Alcohol and Diabetes

In your diabetes treatment counseling, you were probably warned to limit your intake of alcohol, because when consumed without food, alcohol can cause low-blood-glucose episodes and, in large amounts, raise blood pressure. At the same time, you've no doubt seen reports that a daily drink can help reduce the risk of heart disease and stroke—two diseases that pose more problems for people with diabetes. Moderate drinking is even associated with lower risk of type 2 diabetes. What can you conclude from this conflicting advice?

According to the American Diabetes Association, recommendations for people who have their diabetes under control are no different from those aimed at the general population: If you choose to drink, limit it to two drinks a day for men and one daily drink for women. If you're pregnant, have high blood triglycerides (over 500 mg/deciliter) or a history of alcohol problems in your family, it makes sense to stay away from alcohol altogether.

The limits are there for a reason; for people with diabetes, there are real risks associated with going beyond them. The first is low blood glucose. When your liver is processing alcohol, it can't make new glucose. This can cause your blood-glucose levels to drop, sometimes sharply—if you're drinking on an empty stomach and are taking insulin or diabetes drugs. Worse, this effect can last for as long as 12 to 16hours after you drink, depending on how long it takes your body to process the alcohol. And low blood glucose can make you feel and act tipsy, so you could be doubly impaired.

So, make sure to eat something whenever you decide to drink—and take it slow. For a good model, think of the healthy way many Mediterraneans enjoy alcohol: slowly sipped throughout a meal, rather than served alone in cocktails. It's a good idea to check your blood glucose regularly after you've had a drink too.
Another issue to consider is alcohol's effects on your heart, which can be a double-edged sword. When alcohol is enjoyed in small amounts, like the ones defined as "one drink" (15 grams of alcohol equal to 12 ounces beer, or 5 ounces wine, or 1 1/2 ounces spirits), it doesn't affect blood pressure, and in fact might reduce heart problems by boosting heart-healthy HDL cholesterol and by improving sensitivity to insulin. But increase the amount of daily alcohol, and the risk of high blood pressure rises sharply—on a graph, it follows a J-shaped curve.

Alcohol in moderation, enjoyed with food to decrease the risk of low blood glucose, might help your heart, but talk with your health-care providers to determine the best strategy for you. If you're not a drinker now, there's no reason to start. If it's heart disease or diabetes risk you want to avoid, there are plenty of nonalcoholic ways to do it.

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