Key Takeaways

• Alcohol can lead to low blood sugar, especially when consumed on an empty stomach, impairing the liver’s ability to produce glucose.
• Sugary drinks, such as cocktails or sweet wines, can lead to blood sugar spikes.
• If you have diabetes or prediabetes, monitor blood sugar around alcohol consumption and speak with your healthcare provider about interactions with medications.

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What do celebrating a birthday, spending a Friday night at the bars with friends, or simply unwinding solo all have in common? Alcohol! The decision to consume alcohol is very personal, but if you do choose to drink, it’s important to understand the effect that it may have on your blood sugar, especially if you are managing diabetes or prediabetes. Read on to understand how alcohol can affect blood sugar and learn some tips to reduce your risk.

The Biochemistry of Alcohol Metabolism

When you drink alcohol, it is absorbed from your gut into the blood. It travels through the bloodstream to the liver, where it is broken down first into acetaldehyde (by the enzyme alcohol dehydrogenase) and then into acetate (by aldehyde dehydrogenase). Acetate can then be converted into carbon dioxide and water and expelled by the body through breath and urine.

Alcohol is a toxin; acetaldehyde also contributes to liver damage and oxidative stress. It is in the body’s best interest to break down alcohol as quickly as possible to reduce cell damage. But the liver prioritizes alcohol metabolism at the expense of its other activities, including gluconeogenesis (GNG), or the production of new glucose (sugar). Under normal circumstances, GNG occurs when blood sugar is low and the body needs energy. But when the liver is preoccupied with breaking down alcohol, it can’t create glucose. This can result in hypoglycemia, a dangerous drop in blood sugar.

Immediate Effects of Alcohol on Blood Sugar

The effect alcohol has on your blood sugar varies based on several factors. As described above, alcohol can lead to short-term decreases in blood sugar due to inhibition of GNG, especially if you are drinking on an empty stomach or fasting. Eating can buffer the effects of alcohol in two ways. First, if there is food in your stomach, it takes longer to digest the alcohol, leading to a lessened impact on blood sugar (and blood alcohol concentration). Second, food helps to counteract the lack of glucose production in the liver. If your body is digesting food, blood sugar will increase, even if the liver is not creating any.

However, the type of alcohol you drink will impact blood sugar. Higher-sugar alcoholic beverages, such as cocktails, may lead to an increase in blood glucose levels. This highlights the importance of monitoring your blood sugar levels to understand how different types of alcoholic beverages (and different situations related to fasting or eating) affect your body when drinking alcohol.

Types of Alcohol and Their Impact on Glucose Levels

When it comes to blood sugar management, not all types of alcoholic beverages are created equal. Here is a quick rundown of how your booze of choice may impact your blood sugar so that you can drink responsibly:

• Beer: Most beers are moderate to high in carbohydrates, which can lead to increases in blood sugar. Higher-carb beers include ales, stouts, and porters, which can contain 10-20 grams of carbohydrates per serving. Light beers tend to be lower carb and affect blood sugar less.
• Wine: Dry wines, including many red wines, are lower in sugar. Sweet wines, like Moscato or Riesling, can cause blood sugar spikes. Note that dry wines tend to be higher in alcohol.
• Spirits: Most hard liquor is low in carbs. However, mixers may provide a significant source of both calories and sugar, which can cause blood sugar levels to increase.
• Cocktails: These drinks are notoriously high in sugar. A piña colada, for example, might have as many as 70 grams of carbs; that’s more than 5 tablespoons of sugar. Cocktails, therefore, have a significant impact on blood sugar.

Alcohol and Diabetes: Risks and Considerations

While alcohol can be risky for everyone, if you have type 1 or type 2 diabetes, you will need to take extra care when drinking due to the dangers of hypoglycemia. The brain requires glucose to function, so low blood glucose levels resulting from alcohol use can affect the brain. Symptoms of low blood sugar range from mild (such as shakiness or irritability) to severe (including coma or seizures). And it isn’t always easy to know if your symptoms are due to low blood sugar or to intoxication. If you have diabetes, it is important to monitor your blood sugar if you do choose to consume alcohol so that you can respond to any changes.

