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Diabetics can safely drink alcohol, albeit in very small amounts. However there are several things diabetics need to bear in mind about alcohol and diabetes. The alcohol in our wines, beers and spirits is ethanol, also known as ethyl alcohol. One of the oldest recreational drugs used by humans, this chemical is also used as a fuel and a solvent. To make alcohol, fruits, vegetables or grains are fermented. During fermentation yeast or bacteria react with the sugars in these foods, creating ethanol and carbon dioxide as by-products. Wine and cider are made by fermenting fruit or vegetables. The fermentation of cereals such as barley and rye are the basis of beer and spirits. Spirits are produced when the fermented liquid is distilled, ie a portion of the water is removed, which leaves a stronger concentration of alcohol and flavours. The alcoholic content of a drink depends on how long it has been left to ferment and, in the case of spirits, how much water has been removed during distillation. Precautions As a diabetic there are certain things you need to consider when deciding whether to drink or not. Diabetics usually take a range of medicines to treat their diabetes and associated diseases such as hypertension (abnormally high blood pressure) and cholesterol issues. Alcohol can interfere with the actions of certain medications for dealing with these conditions so you should check with your doctor to find out whether you can safely drink alcohol. You should also ask whether alcohol can have an adverse effect on any other medical conditions you may have, such as diabetic eye disease, diabetic neuropathy or high triglycerides. You also need to bear in mind that alcohol can cause your blood glucose to drop seriously low, especially if you are taking insulin or are on the kinds of tablets that stimulate the release of insulin. How much should you drink? The fact is that everyone reacts differently to alcohol. Your gender, height and weight are just a few of many factors that determine how alcohol affects you. Even what you've had to eat during the day or how much sleep you've had the night before can make a difference as to how tipsy you get when you drink. That said, the official recommended limits for men are one and a half pints of beer a day, or two glasses of wine or two measures of a spirit such as whisky or gin. These are either/or amounts, ie you cannot have one and a half pints of beer plus two glasses of wine. The recommended limits for women are half those for men. Empty calories Alcohol, the world's most beloved recreational drug, is low in nutrients but high in calories. These are empty calories, ie calories that have little or no nutritional value. When your liver breaks alcohol down, it turns it into fat. If, like me, you are controlling your diabetes on an extremely low-fat diet, this is not good news at all. Alcohol has just seven calories per gram, which is a bit better than the nine calories per gram you get from animal fat, but a lot worse than the four calories per gram you get from carbohydrates. It's those calories in alcohol that create beer-bellies. Alcohol can also raise triglycerides (blood fats) which increases your risk of heart disease. If you insist on drinking yet, at the same time, wish to maintain your blood glucose and weight at their current levels and preserve the health of your heart, you should: drink light beers instead of stout or dark beers; drink dry wines instead of dessert wines or sparkling wines; avoid mixers such as regular soda, tonic water and juices which are full of calories and carbs, and go for diet tonic water and club sodas instead. Of course, if you want to lose weight, you should avoid the empty calories of alcohol altogether. Alcohol and low blood sugar Alcoholic drinks contain plenty of carbohydrates so, if you are diabetic, drinking moderate amounts of alcohol will cause your blood sugar to go up. However this initial rise soon wears off and the level of glucose in your blood can start falling. If you have more than two or three drinks during one session then, strangely, your blood glucose can continue to fall until you end up with hypoglycaemia (dangerously low blood sugar levels, aka a hypo). This is more likely to happen if you are on insulin. Here's the explanation. Normally, your liver maintains your blood sugar levels by releasing glucose as needed. But when you are drinking alcohol, your liver is so busy breaking the alcohol down that it does a poor job of releasing glucose into your bloodstream. This can lead to a drop in blood sugar levels - especially if you are drinking on an empty stomach. On average, your liver will take one to one-and-a-half hours to fully process a single alcoholic drink. Your risk of low blood glucose exists during this entire time. This is just for one drink, so if you have two drinks, you double the length of time you are at risk for low blood glucose. Indeed, the more you drink, the longer you will be at risk of seriously low blood sugar. Note that if you combine exercise with alcohol (eg, going to the pub after a session in the gym), your risk of low blood glucose is increased because most types of exercise lower blood sugar levels. Drinking tips If you must go drinking, here are some tips: It's best to do your drinking while eating a meal. Never start drinking on an empty stomach as alcohol will be absorbed too quickly into your bloodstream. Have a snack before you meet your buddies. If you are out drinking for the evening, snack on something starchy like crisps. Carry a source of carbohydrates, such as glucose tablets, in case you need a sudden boost in your blood sugar. Wear a medical necklace or bracelet stating that you are diabetic. Tell your boozing companions you are diabetic so they know what to do if you have a hypo, which can be confused with drunkenness when your breath smells of alcohol. If you drink more than a few shots during an evening, eat a starchy snack, such as toast, before going to bed. This is to minimise the risk of a hypo as your liver works throughout the night and into the next day to get rid of the alcohol in your system. To lessen the impact of a hangover, drink lots of water or other rehydrating drink before going to bed. Hangovers Hangover is the catch-all name given to the unpleasant after-effects of drinking too much alcohol. Most of us have experienced a hangover at some time or other, so a description is not needed. They vary, however, so the range and intensity of symptoms differs between persons. The symptoms will also vary depending on what was being drunk and for how long. Hangovers usually begin a few hours after drinking and may last as long as several days. The causes of hangovers depends on what and how much you drink. The main reason is that the ethanol (ethyl alcohol) in drink (up to 40% in the case of spirits) increases the production of urine. This leads to dehydration when you pass water, which you tend to do a lot when you are drinking. Dehydration causes fatigue, headaches and a dry mouth. Alcohol also reacts with your stomach lining which can make you feel nauseous. This happens when the ethanol is metabolized into acetaldehyde. Breaking acetaldehyde down into acetic acid takes time, and it may be noted that acetaldehyde is more toxic, mutagenic and carcinogenic than alcohol. There may be several other things in an alcoholic drink that contribute to your hangover. These include impurities such as other alcohols and preservatives, congeners (secondary products that help determine flavour and colour created during fermentation), and impurities such as zinc or other metals which are deliberately added to enhance the flavour. Yep, you can never be sure what's in a fancy drink such as a liqueur. The only way to prevent a hangover entirely is to avoid drinking. That said, there are a few things you can do to lessen the impact of a hangover: Drink water or another rehydrating fluid... this is probably the best thing you can do A spoonful of baking soda (sodium bicarbonate) may help ease your stomach Do some exercises. This will raise your metabolic rate and help clear the toxins associated with metabolizing alcohol. Exercise also speeds up delivery of oxygen to your cells which can increase the rate at which you detoxify harmful compounds. If you are desperate, you could go on a ventilator and get a dose of supplemental oxygen which would save you the bother and effort of exercising. My boozing So there you are... to drink or not to drink... question answered (more or less). Being diabetic does not mean that you have to become a teetotal monk. However you must restrict the amount of alcohol you drink quite severely. Personally I limit myself to one long glass of extra dry wine during Sunday dinner. I find it relaxing. It's enough.
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