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Alcohol, Blood Glucose and Diabetes

Chart 1. Effect of Moderate and Heavy Drinking on the Blood Glucose Levels

DRINKING PATTERN EFFECT ON THE BLOOD GLUCOSE
Healthy individuals Individuals with Diabetes 1 Individuals with Diabetes 2
A SINGLE alcohol session (0.5-1 gram alcohol/kg body weight or 2-5 drinks) with a meal No significant change in the blood glucose levels [9,12,13] Possible slight fall of the fasting or after-meal glucose levels [4,9] No change, or slight fall of the after-meal glucose [9]
BINGE drinking on an empty stomach Possible hypoglycemia [9] Possible hypoglycemia [9] Possible hypoglycemia [9]
REGULAR MODERATE drinking (1 drink = 13 g alcohol/day) before meals Decreased risk of diabetes 2 [3,6,7,8] Decreased HbA1c levels [11] Lower fasting glucose, but not after-meal glucose levels [2,14], decreased HbA1c levels [11]
HABITUAL drinking (3-4 drinks = 45 g alcohol/day) by well nourished individuals Decreased risk of diabetes 2 [10] Decreased HbA1c levels [11] Decreased HbA1c levels [11]
CHRONIC HEAVY drinking (>4 drinks, that is >50 g alcohol/day by well nourished individuals Increased risk of diabetes 2 [1] Decreased HbA1c levels [11] Decreased HbA1c levels [11]; increased fasting glucose and glucose after a meal [15]

Chart 1 references: [1,2,3,4,6,7,8,9,10,11]

Alcohol and Blood Glucose in Healthy People

In healthy individuals, long-term moderate drinking does not significantly affect fasting and after-meal blood glucose levels [6,16,17,18].

Binge drinking increases the risk of diabetes 2 in women [10].

In one study, in lean healthy individuals, moderate amounts of alcohol (1-3 drinks) consumed with carbohydrate meals attenuated the rise of glucose levels after meals for up to 37% [6].

Blood Glucose in Chronic Alcoholics

It is estimated that 45-70% of chronic alcoholics with alcoholic liver disease (hepatitis or cirrhosis) have glucose intolerance or diabetes type 2 [1]. Hyperglycemia is also common in chronic alcoholics without liver disease [19].

Alcohol Effect on Blood Glucose in Diabetes Type 1

According to one large 2006 study, alcohol drinking (mild, moderate or heavy) decreases HbA1c (hemoglobin with attached glucose) levels in individuals with diabetes 1 [11]. HbA1c reveals average glucose levels over the last 2-3 months. Lower HbA1c means better control of blood glucose (less hyperglycemia) during 2-3 months preceding testing [20].

Individuals with diabetes type 1 who drink moderately amounts of alcohol in the evening may have hypoglycemia after the breakfast next morning [21].

Diabetics type 1 who binge drink on an empty stomach for several days may develop diabetic ketoacidosis with nausea, vomiting, fruity smell of breath, frequent urination, thirst, confusion, coma or can die [22].

Alcohol Effect on Blood Glucose in Diabetes Type 2

  • Moderate drinking decreases insulin resistance and the risk of diabetes type 2 [3,6,7,8].
  • Alcohol drinking (mild, moderate or heavy) can decrease HbA1c levels in individuals with diabetes 2 [11].
  • In one study, in individuals with diabetes type 2 who previously abstained from alcohol and were then drinking 150 mL of wine (13 g alcohol) with dinner each day for 3 months, a drop of fasting glucose from 140 to 118 in average, but no change in glucose levels after a meal, was observed [2].
  • Alcohol consumed together with certain oral anti-diabetic drugs (chlorpropamide, glibenclamide, glipizide, glyburide, tolbutamide) may cause hypoglycemia, especially in fasting individuals [4,5,17,23].
  • Heavy drinkers are at increased risk of developing diabetes type 2, probably due to the damage of the pancreas and decreased insulin sensitivity [1].

Should Diabetics Drink Alcohol?

Moderate drinking may be beneficial for both diabetics type 1 and type 2, since it decreases HbA1c levels and thus the risk of long-term complications [11]. Excessive drinking may be harmful for diabetics, because it increases the risk of obesity, elevated blood triglycerides, high blood pressure, peripheral neuropathy, hypoglycemia or hyperglycemia, impotence and diabetic retinopathy [9].

Alcohol-Related Hypoglycemia

Heavy drinking without eating for more than 24 hours may, especially in chronic alcoholics, result in severe hypoglycemia (low blood glucose level) within 6 to 36 hours after drinking. Mechanism: fasting depletes the body’s stores of glycogen – a molecule from which glucose is released into the blood, and alcohol inhibits formation of new glucose in the liver [9,24,25,26,27,28]. Severe alcohol-related hypoglycemia seems to be rare [28].

