First, before I write this post about diabetes and alcohol, I have to say that I'm almost a tee-totaller, and I don't want to encourage anyone who doesn't drink to start.  There is almost no benefit to drinking alcohol and there are plenty of risks.  Having said that, I know that lots of people drink alcohol and don't plan to stop.  They need help figuring out how to navigate drinking alcohol without getting their blood sugars out of whack.  So, here goes...

If you think diabetes and alcohol can't mix, you might like what you read in this post.  Many of my clients are surprised to learn that they can still enjoy some of their favorite adult beverages while keeping their blood sugars in good control.  But don't break open the bottle just yet — there are some caveats that come with imbibing when you have diabetes, and you'll need to know what to watch out for.

Alcohol may lower blood sugar

Alcohol prevents the liver from releasing sugar into the bloodstream, so a person with diabetes who drinks pure alcohol would see a drop in their blood sugar levels.

But...some alcoholic beverages, like beer, naturally contain carbohydrates.  While the alcohol in the beer lowers blood sugar, the carbs in the beer raise blood sugar.  Most of the time, the carbs win this battle and the overall effect of drinking a regular beer is a rise in your blood sugar.  But, each person is different, so you'll need to check your blood sugar more often if and when you drink.

Carbohydrate content of alcoholic drinks

Spirits such as vodka and rum have little to no carbohydrates.  If you drink them straight or with a sugar-free mixer like a diet soda or sparkling water, your blood sugar is likely to go down.

The "mixers" are usually the problem when blood sugar spikes after drinking alcohol.  Regular sodas, juices, and flavorings like grenadine are very high in carbs.  These add-ons are really the culprit when blood sugar spikes after drinking liquor.  Think rum-and-Coke, vodka-and-OJ, or Pina Coladas.

Diabetes and alcohol, and your long-term health

I'm sure you don't need me to tell you that drinking too much alcohol can lead to a host of serious problems, like these:

• High blood pressure, heart disease, and stroke

• Liver disease

• Cancer of the breast, mouth, throat, esophagus, liver, and colon

• A weakened immune system, increasing your chances of getting sick

• Memory problems, like dementia

• Depression and anxiety

• Alcohol dependence/addiction

The recommendation is that women drink no more than one alcoholic beverage each day and that men limit their intake of alcoholic beverages to two per day.  And no...you can't save them all up and have them on Friday night!  (I've been asked that question at least a thousand times.)

How to mix diabetes and alcohol

If you have diabetes, drinking alcohol requires a little more attention than it would if you didn't have diabetes.  (No surprise there!)  Here's what you need to do to stay safe:

• Check your blood sugar before you drink alcohol

• Know how many grams of carbs are in your alcoholic beverages

• If you use meal-time insulin, bolus for the carbs in the alcohol just like you would for carbs in food

• Check your blood sugar again 1-2 hours after drinking alcohol.  If you continue to drink  (which I have to say again is not recommended), continue to check your blood sugar every 1-2 hours.

• Be prepared and have supplies ready in case of high blood sugar or low blood sugar emergencies.

Diabetes and alcohol can mix, as long as you consider the carbs in the alcohol and the fact that the alcohol itself will likely decrease your blood sugar.  Pay attention to how your body reacts to alcohol — because everybody is different.  If you have diabetes, you can have an alcoholic drink every now and then.  Like everyone else, you just need to know your own limits.

Action Items:

1. If you don't drink alcohol, great.  Skip to #7 below.

2. If you drink alcohol, use the Carb Content of Alcoholic Drinks chart to learn how many grams of carbohydrate are in one standard drink of your favorite beverage.

3. Think about whether you normally drink a "standard" size beverage, or whether your normal drink is smaller or larger than the size on the chart.  Measure it out if you need to.

4. Do the math to determine how many grams of carbs you normally drink in your alcohol alone (grams of carb in a standard serving x number of standard servings you consume).

5. Repeat the same process with any mixers you use.

6. Is it worth it, or are you blowing your carbohydrate budget beverages before you even get to those bar snacks?

7. Could you switch to a light or an ultralight beer or a sugar-free mixer?  If you did, how much would that change your carbohydrate intake?