Diabetes and Alcohol: What You Need to Know

Diabetes makes drinking alcohol especially complicated. Alcoholic drinks can cause both blood sugar rises and blood sugar drops, making it important to think cautiously and plan ahead.

Medical experts have determined that even moderate drinking increases health risks for everyone, but for people with diabetes it holds unique short- and long-term dangers.

The Immediate Effect of Alcohol in People With Diabetes

The most important thing to know is that alcohol consumption can cause a significant blood sugar drop ( hypoglycemia ).

Every person at risk of hypoglycemia should be aware of this dangerous side effect, including everyone with type 1 diabetes and all those with type 2 diabetes who use insulin or other medications that can cause low blood sugars, such as sulfonylureas .

Why does it happen? Briefly, alcohol interrupts the liver from doing its regular work of releasing stored glucose into the bloodstream. When the liver is forced to deal with alcohol, it slows or stops releasing sugar - leading to lower blood sugar levels.

At the same time, alcohol also may increase insulin sensitivity.

This alcohol-induced hypoglycemia may have a delayed effect, hitting you after you've stopped drinking, possibly after you've fallen asleep, or even during the next day.

As an added complication, there is a substantial overlap between the feeling of tipsiness (or drunkenness) and the symptoms of hypoglycemia. Both conditions can make you feel woozy, wobbly, hungry, tired, or confused.

If you're a little drunk, you're definitely not in the right condition to recognize your hypoglycemia and react to it properly. People nearby, whether friends or strangers, may also misinterpret your symptoms, with potentially disastrous results. Alcohol is a factor in many hospital admissions for hypoglycemia.

While light or moderate drinking is not likely to create an undue risk of hypoglycemia, heavy drinking (and binge drinking) can be very dangerous. Young adults, especially college students, may be at an especially high risk, given their tendency to engage in risky drinking behaviors.

Many college students already struggle to maintain optimal glucose control, an effort that a heavy dose of alcohol only makes even harder.

Going to sleep drunk is particularly risky, as you may be unable to perceive the symptoms of hypoglycemia which would normally wake you up.

The Diabetes Link, a nonprofit dedicated to helping teens and young adults with type 1 diabetes, maintains a resource page with advice on how to navigate drinking and diabetes.

The Morning After

The glucose-lowering effect of alcohol is not restricted to the peak of drunkenness - it actually peaks hours later.

For instance, scientists got six men with type 1 diabetes drunk on about one bottle of white wine each for a study, and then watched what happened. These brave volunteers drank their fill between 9 p.m. and 10:30 p.m., a few hours after eating dinner. Alcohol caused their blood sugar to drop, as we would expect, but what was surprising was how long that effect took to show up. Five of the six men experienced symptomatic hypoglycemia, all between 10 a.m. and noon the next morning, about 12 hours after drinking.

That means that you're just as likely to have blood sugar issues the morning after drinking. And the more you drink, the greater the likelihood of low blood sugar, and the less capable you will be of dealing with it. Handling a hangover may require additional preparation and care, according to Everyday Health's network site Diabetes Daily .

Alcohol and Carbohydrate Content

Drinking just gets more complicated when you consider the immediate impact that "carby" beverages have on your blood sugar levels.

Alcohol all by itself has few or zero carbohydrates. Many spirits (vodka, tequila, and so on) have only trace amounts of carbohydrates; a glass of wine probably has only a few grams of carbs. A can of light beer may have only a handful of grams of carbohydrates; a regular beer about a dozen. Moderate alcohol consumption, therefore, does not need to result in large carb counts.

But some sweet wines and beers have more carbs than others, and the sugars in cocktails, hard seltzers, and similar drinks can make booze extremely high carb. These drinks may prompt a large and rapid blood sugar spike, necessitating the use of insulin (for those who customarily use insulin before meals).

Insulin's effect is always at least somewhat unpredictable, and you also have the delayed blood sugar-lowering effect of alcohol to worry about. The use of rapid insulin could make the morning-after hypoglycemia even more extreme. It may be safer to avoid sugary booze - and safer still to avoid any alcohol in the first place.

Mitigating the Risks of Drinking Alcohol for People With Diabetes

Sadly, many people with diabetes do not receive adequate education on the subject of alcohol.

