When it comes to alcohol and diabetes, there is some confusion as to whether it can be included or not. There is a large body of information that states that moderate drinking has cardio (heart) protective effects but it can also cause havoc with your blood sugar levels. Ask yourself the following questions?
- Is your blood sugar controlled?
- Do you know how alcohol can affect you?
- Are you sticking to the recommended amount?
If not, this article will give you insight and tips on how to make sure you are managing your blood sugar levels while drinking alcohol.
HOW DOES ALCOHOL AFFECT YOUR BODY?
First let’s find out about what alcohol does in your body. With your first drink, 20% is rapidly absorbed into the bloodstream; the rest is absorbed as it progresses through your gastrointestinal tract1 .Alcohol is metabolized by the liver1. For the average person it takes about 1 to 3 hours to metabolise alcohol, depending on if it’s a shot, pint or 250ml glass of wine2,3. If you drink faster than your body can metabolize it, it moves through your bloodstream to other parts of the body especially your brain, causing the ‘buzz sensation’. Other factors such as body size, weight, amount of muscle vs. fat, medication, drinking on an empty stomach and differences in metabolic rates all affect how you react to alcohol2, 3.
Alcohol can have different effects on your blood sugar levels4. This is often determined by how much as well as what we drink. Your liver is a remarkable organ, however not a great multitasker. When it is busy metabolising the alcohol it’s not able to focus too well on managing blood sugar levels as alcohol blocks glucose production in the liver5. Due to this, your liver isn’t able raise your blood sugar if it drops too low4. This hypoglycaemia can occur shortly after and for up to 24 hours after drinking4, 5, 6. For those who are taking insulin or oral medications such sulfonylureas (glipizide, glyburide) and meglitinides (Prandin), extra care needs to be taken as these drugs lower blood glucose even more as can also stimulate the pancreas to make more insulin4,6,7. This combined effect of alcohol and medication could cause hypoglycaemia and caution needs to be taken.
Other effects of alcohol on your body include:6,7
- Stimulating your appetite, which may cause you to overeat, thereby affecting your blood sugar control.
- Alcohol does not contain any useful nutrients and is the second most calorie-rich nutrient after fat. One gram of alcohol is equal to about 7kCal / calories. Therefore if weight loss is your goal it might make it more difficult to achieve.
- It can also affect your judgment or willpower, resulting in poor food and treatment decisions.
- It may increase triglycerides as well as blood pressure.
- It can also cause slurred speech, flushing, nausea and increased heart rate.
- It can negatively impact the quality of your sleep as it interferes with REM (rapid eye movement) sleep, which is a restorative type of sleep. As a result, you can end up feeling groggy and unable to concentrate the next day.
- Symptoms of hypoglycaemia are similar to those of drinking too much alcohol. These include sleepiness, dizziness and disorientation. Therefore care needs to be taken not to confuse hypoglycaemia for drunkenness.
HOW MUCH SHOULD WE DRINK?
When it comes to alcohol, the South Africa Food based Dietary Guidelines recommend that ‘if you drink alcohol, drink sensibly’8. They also state that if you drink make sure it is in moderation3,6,7,8. This is by no means saying you need to start drinking if you do not currently, but what do we mean by moderation? This is 1 drink per day for women and 2 drinks per day for men3,6,7,8. It is important to remember that the alcohol guideline is the same for those with diabetes and for those without. Now when we talk about “drinks” in the guideline, one alcoholic drink is equivalent to:
- 1 can or bottle (330ml) of bee
- 120ml of wine
- 25ml / 1 shot of spirits9
Now this might seem like a lot if you count the total number of drinks per week, but there are no savings accounts here – it is better to drink moderate amounts daily than binge drink on the weekends. There is evidence for light to moderate drinking and a reduced risk of heart disease, due to an associated increase in HDL cholesterol and improved insulin sensitivity, while heavy drinking appears to increase your risk7,10, 11,12,13. Research has shown that people who drink about 150ml of red wine a day have been shown to have a 32% lower risk of developing heart disease than non-drinkers13.
USEFUL TIPS IF YOU ARE GOING TO DRINK ALCOHOL4,5,7
- Do not drink on an empty stomach or when your blood glucose is low. Make sure you eat beforehand or while you drink as food slows down the absorption of alcohol into the blood stream.
