Almost 1.8 million Canadians suffer from diabetes, out of which 90% of cases are of Type 2 diabetes. Lifestyle factors including excess alcohol intake, are responsible for an increased risk of Type 2 diabetes.

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While this does not mean that one cannot have alcohol at all, one should take precautions to prevent any complications.

Type 2 Diabetes and Alcohol Risk Factors

The pancreas produces insulin, a hormone that regulates blood glucose levels. In Type 2 diabetes, the body does not respond adequately to insulin. Alcohol consumption, especially when taken in excess, can further worsen this scenario. 

Besides, heavy drinking can cause a buildup of certain acids in the blood, which may be detrimental to health. Furthermore, alcohol can deteriorate diabetes complications, such as nerve damage and eye disorders.

Various studies have investigated the effect of alcohol on blood sugar levels of individuals with type 2 diabetes. The results depend on the fed state of the individuals; whether it is fasting or post meals.

Effect of Drinking Alcohol on Fed State

It is seen that single episodes of alcohol consumption generally do not significantly alter blood sugar levels. In fact, isolated drinking episodes may prove beneficial by lowering blood glucose levels, which tend to be high in people with type 2 diabetes.

Conversely, in well-nourished Type 2 diabetes patients, excess alcohol can increase blood sugar levels.

Effect of Drinking Alcohol on Fasting State

In such cases, when a person is in a fasting state, contrast effects are seen to that of the fed state. Long-term or heavy drinking in a fasting state profoundly reduces blood glucose levels, resulting in hypoglycemia. Low blood glucose levels can have life-threatening or severe consequences as the brain does not get adequate glucose for functioning. 

Typically, the liver prevents this by releasing stored form of glucose (glycogen), so that the body and brain get glucose even if you haven’t eaten. However, when you drink, the liver has to work for removing alcohol from your blood instead of managing blood glucose levels. This can cause profound hypoglycemia.

Some symptoms of hypoglycemia are:

• Sweating
• Nervousness
• Racing of the heart
• Weakness

Alcohol and Type 2 Diabetes Complications

Heavy or long-term drinking can increase the risk of following complications associated with Type 2 diabetes:

• Ketoacidosis: It is a condition where certain acids called ketone bodies accumulate in the blood. Ketoacidosis can cause nausea, vomiting, coma, impaired mental functioning, and even death. 
• Cardiovascular disorders: While moderate alcohol consumption may offer protection against cardiovascular diseases, excess consumption increases its risk.
• Peripheral neuropathy: In this condition, the nerves are damaged, resulting in tingling, pain, numbness, or burning.
• Retinopathy: Diabetic eye complications or retinopathy is one of the most prevalent causes of blindness.
• Impotence: Neuropathy and vascular disorders increase the risk of infertility in diabetic men.

Alcohol and Type 2 Diabetes Medications

Alcohol can interact with some Type 2 diabetes medications, such as:

• Chlorpropamide: It aids in managing Type 2 diabetes by increasing insulin secretion. Some people on chlorpropamide may experience unpleasant symptoms such as nausea and vomiting after consuming alcohol.
• Troglitazone: It improves insulin sensitivity. However, it may impair liver function, and alcohol might exaggerate this effect.
• Metformin: This medication decreases insulin resistance. Metformin may cause severe side-effects in patients with liver disorders, and alcohol further increases this risk.

Do’s and Don’ts of Having Alcohol with Type 2 Diabetes

Do’s

• Check blood sugar levels before you drink.
• Drink slowly and have a second drink without alcohol.
• Use sugar-free mixers with alcohol, such as diet tonic, water, or club soda.
• Prefer drinks with less alcohol, such as dry wine or light beer.
• Check blood sugar level before crashing on the bed.
• To prevent hypoglycemia during sleep, have a snack before going to bed.
• Wear diabetes identification, such as a MedicAlert® bracelet.
• Alcohol can cause hypoglycemia for up to 24 hours, so monitor your blood sugar levels.
• Taking sulfonylurea or insulin further increases the risk of hypoglycaemia after drinking, therefore, look for symptoms of hypoglycaemia and manage them immediately. 

According to Diabetes Canada, low blood sugar management includes three glucose tablets or 150 mL regular pop or six Life Savers®).

Don’ts

• Don’t drink on an empty stomach.
• Don’t drink after exercise. This increases the risk of hypoglycaemia.
• Don’t drink at all if you have problems identifying signs of low blood sugar levels.
• Don’t drink at all if you have nerve damage.
• Don’t have more than three standard drinks and more than 15 drinks in a week (for men) and no more than two standard drinks in a day and more than ten drinks a week (for women).

According to Diabetes Canada, “A standard drink is 341 mL (12 fl oz) of beer, 142 mL (5 fl oz) of wine, or 43 mL (1.5 fl oz) liquor.”

Final Thoughts

Occasional drinking episodes rarely hamper blood sugar levels in individuals with Type 2 diabetes. Moderate alcohol consumption may even prevent cardiovascular complications associated with Type 2 diabetes. But excess and long-term alcohol intake interferes with blood sugar control and increases the risk of diabetic complications, such as ketoacidosis and peripheral neuropathy.

If you plan to drink, follow do’s and don’ts to prevent hypoglycemia and other complications, it is a good idea to consult your doctor in case of doubts.