Living with Type 2 diabetes often means cutting back on our favourite foods and beverages. Much time is spent in every medical consultation discussing appropriate food choices. Some of the most frequently asked questions by people with diabetes pertain to the consumption of alcohol. Can I have alcohol or not? How much? How frequently? What type of alcohol? And so on and so forth.
When first diagnosed with Type 2 diabetes, many alcohol-drinkers are concerned whether alcohol can be the cause of their diabetes. Commonly known risk factors for Type 2 diabetes are family history, obesity, older age, and sedentary lifestyle. The relationship of alcohol and diabetes is complicated. Women metabolise alcohol less efficiently than men. Moderate intake of alcohol (eg <30 ml/day whisky for women, <60 ml/day for men) does not increase the risk of developing diabetes. However, excessive intake of alcohol is associated with an increased risk of developing diabetes as it can cause weight gain. Alcohol abuse may also cause inflammation of the pancreas (pancreatitis), a dangerous condition, which can lead to diabetes.
In general, it is advisable for people with diabetes to avoid alcohol. This is particularly true for those whose diabetes is not well-controlled. It is true that drinking alcohol in excess, either on a single occasion or over time, can take a serious toll on one’s health. An alcohol binge causes changes in behaviour and make it harder to think clearly, leading to random, uncontrolled eating and unsafe activities. This may result in alcohol poisoning, hospitalisation, car accidents and other injuries. Drinking excessively over time can cause high blood pressure, damage the heart, liver, pancreas and even increase the risk for certain cancers.
For people with diabetes, alcohol consumption does not usually raise blood sugar levels. However, alcohol has been shown to be associated with a short-term risk of developing low blood sugar (hypoglycemia) and long-term risk of damage to organs. The effect of alcohol on blood glucose levels differs depending on whether it is consumed with or without food.
In the fasting state, the liver pours out stored glucose into the blood stream and prevents blood glucose from plummeting to dangerous levels. When our liver is exposed to alcohol, it prefers to metabolise alcohol first and the release of glucose is hampered. If drinking alcohol is combined with the medications often used to treat diabetes—particularly insulin and sulfonylureas — it can lead to low blood glucose levels (<70mg/dl). This risk can last up to 24 hours after drinking alcohol. If you have had alcohol with dinner, it is advisable to check blood sugar before you sleep. If blood sugar is lower than 100 mg/dl, taking a small snack is advisable — a fruit, milk, or half a sandwich are good choices. Symptoms of low blood sugar can be confused with those of being in a drunken state, which can result in a low blood sugar reaction being missed with dangerous consequences.
As far as calories in different types of alcohol are concerned, ultimately it is the amount of alcohol that matters. One alcohol unit is measured as 10 gm. This equals about 275 ml beer, 100 ml wine and 30 ml spirits (hard liquor). To find out how many units are there in a drink, check for the Alcohol by Volume (ABV) on the label. ABV is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink. If the ABV is 12 per cent, it means 12 per cent of the volume of that drink is pure alcohol. You can find out how many units there are in any drink by multiplying the total volume of a drink (in ml) by its ABV (measured as a percentage) and dividing the result by 1,000. For example, if you have 500 ml of 5 per cent beer, you are taking 2.5 units of alcohol. Now, 30 ml of 40 per cent whisky will comprise 1.2 units of alcohol.
However, if alcoholic drinks (e.g., vodka) are taken with juice or sugary cocktail mixes, they will provide excessive calories. Therefore, to avoid these excessive calories, cocktails or mixed drinks made without fruit juice, regular soda, milk, or ice cream can be taken. For example, gin with diet tonic water or rum and diet cola.
The popular practice of consuming fried snacks with alcohol adds a huge burden of calories with unhealthy fats thrown in for good measure. Replace fried snacks with salads and roasted snacks like makhana, chana or egg white. The speed of drinking also matters. It is best to restrict yourself to one drink per hour to allow the body to metabolise the alcohol. Binge drinking is harmful — one drink per day is not the same as seven drinks on a Saturday!
The choice of drink depends on your personal choice but it is wise to avoid sweet wines and choose dry ones. Light or low carb beers are preferable. Among different types of spirits, it is the alcohol content that matters. The popular notion that vodka or gin are safer than whisky or rum is false.
If you can’t resist alcohol, please remember the rule of moderation and keep treatment for low blood glucose (sugar / sweets/ glucose) ready, particularly if you have a history of hypoglycemia (low blood sugar).
Alcohol consumption guidelines for people with diabetes
👉🏽 Do not drink more than two units of alcohol in a one-day period if you are a man or one unit if you are a woman.
👉🏽 Strictly avoid alcohol if you have associated conditions like high blood pressure, heart, liver, kidney, eye, nerve or pancreatic disease.
👉🏽 Drink plenty of water with alcohol to prevent dehydration and hangover.
👉🏽 Choose low calorie snacks with alcohol.
👉🏽 Avoid drinking on an empty stomach.
👉🏽 Drink slowly — one drink in an hour.
👉🏽 Avoid “sugary” mixed drinks, sweet wines or cordials.
👉🏽 Mix liquor with water, club soda, or diet soft drinks.
👉🏽 Monitor blood glucose few hours after alcohol consumption.
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