It seems to be common knowledge these days that a moderate alcohol intake may reduce the risk of cardiovascular disease. Less commonly discussed is alcohol and diabetes. A moderate alcohol intake may also help to reduce diabetic risk and complications. Most important to note is that (as with most things), healthy moderation combined with a healthy diet and lifestyle is key.
Just in case you don't believe it, let's look at the research.
- In a very large study of over 38,000 people with diabetes, researchers asked participants to self-report alcohol intake and Hgb A1C levels. (Hgb A1C levels paint a picture of how well blood sugar is controlled over a period of time). The study found that moderate drinkers had the best blood sugar control. The researchers theorized that a moderate alcohol intake may somehow improve the body's ability to respond to insulin, thereby lowering average blood sugar levels.
- A large meta-analysis of 20 studies found that the risk of type 2 diabetes was lowest with consumptions of 22-60 g/day alcohol in men and 24-50 g/day in women (which translates to about 1-2 drinks a day for men, and 1 for women).
What's the catch? Well, certainly you will want to abstain from alcohol if you are pregnant, have a history of alcohol abuse, have liver disease, or plan to drive shortly after you have a drink. But also if you easily become hypoglycemic, drinking alcohol isn't advised because it can make recognizing the signs of hypoglycemia more difficult. If you are currently overweight, note that alcohol provides 7 calories per gram -- so drinking alcohol can make losing weight more difficult. In addition, if you are someone who has difficulty with moderation -- if you don't trust yourself to be able to stop at 1-2 drinks, then it may be better to just abstain, since drinking three or more drinks a day has been linked to diabetic complications resulting from prolonged poor glucose control, such as eye disease. Drinking too much can also raise triglycerides, increase blood pressure, and increase the risk of stroke.
Diabetics who choose to drink occasionally or in moderation should also consider the following safety tips:
- After you have a drink, test your blood sugar more frequently than you ordinarily do. I recommend testing one hour after a drink, two hours after, and again before bed. Alcohol can affect blood sugar for up to 12 hours after you drink.
- Drinking on an empty stomach can increase the risk of hypoglycemia, so have your drink with a meal. If you drink only occasionally in moderation, it is best to not adjust your meal plan. If you drink regularly in moderation, 2 servings of fat can generally be substituted for a drink - but consult your doctor or dietitian before modifying your meal plan.
- Keep your emergency glucose on you if you plan to drink, just to be safe. Even if you generally don't feel the effects of one drink, if you ate slightly less carbohydrate or were more active for some reason that day, you may be more at risk for hypoglycemia.
Another question you may have is, what is considered a "drink"? A serving size for one drink is based on alcohol content and is equal to:
- 12 ounces of beer
- 5 ounces of wine
- or 1-1/2 ounces of hard alcohol like vodka, whisky, and liquors
Although alcohol intake can make your blood glucose go low, it is still probably best to avoid sugary alcoholic beverages like mixed drinks. Rather than balancing out the hypoglycemic effects of alcohol, sugary mixed and blended drinks tend to spike blood sugar, and then still cause it to drop later. The best options for diabetic alcoholic drinks are probably light or low-carbohydrate beers, or red wine. The good thing about beer for diabetics is that it usually comes portion-controlled for you in a bottle, making it more difficult to drink too much. Be more cautious with your serving of wine -- don't automatically fill up your wine glass to the top. Rather, measure out 5 ounces of wine. It may surprise you to find that 5 ounces only fills 1/3 to 1/2 of your glass, especially if you are using rounder or taller drinkware. And finally, be extra cautious with straight hard alcohols like vodka, whiskey, and liquors: at 45 mls, the portion size of a "drink" is so small that it is pretty easy to pour too much.
Ameena T. Ahmed, MD, MPH, Andrew J. Karter, PhD, E. Margaret Warton, MPH, Jennifer U. Doan, MD, and Constance M. Weisner, DrPH, MSW. The Relationship Between Alcohol Consumption and Glycemic Control Among Patients with Diabetes. J Gen Intern Med. 2008 23(3):275.282.
Dolly O. Baliunas, MSC, Benjamin J. Taylor, MSC, Hyacinth Irving, MA, Michael Roerecke, MSC, Jaydeep Patra, PhD, Satya Mohapatra, PhD, and Jurgen Rehm, PhD. Alcohol as a Risk Factor for Type 2 Diabetes - A Systematic Review and Metanalysis. Diabetes Care. 2009 32(11):2123-2132.