- Don’t skip a meal in order to drink.
- Make sure you drink slowly.
- Keep yourself hydrated by drinking water or sugar free drinks in between.
- Don’t mix alcohol and exercise, both increase your risk of hypoglycaemia.
- Check your blood sugar before you drink and for up to 24 hours afterwards. Make sure you check your blood sugar levels before you go to bed to ensure it is at a safe level to prevent a hypo during your sleep. If it is low then a carbohydrate containing snack before bed might be necessary.
- If you drink alcohol several times a week, tell your doctor or diabetic nurse so that he or she knows this before prescribing certain diabetic medications.
WHAT ALCOHOLIC DRINK SHOULD I CHOOSE?
For everyone, not just those living with diabetes, following a healthy balanced diet means making sure we choose better options when it comes to certain foods. What about alcohol, is it the same? The answer is yes… there are definitely better options when choosing alcohol1,3,9.
- Choose low carbohydrate alcoholic beverages where possible such as light beer, liquors (Vodka, rum, gin, tequila, whiskey) or dry wine as they have less alcohol and fewer calories. Usually one or two units can be had without affecting your blood sugar too much.
- Try to avoid sugar-rich alcoholic drinks such as ciders, alcoholic fruit drinks or coolers, liqueurs, cocktails containing fruit juices or spirits with sugar-rich drinks (coke, lemonade etc.). These are high in sugar and therefore carbohydrates.
- Rather mix your alcohol with water, soda water or sugar free soft drinks to reduce the sugar content e.g. replace the coke for diet coke or tab, mix sparkling water or soda water into your wine to make spritzers.
- Steer clear of drinks such as cocktails that contain more than one unit of alcohol per drink.
There you have it…the low down on your what, how much and how you can ensure that you are drinking alcohol safely. Remember, if you have any other questions about alcohol chat to your diabetic nurse, doctor or dietitian.
- West Virginia University School of public health. Alcohol Metabolism. Available at: http://publichealth.hsc.wvu.edu/alcohol/effects-on-the-body/alcohol-metabolism/ (Accessed February 2018)
- Healthline (2017). How Long Does Alcohol Stay in Your Body? Available at: https://www.healthline.com/health/how-long-does-alcohol-stay-in-your-system (Accessed February 2018)
- NHS choices (2015). How long does alcohol stay in your blood? Available at: https://www.nhs.uk/chq/Pages/853.aspx?CategoryID=87 (Accessed February 2018)
- Healthline. Diabetes, Alcohol, and Social Drinking. Available at: https://www.healthline.com/health/type-2-diabetes/facts-diabetes-alcohol#1 (Accessed February 2018)
- American Diabetes Association. Alcohol. Available at: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html?referrer=https://www.google.co.za/ (Accessed February 2018)
- Diabetes self-management. Drinking and Diabetes: Seven Facts to Know. Available at: https://www.diabetesselfmanagement.com/blog/drinking-and-diabetes-seven-facts-to-know/ (Accessed August 2017)
- WebMD (2017). Diabetes and Alcohol. Available at: http://www.webmd.com/diabetes/guide/drinking-alcohol (Accessed August 2017)
- Jacobs L, Steyn NP. Food-Based Dietary Guidelines for South Africa: If you drink alcohol, drink sensibly. Is this guideline still appropriate? S Afr J Clin Nutr. 2013;26(3)(Supplement)
- Accu-check. Carbohydrate Counting. Can’t tell your carbs from your protein? Accu-check booklet Available at: https://www.accu-chek.co.za/eating-well/carbohydrate-counting-and-exchanges (Accessed August 2016)
- Mahan, L. Kathleen., Escott-Stump, Sylvia. (2008) Krause’s food & the nutrition Therapy 12th edition. St. Louis, Mo.: 8. (Accessed February 2018)
- Healthline (2017). Alcohol and Health: the Good, the Bad and the Ugly. Available at: https://authoritynutrition.com/alcohol-good-or-bad/ (Accessed August 2016)
- Healthline (2017). Red Wine: Good or Bad? Available at: https://authoritynutrition.com/red-wine-good-or-bad/ (Accessed August 2016)
- PubMed (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21343207 (Accessed August 2016)