/membership/dialogue/fall00-askprof.html
Last update: 21/07/2006
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