Written by Kerry Benson, MS, RD and Diana Licalzi, MS, RD

Summer is here and with it comes invitations to picnics, barbecues, family gatherings, and dinner with close friends. And, undoubtedly, alcohol will be served at them all. You enjoy socializing and look forward to attending as many of these events as you can. You also can have type 2 diabetes, and perhaps are wondering how alcohol impacts your blood sugar levels.

Like most people, you probably don’t want to give up the camaraderie, conviviality, and merriment of these social occasions. But maybe you want to drink less and make healthier choices around alcohol. In this blog, we will discuss the impact alcohol has on diabetes and ways to make smarter choices around drinking.

Is it safe for people with diabetes to drink alcohol?

The American Diabetes Association neither promotes drinking nor forbids it; however, if someone with diabetes chooses to drink, they should limit their consumption to moderate drinking, which is defined as one drink per day for females and up to two drinks per day for males.

However, drinking alcohol doesn't come without its risks. One of the biggest concerns for people with diabetes who drink alcohol is hypoglycemia— when blood sugar falls below 70 mg/dL. Our liver helps maintain healthy glucose levels in our blood by releasing stored glucose overnight and between meals. However, when we drink, our liver prioritizes metabolizing alcohol over its normal duties. So, when alcohol is combined with certain glucose-lowering medications (particularly insulin or sulfonylureas), it can lead to dangerously low blood glucose levels, which, if left untreated, can be life-threatening. This is why it's important to never drink on an empty stomach, especially if you have diabetes. 

Chronic heavy drinking can also increase the risk of diabetes complications, which include cardiovascular disease, nerve damage, and diabetic eye disease.

How does drinking alcohol impact diabetes?

Drinking alcohol doesn't directly cause diabetes, but chronic heavy drinking increases the risk of developing it. Excessive consumption of alcohol disrupts certain metabolic processes that make the onset of diabetes more likely. Its effects are pernicious.

Overuse of alcohol may inflame the pancreas (pancreatitis), impairing its ability to release insulin, a hormone that regulates blood glucose levels. Too much glucose stays in your bloodstream (hyperglycemia), which, if left untreated, may cause serious health problems. Fortunately, provided no damage has been done to our organs, we are able to restore normal glucose metabolism upon the cessation of alcohol.

Heavy drinking brings with it lots of calories and often weight gain, the latter being a major risk factor in the development of type 2 diabetes. If not used, all those extra calories are stored as fat in our cells. But cells have a finite storage capacity, and when it is reached, insulin receptors within the cell membrane wall begin to shut down. That blocks glucose from entering the cell, leaving it in the bloodstream causing hyperglycemia.

Tips for cutting back on alcohol

Want to cut back on drinking but don’t want to eliminate alcohol completely? Here are tips on how to drink less.

1. Measure your consumption (you are probably drinking more than you realize!)

It is so easy to consume more alcohol than we realize and in excess of the recommendations from health experts. In the U.S., moderate drinking is defined as 2 standard drinks per day for men, and one standard drink per day for women. A standard drink is about 12 ounces of beer (5% alcohol by volume, or ABV), 5 ounces of wine (12% ABV), or 1.5 ounces of liquor (40% ABV).

2. Keep your portions in check

Invest in smaller glassware, or add extra ice or garnish to a drink to fill more of your glass with non-alcoholic contents.

If you are a cocktail drinker: 

• Measure your liquor using a shot glass or jigger (and measure your shot glass to see how many ounces it holds, as this can vary). 
• Choose low ABV cocktails, such as spritzes and champagne cocktails. These are becoming very trendy.

If you are a wine drinker: 

• Measure a serving of wine and compare it to the size of your glass (you can eyeball the portion going forward). 
• There are about five servings per standard bottle. 
• Make a wine spritzer to dilute the alcohol content.

If you are a beer drinker: 

• Be mindful of the ABV. Some beers have more than 10% ABV!

3. Try something new!

Have fun exploring the variety and quality of alcohol-free products and recipe books that are available! From beers to mixers to non-alcoholic liquors, there is something for everyone.

4. Alternate drinks

Alternate your drinks with water or a non-alcoholic beverage. Also, practice mindful drinking, sip slowly, and actually enjoy your drink. Notice the flavors, the color, the fragrance. If you catch yourself drinking mindlessly or sucking down a drink because you don’t love the taste, maybe it is time for a change! Observe how alcohol makes you feel while you’re drinking and the next day, both physically and mentally.

5. Give it some thought

Dig deep and think about what you’re hoping to gain by drinking less alcohol. Set small, achievable goals, and set yourself up for success.

6. Set boundaries

If you think this would be helpful for you and not feel too restrictive. For example, you might limit how much money you will spend on alcohol a month, or you can set an intention not to drink when you are feeling bored or upset.

7. Take a break

Even if it is just for a night. Take stock of how you feel the next day: do you notice any changes in your energy level or mental clarity, for example?

Dietitian-approved tips for choosing healthier cocktails or mocktails if you have type 2 diabetes

Here are some tips from two dietitians for choosing healthier cocktails or mocktails.

1. Ask the bartender to transform your favorite traditional drinks into alcohol-free and/or low-sugar versions

Mojitos and Bloody Marys are examples of classic cocktails that can be easily made without the addition of alcohol. Are you concerned about how much sweetener they are adding to your drink? Just ask them to keep it to less than ½ fluid ounce, or 1 tablespoon.

2. Beware of frozen and -ade drinks

These can be loaded with sugar, particularly if prepared with a pre-made mix. Instead, enjoy a fresh margarita on the rocks, for example.

3. Avoid sodas, tonic water, and ginger beer

If you choose drinks that include these ingredients, be mindful of the quantity. Seltzer water and club soda are good alternatives if you like carbonation but want to minimize added sugar.

4. Add a splash of juice to seltzer or water to add flavor and a boost of antioxidants

While all juices have something to offer in terms of nutrients—pomegranate, cranberry, and tart cherry juice are particularly high in antioxidants. Avoid drinks made with juice cocktails and nectars, as these will have more sugar.

5. Choose unsweetened over sweetened tea

Add sweetener to taste or use zero-calorie sweeteners like stevia or monkfruit. That way, you are in control of the sugar content of your drink!

6. Infuse flavor into drinks using fresh herbs, spices, or pieces of whole fruit

Ask the bartender to muddle fresh herbs, like mint, in your drink. Or ask them to incorporate whole fruit into your drink. A little goes a long way!

Interested in trying new non-alcoholic drinks?

If you are looking to experiment with more non-alcoholic drinks, then pick up a copy of “Mocktail Party” which Diana and Kerry, two Registered Dietitians co-authored.  In it, you will find 75, plant-based recipes for healthy mocktails such as Classic Mock-jito, Blackberry Mint Mocktail Mule, and Salted Caramel Mock-tini. It is available on Amazon, Barnes & Nobles, and many independent bookstores.

The recipes are healthy, low in sugar, straightforward and simple to follow with all the required ingredients readily available at your local food store. Best of all? There is no alcohol! Not only will you have fun preparing these beverages, but you will also enjoy their flavors, and avoid any feeling of not being part of the celebration. Your cocktail glass will look just like everyone else’s. Perhaps even more satisfying will be knowing that your diabetes-reversing journey is intact.