People with diabetes should be particularly cautious when it comes to drinking alcohol because alcohol can make some of the complications of diabetes worse. First of all, alcohol impacts the liver in doing its job of regulating blood sugar. Alcohol can also interact with some medications that are prescribed to people with diabetes. Even if you only rarely drink alcohol, talk with your healthcare provider about it so that he or she knows which medications are best for you.
Here’s what you need to know:

1. Alcohol interacts with diabetes medications

Alcohol can cause blood glucose levels to rise or fall, depending on how much you drink. Some diabetes pills (including sulfonylureas and meglitinides) also lower blood glucose levels by stimulating the pancreas to make more insulin. Combining the blood-sugar-lowering effects of the medication with alcohol can lead to hypoglycemia or “insulin shock,” which is a medical emergency.

2. Alcohol prevents your liver from doing its job

The main function of your liver is to store glycogen, which is the stored form of glucose, so that you will have a source of glucose when you haven’t eaten. When you drink alcohol, your liver has to work to remove it from your blood instead of working to regulate blood sugar, or blood glucose. For this reason, you should never drink alcohol when your blood glucose is already low.

3. Never drink alcohol on an empty stomach

Food slows down the rate at which alcohol is absorbed into the bloodstream. Be sure to eat a meal or snack containing carbohydrates if you are going to drink alcohol.

4. Always test blood sugar before having an alcoholic beverage

Alcohol impairs your liver’s ability to produce glucose, so be sure to know your blood glucose number before you drink an alcoholic beverage.

5. Alcohol can cause hypoglycemia

Within a few minutes of drinking alcohol, and for up to 12 hours afterward, alcohol can cause your blood glucose level to drop. After consuming alcohol, always check your blood glucose level to make sure it is in the safe zone. If your blood glucose is low, eat a snack to bring it up.

6. You can save your life by drinking slowly

Drinking too much alcohol can make you feel dizzy, sleepy, and disoriented—the same symptoms as hypoglycemia. Be sure to wear a bracelet that alerts people around you to the fact that you have diabetes, so that if you start to behave like you are intoxicated they know that your symptoms could be caused by hypoglycemia. If you are hypoglycemic, you need food and/or glucose tablets to raise your blood glucose level.

7. You can save your life by knowing your limit

Your healthcare provider will tell you how much alcohol is safe for you to drink. Depending on your health condition, that may mean no alcohol at all. In some cases, women with diabetes may have no more than one alcoholic beverage a day. Men should have no more than two.

Type 2 Diabetes and Alcohol: Proceed With Caution

Alcohol can worsen diabetes-related nerve damage. (RON CHAPPLE STOCK/CORBIS) Hoping for a beer at the ball game, or a glass of wine with dinner?
If you have type 2 diabetes, that's probably OK as long as your blood sugar is under control, you don't have any complications that are affected by alcohol (such as high blood pressure), and you know how the drink will affect your blood sugar, according to the American Diabetes Association.
An alcohol-containing drink a day might even help your heart (though if you don't already drink, most experts say that's not a reason to start).
In moderation, alcohol may cut heart disease risk
According to a study by researchers at the Harvard School of Public Health, women with type 2 diabetes who drank relatively small amounts of alcohol had a lower heart-disease risk than those who abstained. A second study found that men with diabetes had the same reduction in heart risk with a moderate alcohol intake as non-diabetic men.
In general, the recommendations for alcohol consumption for someone with type 2 diabetes are the same as anyone else: no more than two drinks per day for men and no more than one drink per day for women. (Make sure to measure: A drink serving is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor such as scotch, gin, tequila, or vodka.)
People with diabetes who choose to drink need to take extra care keeping food, medications, alcohol, and blood sugars in balance.
Janis Roszler, RD, a certified diabetes educator in Miami, Fla., recommends:
  • Mixing alcoholic drinks with water or calorie-free diet sodas instead of sugary (and calorie- and carbohydrate-laden) sodas and other mixers.
  • Once you have had your drink, switch to a non-alcoholic drink, such as sparkling water, for the rest of the evening.
  • Make sure you have an eating strategy and plan in place to avoid overeating and overdrinking in social situations. Alcohol can make you more relaxed, and may lead you to make poor food or drinking decisions.
  • Don't drink on an empty stomach because alcohol can have a very rapid blood glucose lowering effect, which is slowed if there is food in your stomach.
  • If you're going to have a drink, wear your diabetes identification bracelet or necklace.
"If you become hypoglycemic and there is alcohol on your breath, police or paramedics may mistake your condition for being drunk and may not get the care you need," says Roszler.
Alcohol may also worsen nerve damage

Some people with diabetes, though, should not consume alcoholic beverages.
Drinking can worsen nerve damage from diabetes and increase the pain, burning, tingling, and numbness that people with nerve damage often experience.
If you have complications related to your diabetes, you should be more careful about your alcohol intake. More than three drinks a day can worsen diabetic retinopathy. And even if you have fewer than two drinks per week, you can increase your risk of nerve damage (alcohol abuse can cause nerve damage, even in people without diabetes). Alcohol can also raise levels of fat called triglycerides in the blood.
Here's something else to consider: Researchers at Kaiser Permanente in California wanted to see whether there is a relationship between drinking and diabetes self-care behaviors. The team examined survey data for 65,996 adults with diabetes to determine their levels of alcohol consumption and adherence to good health habits, such as testing their blood sugar, getting their A1C levels checked, and taking their medicines.
People who drink alcohol, the study found, are less likely to follow recommended practices than those who don't drink, and the more they imbibe, the less likely they are to stick with recommended health practices.
Although the study doesn't prove that drinking causes poor health behaviors, it does suggest that drinking is a marker for poor self-care.
You'll need to test your blood sugar to gauge alcohol's effect

If you do choose to drink, there are no specific recommendations for one type of alcoholic beverage as better than another. However, the American Diabetes Association notes that light beer and dry wines tend to have less alcohol, carbohydrates, and calories.
It's important to test before and after having a drink to see the impact on your blood sugar, especially when you've first been diagnosed with diabetes or if you're taking insulin or other medicines that can cause hypoglycemia. Treat abnormal blood sugar levels as directed by your health care team.
Alcohol usually causes blood sugar to drop (while the liver is processing alcohol, it takes a break from its other role of releasing stored glucose as needed). However, alcohol can sometimes raise blood sugar.
"I do drink alcohol in very moderate amounts," says Donna Kay, 40, of Prairie Village, Kan., who was diagnosed with type 2 diabetes in 2003. She always checks her blood sugar before and after consuming alcohol. "If I'm at a dinner party, I'll duck into a bathroom," she says.
"For me," says Kay, "beer will raise my blood glucose, while a martini will cause it to fall a little. I avoid drinks with fruit juice or a lot of sugar, such as a cosmopolitan or a piña colada. "They are not worth the blood sugar spike or the calories. Also, some alcohol, such as Baileys Irish Cream, has lots and lots of added sugar skip the sugary stuff so I can save those carbs for something else," Kay says.
Red and white wine both have about 100 calories per five-ounce glass; sweeter red wines will have a higher calorie count because of the extra sugar from the grapes. A screwdriver (vodka and orange juice) made up of 1.5 ounces of vodka and eight ounces of orange juice would have 208 calories and 25 carbohydrate grams (all the carbohydrate is from the orange juice.)
You may have to adjust other food choices during the day to accommodate the extra calories and carbohydrates from alcoholic drinks. As a general rule, it is better not to "drink" your calories; healthy food choices should come first.