Nutrition for People with Diabetes: Use of Alcohol

Is it OK for people with diabetes to drink alcohol?

It may be OK for you to drink alcohol some times, but when you have diabetes you need to be especially cautious. Too much alcohol can make blood sugar levels fall too low. If you haven't eaten anything recently, drinking even a small amount of alcohol can lead to a very low blood sugar. If you take insulin or diabetes pills, you have an even greater risk for low blood sugar because alcohol increases the effects of the medicine. Also, some diabetes medicines can interact with alcohol and cause serious and potentially life-threatening problems. Always ask your healthcare provider about possible drug interactions if you drink alcohol.

What are the other effects of drinking alcohol when you have diabetes?

Alcohol can make some diabetic health problems worse. If you have nerve damage in the arms or legs (neuropathy), eye disease, high blood pressure, or liver disease, drinking any amount of alcohol can make these problems worse.

People with diabetes are at risk for high blood pressure. Drinking too much alcohol increases blood pressure. High blood pressure can worsen diabetic complications, such as kidney failure, retinopathy, and heart disease.

Diabetics who have high levels of triglycerides in their blood should not drink alcohol. Drinking even small amounts of alcohol can cause the liver to make even more triglycerides.

What are the guidelines for drinking alcohol if I have diabetes?

If you have trouble controlling your blood sugar level or you have complications from diabetes, you should never drink alcohol.

If you do not have any complications, your blood sugar is in good control, and you do drink alcohol, follow these tips:

• Never drink alcohol on an empty stomach. Always eat a meal or a snack that contains carbohydrate (starch, fruit, or milk) before or with your drink. If you are involved in a physical activity, such as dancing, eating enough carbohydrates is especially important because exercise also lowers the blood sugar level.
• The general guidelines for how much alcohol is safe to drink are the same as for people who don't have diabetes. Research shows that drinking alcohol in moderation may have some health benefits. Drinking alcohol is a personal choice that should be based on your current health, other risk factors, and your healthcare provider's advice. Moderate levels are 1 drink a day if you are a woman and 2 drinks a day if you are a man. One drink equals one 12-ounce beer, one 5-ounce glass of wine, or a shot of one and one half ounces of spirits.
• If you cook with alcohol, use regular drinking wine, not cooking wine. There is less sodium in the drinking wine. Cook the food slowly so that the alcohol has time to burn off.
• Always wear a diabetes alert bracelet or necklace because the signs and symptoms of low blood glucose and intoxication from alcohol are similar. Make sure your companions know that you have diabetes and know that if you are acting drunk, you may actually be having a low blood sugar reaction that needs to be treated. Tell them how to help you when you are having low blood sugar.
• Alcohol can affect your body's ability to get over a low blood sugar level. If you have low blood sugar, you may need to treat it more than once. If you've been drinking, always check your blood sugar before you go to sleep. It should be at least 100 to 140mg/dl. Eat a snack before bedtime to avoid a low blood sugar reaction while you sleep.
• Check your blood sugar often. Keep a high-carbohydrate snack or glucose tablets on hand to treat low blood sugar.
• Combining alcohol with exercise can cause blood sugar to go dangerously low, even hours after the physical activity. It is better to quench your thirst with water rather than alcohol before, during, and after exercise.
• If you have insulin-dependent diabetes, glucagon shots do not work for severe low blood sugar caused by drinking alcohol. Glucagon shots treat very low blood sugar reactions caused by too much insulin. Avoid letting your blood sugar level go to too low because you need to be able to treat your reaction with a carbohydrate, such as oral glucose tablets or gels. If you pass out, you will need glucose injected into your bloodstream by a healthcare professional.

How do I fit alcoholic beverages into my meal plan?

Drinking alcohol can make it harder to lose weight. Alcohol is high in calories. Factor in the extra calories that you may get from eating snacks, meals, or mixers to avoid low blood sugar and you can easily go over your calorie limit for weight loss. Either avoid alcohol completely or use the following tips to fit the added calories better into your meal plan.

• If you do not take insulin, the calories from alcohol can be substituted for some of the fat portions in your diabetic meal plan. (Most meal plans allow for 3 to 6 fat portions per day.) Your body breaks down alcohol in a way similar to how it breaks down fat. Each drink is equal to 2 fat portions, or about 100 calories.
• If you take insulin, you can occasionally include 1 or 2 drinks in your daily meal plan. Do not omit any foods from your usual eating plan. When you are using insulin, you have a greater risk for hypoglycemia.
• You can make your drink last longer by combining wine with no-calorie mixers such as club soda, sparkling water, or diet soda for a spritzer. Try to drink slowly.
• As a rule, choose alcoholic beverages and mixers that are lower in alcohol, carbohydrates (sugars), and calories. Examples are dry or light wines; light beers; and sugar-free mixers such as diet soda, water, seltzer, club soda, and low-salt vegetable juice. Avoid sweet wines, wine coolers, and sweet liqueurs, such as Irish Cream. They are high in calories, sugar, and carbohydrate.
• A good alternative is to drink nonalcoholic beer or wine. Check labels. Count every 15 grams of total carbohydrate in a beverage as 1 carbohydrate choice in your food plan.

Listed below are the average calories, carbs, and meal plan equivalents for different alcoholic drinks.

 
Serving            Calories       Carbohydrates    Meal Plan
                                      (grams)      Equivalent
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Distilled spirits (vodka, whiskey, rum, etc.) 
 1.5 ounce (oz)    100             negligible        2 fats

Wine - Dry White 
 5 ounces           100              1.2 g           2 fats

Wine - Dry Red
 5 ounces           105              2.5 g           2 fats

Wine - White Zinfandel
 5 ounces           100              6.5 g           1.5 fats and
                                                     0.5 carb

Sweet or Dessert Wine 
 3.5 ounces         165             14 g             1 carb and
                                                     2 fats

Wine Coolers 
 12 ounces          190            23 g               1.5 carb and
                                                     3 fats

Beer, Regular 
 12 ounces          150            13 g               1 carb 
                                                     1.5 fats

Beer, Light 
 12 ounces          70 to 100      3 to 7 g          1 to 2 fats

Nonalcoholic Beer 
 12 ounces          80            15 g               1 carb 
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For more information, visit the American Diabetes Association Web site at http://www.diabetes.org or call 1-800-342-2383.