Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 20 years and a Certified Diabetes Educator for more than 15 years. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner.
We know all too well that whether out to dinner or at a party, we have more than just food choices to make. Should I have a drink? A glass of wine? A shot of tequila? This is a very personal choice, and for people with diabetes that choice may depend on several factors.
First of all, let me say that I find a glass of wine to be a relaxing end to my day, and with the permission of your own health care team, it may be just what the doctor ordered.
It is important, however, to know how alcohol may affect your diabetes. The United States Department of Health and Human Services recommends a maximum of one drink per day for women and two drinks per day for men. One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.
While drinks do carry carbohydrate value, which can contribute to overall blood sugar control, one of the biggest issues with drinking and diabetes is the potential for hypoglycemia, where your blood sugar drops too low. This risk can carry over for 8-10 hours after you drink alcohol. When do we typically have drinks? The evening, meaning that 8-10 hours later you may be sleeping!
It is important to understand that you may develop hypoglycemia in the night, which is why proper food and clear fluid consumption is important if you choose to drink. I would advise a patient to set an alarm between 2 and 3 a.m. to test their blood sugar to make sure that they don’t go too low if they have had alcohol at night, especially if they had more alcohol than they may normally consume.
It is the way that alcohol gets metabolized in the body that makes it especially dangerous for a patient with diabetes. When alcohol is ingested, it takes up most of the liver’s capacity; food gets broken down only after the liver is finished dealing with the alcohol. This is what makes the risk for hypoglycemia so great.
In addition, the effects of the alcohol may be confused with signs of hypoglycemia. Even glucagon will not work effectively in the presence of too much alcohol consumption, because, as you may recall, glucagon causes the liver to produce glucose from glycogen. But if the reserves are empty or the liver is “busy,” glucagon may not work properly.
Another effect of alcohol is to raise triglycerides. If your triglycerides are high already, your doctor may advise you to avoid alcohol whenever possible. This is because alcohol can interfere with your body’s ability to clear triglycerides from the bloodstream.
Lastly, as you may know, alcohol possesses some sedative properties. Oddly enough, alcohol can also have a stimulant effect in some cases. The exact mechanism for this has not been fully elucidated. This has been referred to as the biphasic effect of alcohol. Alcohol can disrupt sleep several hours after consumption, which is known as “rebound wakefulness.”
So, if you act on this knowledge and get the advisement of your own health care team, you will probably able to have a drink or two if you choose to.