Alcohol and Hypoglycemia: Navigating Alcohol Consumption with Diabetes 

Published on: 04/30/2024

Written by Caiton Wilmoth, BS, Master’s Dietetic Intern University of Oklahoma Health Sciences Center

An estimated 90 million Americans consume alcohol every day. Drinking alcohol has a major social aspect, especially around sporting events, tailgates, holiday parties, and special occasions. There can be a feeling of isolation for those with medical conditions that are not aware of how to safely drink if they so choose. The purpose of this post is to provide information on alcohol consumption for people with diabetes that may be concerned about the effect of drinking on their blood glucose levels.  

Diabetes is a chronic condition that affects the way the body processes blood glucose. In type 1 diabetes, the pancreas does not make insulin, which is a hormone that regulates the amount of glucose in the blood. In type 2 diabetes, the body either does not produce enough insulin to regulate blood glucose, or there is insulin resistance that affects regulation as well.  

An alcoholic beverage contains ethanol, which is produced by fermentation of grains, fruits, or other sugar sources. Alcohol consumption without proper planning can negatively impact blood glucose levels in all people, but can especially be dangerous for those with diabetes.  

Alcohol Metabolism 

When you drink alcohol, it can be metabolized in the body in a few different ways. The most common pathways involve an enzyme called alcohol dehydrogenase. It converts the alcohol to a highly toxic substance called acetaldehyde, which is further metabolized into acetate, and then water and carbon dioxide for elimination from the body. The alcohol dehydrogenase pathway is utilized when low to moderate drinking occurs, about 1-2 drinks. When excessive drinking occurs, a secondary metabolic pathway called the microsomal ethanol oxidizing system (MEOS) is activated. Both of these pathways occur in the liver.  

The liver is also responsible for carbohydrate metabolism and balancing blood glucose levels. When alcohol is consumed, liver function prioritizes the metabolism of alcohol over blood sugar regulation, since alcohol can have toxic effects. This is why excessive drinking can lead to blood glucose complications. 

Alcohol and Diabetes 

For people with diabetes, drinking alcohol can cause low or high blood sugar, depending on what and how much is consumed. Often, while the liver is processing alcohol, blood glucose levels can drop because the liver is not prioritizing the synthesis or release of glucose. This leads to a drop in blood sugar, with a potential for hypoglycemia to occur. Excessive alcohol consumption raises the risk for hypoglycemia, especially if insulin or other diabetes medications are also working to lower blood glucose in the body.  

Hypoglycemia is a state of low blood sugar. It can cause symptoms such as: 

  • shakiness 
  • heart palpitations 
  • confusion 
  • anxiety  

Hypoglycemia can be fatal if not corrected, so it is important for people with diabetes to be aware of the risk for hypoglycemia when drinking and to recognize these symptoms so they can take action to raise blood glucose levels as needed.  

Because diabetes medications like insulin and sulfonylureas (like glipizide) can increase the risk of hypoglycemia while drinking, people taking these medications should talk to their physician for drinking guidance more specific to their needs. 

Recommendations for Drinking Safely with Diabetes 

Here are some tips for safe drinking with diabetes: 

  • Consider the Dietary Guidelines for Americans. These recommend alcohol consumption of less than 1 drink per day for women and 2 drinks per day for men. Moderation is key for safely drinking. 
  • Remember that one standard drink is roughly equivalent to 12 oz of beer (5% alcohol), 8-10 oz of hard seltzers (7% alcohol), 5 oz of wine (12% alcohol), or 1.5 oz of distilled spirits (40% alcohol). Below is a visual aide for standard drinks, using the lines on a typical red solo cup. 
  • Plan ahead for social events where alcohol may be served. Hydrating and eating a balanced meal before and during drinking can decrease the risk for adverse effects of alcohol like hypoglycemia.  
  • Plan for a ride home, and never drink and drive.  
  • If available, read the drink’s nutrition label to determine the alcohol and carbohydrate and sugar content. Drinks with lower carbohydrate content will typically be safer choices for people with diabetes that are trying to control their blood glucose. This includes light beers, some red or white wines, distilled spirits, and mixed cocktails without a lot of sugary juices or syrups. 
  • Alcohol by volume, or ABV, is one way to determine the alcohol content of a drink. This value represents the amount of pure alcohol in the beverage. The ABV can determine how much of the beverage is equivalent to a standard drink.  
  • The proof of an alcoholic beverage is another way to determine its alcohol content and the amount equal to one standard drink. The proof of a drink is two times the ABV.  
  • The proof or ABV can typically be found on the front label of the can, bottle, or box containing the alcoholic product. 
In the image above, the labels of a White Claw Hard Seltzer are shown. The front of the can’s label shows the drink has a 5% ABV, and the nutrition facts label on the back of the box shows the breakdown for the drink’s serving size, calorie content, carbohydrate content, and more. 
  • For non-alcoholic options, consider ordering a mocktail, but be aware of its ingredients and their potential impact on blood glucose. Many mocktails contain sugary sodas, juices, and syrups. Diet sodas, diet tonic water, and sugar-free syrup options may also be available. 
  • Monitor your blood glucose and medication usage,  and seek medical help if blood glucose levels get too high or too low.  

In conclusion, people with diabetes can drink alcohol in moderation with safety measures and close monitoring of blood glucose levels. Reading labels, considering individual situations, and planning ahead are key for making informed choices about alcohol and taking control of your health. Food and alcohol play an important role in social lives, and people with diabetes should not feel like they have to miss out.  

Dietitians can help people with diabetes navigate their condition and health. To book a free intro call with a Amanda to talk more about your needs, schedule today.

Talk to your healthcare team about alcohol consumption and if it is right for you. For more information about diabetes, visit the following links: 


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