Individuals who use glucose-lowering drugs, especially insulin and sulfonylureas, should aim to keep critically aware of their blood glucose levels while drinking and for up to 24 hours afterward.

Here are some other ideas on how to make drinking with diabetes a bit safer:

• Practice moderation! The less you drink, the better.
• Check your blood sugar frequently, both while you're drinking and the day after. A continuous glucose monitor (CGM) can be extremely helpful.
• Consider what you're eating. It may be possible to prevent hypoglycemia with a snack.
• Stay mindful of the carbohydrate counts of your drinks.
• Be especially cautious about exercising during or after drinking - and that includes both dancing and sex! A workout can seriously drop your blood sugar.
• Have a sober friend with you who understands how alcohol use affects your blood sugar management who can help in a hypoglycemic emergency. Think of them as a designated driver for your diabetes management decisions.
• Remember that hypoglycemia and drunkenness feel very similar, and the drunker you are, the more difficult it is to perceive the early subtle signs of a hypo.
• Wear a medical alert bracelet, so that a paramedic will be able to diagnose hypoglycemia more quickly. If you get woozy or pass out, others may presume that it's from drunkenness, not hypoglycemia, and decline to offer the help you need.
• Remember that drinking can cause delayed hypoglycemia. You should be especially cautious about using insulin to correct high blood sugars during or after a night of heavier drinking.
• Talk to your doctor about adjusting your use of insulin and other glucose-lowering medications for a drinking session.

Diabetes, Alcohol, and Ozempic

While some diabetes drugs are especially hazardous when combined with alcohol, the world's trendiest diabetes drugs may help curb compulsive drinking. A real-world study found that people who use semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) drink less alcohol; most users reported "craving reduction, decreased desire to drink," and other similar effects.

It's not just drinking: Drugs in this class are now being investigated for their apparent potential to reduce a broad range of compulsive behaviors.

Nevertheless, it would be wise for GLP-1 users to remain careful with alcohol. Drugs in the GLP-1 family, including semaglutide and tirzepatide, are known to provoke vomiting - just like excessive drinking.

The Long-Term Effect of Moderate Drinking With Diabetes

You may have heard that a nightly glass of wine is good for your health. Alcohol use can cause an immediate increase in insulin sensitivity and one study even found that moderate drinkers had an impressive 30 percent reduced risk of type 2 diabetes.

But more recent research has indicated that light alcohol use does not guard against diabetes in any way.

In 2023, the World Health Organization declared that "when it comes to alcohol consumption, there is no safe amount that does not affect health."

The Long-Term Effect of Heavy Drinking With Diabetes

First of all, here's a warning that hopefully shouldn't be necessary: Heavy drinking isn't good for anyone. Binge drinking and alcoholism both have far-reaching negative health effects, regardless of diabetes. And the combination of alcoholism and diabetes is especially bad, associated with the acceleration of diabetic complications such as neuropathy and retinopathy.

Diabetes and alcohol abuse are also two of the most harmful risk factors for dementia . People with both diabetes and alcohol use disorder have shortened telomeres, a measure of biological age associated with the development of Alzheimer's disease.

Heavy drinkers, by the way, do not benefit from any of the positive (but questionable) effects associated with moderate alcohol use. People who consume more than three or four drinks daily do not experience any diabetes risk reduction.

And binge drinkers are even more likely to develop type 2 diabetes

, perhaps because large amounts of alcohol have toxic effects on the pancreatic beta cells.

The Takeaway

Drinking carries some real immediate risks. It is particularly important to be mindful of low blood glucose. Hypoglycemia is a frequent and substantial problem after alcohol consumption, in people with both type 1 and type 2 diabetes. The hazards are greater for people who take medications that are known to cause hypoglycemia, especially insulin and sulfonylureas.

Frequent heavy drinking is associated with many detrimental effects, especially for people with diabetes. If you're concerned about your own drinking habits, please reach out to a professional for help.

Resources We Trust

• Mayo Clinic: Balancing the Risks, Benefits of Alcohol
• Cleveland Clinic: Diabetes and Alcohol: Do They Mix?
• Lose It!: A Quick Reference Guide to the Calories, Carbs, and Sugar in Alcohol
• Diabetes Link: Partying With Diabetes
• Johns Hopkins Medicine: Mixing Alcohol With Your Diabetes

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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