The risk of hypoglycemia may be increased when taking certain diabetes medications. If you take any of these, talk to your healthcare provider to understand what is best for you:

• Insulin: Insulin lowers blood sugar by removing glucose from the bloodstream and letting it into the body’s cells. Because alcohol use can already contribute to low blood sugar, combining alcohol with insulin can lead to hypoglycemia.
• Metformin: Metformin lowers blood sugar by inhibiting liver production of glucose and decreasing intestinal absorption of glucose. Combining metformin with alcohol compounds the effect on the liver, resulting in even less glucose production. Severe hypoglycemia can result. There is also a risk of lactic acidosis, a rare but serious side effect of metformin exacerbated by alcohol intake, by impairing the liver’s ability to clear lactate when it is prioritizing alcohol breakdown.
• Sulfonylureas: These medications stimulate the pancreas to produce insulin, which helps clear glucose from the bloodstream. Alcohol can lead to a higher risk of hypoglycemia if the liver is not able to produce glucose and the body is producing more insulin.

Strategies for Safe Alcohol Consumption

Alcohol is not a health food, but the decision to drink is very personal; if you do choose to drink, there are some strategies for doing so in the healthiest way possible:

• Consume alcohol with food to mitigate blood sugar drops. Food slows alcohol absorption and release into the bloodstream and liver. Eating also helps to stabilize blood sugar to counter the hypoglycemic effects of alcohol. But don’t use this as an excuse to load up on bar food! Choose foods high in fiber and protein - these foods slow digestion the most and are packed with nutrients.
• Choose beverages with lower sugar content. Liquors, dry wines, and some beers are lower in sugar (and calories!), which may prevent a blood sugar spike. Opt for a glass of wine over a cocktail.
• Monitor blood sugar levels before and after drinking. If you have diabetes, check your glucose so you can respond if needed to prevent hypoglycemia or hyperglycemia. Remember that symptoms of hypoglycemia are similar to those of intoxication.
• Limit intake to moderate levels. The Dietary Guidelines for Americans recommend limiting alcohol intake to one drink per day for women and two drinks per day for men.¹ According to the CDC, one drink is equal to 12 oz of beer with 5% alcohol, 5 oz of wine with 12% alcohol, or 1.5 oz (a shot) of 80-proof liquor.²

Long-Term Implications of Alcohol on Blood Sugar Control

Heavy drinking, particularly in the long term, can lead to insulin resistance. A study in rats suggests that drinking a high amount of alcohol disrupts the brain’s response to insulin.³ This leads to liver damage and increased sugar production by the liver. The result? Increased blood sugar levels and reduced insulin sensitivity, even after all alcohol has left the bloodstream.

Frequent drinking can also contribute to weight gain or make it harder to lose weight. Weight gain can lead to insulin resistance and increase the risk of not only diabetes but also metabolic syndrome and heart disease.

The Bottom Line

Alcohol has complex effects on blood sugar that may be lessened or worsened depending on your booze of choice or other drinking habits. If you have diabetes or prediabetes, understanding how different types of alcohol and drinking contexts impact glucose levels is critical to avoid dangerous lows or highs. With mindful choices, such as drinking with food, limiting sugary beverages, and monitoring blood sugar levels, it’s possible to reduce the risk while still enjoying an occasional drink.

Learn More With Signos’ Expert Advice

Blood sugar health seriously affects how you feel and how well your body functions. That’s why it’s so important to choose the right medication and make healthy choices to manage your blood sugar. Understanding the connections between medications, lifestyle choices, and blood sugar can give you the tools that you need to stay healthy.

A CGM empowers you to improve your health by tracking your diet, exercise, sleep habits, and blood sugar levels. Knowledge is power, and a CGM can provide you with specific information about how your habits impact your health. 

Signos has a team of health experts who compile evidence-based nutrition information to help you improve your health and wellness. Check out the resources here.