Combining alcohol and carbohydrates (sweet liqueurs, vodka and soft drinks, rum and cola, gin tonic, or alcohol with carbohydrate snacks) may, within 1-3 hours of consumption, trigger reactive hypoglycemia with hunger, shakiness, dizziness and weakness [29,30]. Mechanism: carbohydrates stimulate insulin secretion and alcohol enhances its effect what results in excessive drop of blood glucose [29,31]. Risk factors for reactive hypoglycemia include obesity, anxiety, irregular meals, diabetes 2, adrenal insufficiency, hypopituitarism [32,33].

Glycemic Index of Alcohol Beverages

An estimation of glycemic index of some alcoholic beverages [6]:

  • Beer GI = 57
  • White wine GI = 7
  • Gin GI = 10
  • Liqueurs with high sugar content may have high GI.

  1. Alcoholic beverages  Linus Pauling Institute
  2. Shai I et al, 2007, Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a multicenter, randomized, clinical intervention trial  PubMed
  3. Rimm EB et al, 1995, Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men  PubMed
  4. What is tolbutamide?  Drugs.com
  5. Chlorpropamide  Drugs.com
  6. Brand-Miller JC et al, 2007, Effect of alcoholic beverages on postprandial glycemia and insulinemia in lean, young, healthy adults  PubMed
  7. Beulens JW et al, 2005, Alcohol consumption and risk of type 2 diabetes among older women  PubMed
  8. Flanagan DE et al, 2000, Alcohol consumption and insulin resistance in young adults  PubMed
  9. Emanuele NV et al, 1998, Consequences of Alcohol Use in Diabetics  National Institute on Alcohol Abuse and Alcoholism
  10. Vannamethee SG et al, 2002, Alcohol consumption and the incidence of type II diabetes  PubMed Central
  11. Ahmed AT et al, 2008, The Relationship Between Alcohol Consumption and Glycemic Control Among Patients with Diabetes: The Kaiser Permanente Northern California Diabetes Registry  PubMed Central
  12. Raben A et al, 2003, Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake  PubMed
  13. Kokavec A et al, 2003, Effect on plasma insulin and plasma glucose of consuming white wine alone after a meal  PubMed
  14. Christiansen C et al, 1994, Effect of alcohol on glucose, insulin, free fatty acid and triacylglycerol responses to a light meal in non-insulin-dependent diabetic subjects  PubMed
  15. Ben G et al, 1991, Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes  PubMed
  16. Facchini F et al, 1994, Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity  PubMed
  17. van Staa T et al, 1997, Rates of hypoglycemia in users of sulfonylureas  PubMed
  18. Siler SQ et al, 1998, The inhibition of gluconeogenesis following alcohol in humans  PubMed
  19. Iturriaga H et al, 1986, Glucose tolerance and the insulin response in recently drinking alcoholic patients: possible effects of withdrawal  PubMed
  20. A1C and eAG  American Diabetes Association
  21. Turner BC et al, 2001, The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes  PubMed
  22. Diabetic ketoacidosis symptoms  Mayo Clinic
  23. Burge MR et al, 1999, Low-dose ethanol predisposes elderly fasted patients with type 2 diabetes to sulfonylurea-induced low blood glucose  PubMed
  24. Alcohol use disorder complications  Mayo Clinic
  25. Hypoglycemia causes  Mayo Clinic
  26. 1994, Alcohol and hormones  National Institute on Alcohol Abuse and Alcoholism
  27. Hypoglycemia  National Institute of Diabetes and Digestive And Kidney Diseases
  28. Hammerstedt H et al, Alcohol-related hypoglycemia in rural Uganda: socioeconomic and physiologic contrasts  PubMed Central
  29. Flanagan D et al, 1998, Gin and tonic and reactive hypoglycemia: what is important-the gin, the tonic, or both?  PubMed
  30. Hamdy O, Hypoglycemia, clinical presentation  Emedicine
  31. Ylikahri RH et al, 1981, Hormonal changes during alcohol intoxication and withdrawal  PubMed
  32. Hofeldt FD, 1989, Reactive hypoglycemia  PubMed
  33. Hamdy O, Hypoglycemia  Emedicine

2 Responses to "Alcohol, Blood Glucose and Diabetes"

  1. RACHID TLEMCANI says:

    Hi,
    The morningn after having driking a bottle of red wine the evening, the glycemia is fine, between 90 and 110? So drinking wine is fine!
    Thanks alot

    • Jan Modric says:

      Rachid, in Chart 1 above in the article there are various situations described about how alcohol can affect blood glucose levels. Alcohol as such does not necessary have a significant effect on blood glucose.

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