Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.
If you have diabetes, you may wonder if you should drink alcohol. When consumed with food, an occasional drink is OK, and if you choose wisely, it may have some positive effects on health.
However, excessive alcohol consumption increases the risk of hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), liver disease, and more.
This article discusses how alcohol can impact diabetes and related conditions and offers tips for safe drinking.
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Studies show drinking moderately (about one drink per day) may improve heart health and decrease the risk of diabetes. However, some studies don’t account for frequency, the population being studied, and the types of beverages consumed.
Regarding alcohol and diabetes, blood-sugar-reducing medications, such as insulin, increase the risk of low blood sugar, and alcohol increases the risk. Symptoms of low blood sugar include shakiness and confusion and must be treated immediately.
Women with diabetes should consume no more than one drink per day and men with diabetes should have no more than two. Frequent alcohol use is associated with increased rates of high blood pressure, obesity, breast cancer, osteoporosis, and stroke.
Carbohydrates are the macronutrients that impact blood sugars the most and are the body’s preferred energy source. But alcoholic beverages containing carbohydrates won’t necessarily stabilize blood sugars (liquid carbohydrates are metabolized quickly). However, carbohydrates from food are digested slowly, so it’s important to eat carbs when consuming alcohol.
When you have alcohol, it may take some time to figure out the foods that work best for you. The number of carbohydrates needed to prevent highs and lows depends on your blood sugar level when you start drinking, your meal plan, and your medication.
Most people benefit from consuming a snack or meal that contains some complex carbohydrates, protein, and fat. For example, if you have a glass of alcohol with dinner, choose roasted chicken, baked sweet potato, and sautéed spinach.
The body converts excess calories from alcohol into fat. Over time, extra fat contributes to insulin resistance (when your body doesn’t respond to insulin as it should), increases blood sugar, and can cause fatty liver disease.
Alcohol is absorbed directly into the bloodstream from the stomach or the small intestine, and it’s then carried through the body and delivered to the liver. While the liver metabolizes alcohol, it cannot convert stored glycogen into the glucose needed to stabilize blood sugar levels.
Many medications are also metabolized in the liver. Excess amounts of alcohol can alter the way your medicines work. Drinking alcohol when you take glucose-lowering medications (insulin) or certain oral medications can increase the risk of low blood sugar.
If you take Glucophage (metformin), drinking excessive amounts of alcohol can increase the risk of a rare condition called lactic acidosis when lactic acid builds up in the bloodstream.
It's important to discuss with your healthcare provider how alcohol impacts diabetes. Some helpful tips to keep in mind are:
One drink is defined as containing 14 grams (0.6 ounces) of pure alcohol, as follows:
If you struggle to keep your diabetes stabilized, you may want to avoid alcoholic drinks or speak with your healthcare provider first. Consuming alcohol can worsen diabetes complications, such as retinopathy (damage to blood vessels in the retina), neuropathy (nerve damage), and nephropathy (kidney damage).
Alcohol intoxication mimics signs of low blood sugar, such as dizziness, blurred vision, and fatigue. So you may not know if your blood sugar is low or what you're feeling is just the effects of the alcohol.
You should also avoid drinking alcohol if you have:
Alcohol is a depressant that impacts how your brain communicates with your body. If you have a history of depression or depressive symptoms, drinking alcohol can worsen your condition.
An occasional social drink is usually harmless for people with diabetes. But if you do have diabetes, drinking safely involves more planning. Consider what type of alcohol you are drinking, when, and how much. Understand how your medications work and how alcohol can affect them. Make sure you are drinking with food and that you can check your blood sugar levels before, during, and after drinking and eating.
The effect alcohol will have on your diabetes depends on how much you drink, what you drink, when you drink, and what your medication regimen is. If you are going to drink, do it moderately and responsibly. Speak with your healthcare provider if you have questions or concerns about how alcohol impacts diabetes.
There is no perfect drink for someone who has diabetes. If you choose to drink, you should do so in moderation. Choose something you enjoy and savor it. Drinking in excess can increase weight gain, negatively impacting your health.
If you take insulin and drink alcohol on an empty stomach, your blood sugar will likely lower. However, if you drink frequently, alcohol can increase insulin resistance and raise blood sugars over time.
Holst, C., Becker, U., Jørgensen, M.E. et al. Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population. Diabetologia. 2017; 60:1941–1950. doi:10.1007/s00125-017-4359-3
National Institute of Health. Diabetes and alcohol.
American Diabetes Association. Alcohol & diabetes.
Gangopadhyay KK, Singh P. Consensus statement on dose modifications of antidiabetic agents in patients with hepatic impairment. Indian J Endocrinol Metab. 2017 Mar-Apr;21(2):341-354. doi:10.4103/ijem.IJEM_512_16
MedlinePlus. Lactic acidosis.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. 9th edition.
National Institute on Alcohol Abuse and Alcoholism. What is a standard drink?
Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
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