If You Have Diabetes, Can You Drink Alcohol?
The simple truth about this disputed activity
By Wil Dubois
If you have diabetes can you drink alcohol? I'm rarely asked the question that directly; instead, it usually plays out more like this:
Wife of newly diagnosed type 2 (clutching purse in lap with death grip): "And tell my husband he has to stop drinking."
Me: Uh… Sorry. I can't do that. Because he doesn't have to.
Wife (shocked): If you have diabetes you can drink alcohol?
New diabetic, grumbling: See? I told you so! That's what you just said, right? That I can drink alcohol?
But the fact that the question, "If you have diabetes can you drink alcohol?" is asked, either directly or indirectly, tells me that we need to talk about it. And while the short answer is, "Yes, of course," the long answer is a bit more complicated as, like everything in diabetes, there are some rules. In this case, you can only mix alcohol and diabetes if:
Rule One: Your mixers are sugar-free.
Rule Two: Your intake is moderate.
Oh and the rules aren't fair to age or sex.
But before we get into those rules in more detail, I need to be clear that there's a difference between what's good or bad for your diabetes, and what's good or bad for the rest of your health. As you know, I'm only responsible for your diabetes, but I feel duty-bound in this case to point out that too much alcohol can affect your health in many ways beyond your diabetes. Everyone knows it can pickle your liver, leading to cirrhosis and death, but it can also raise your blood pressure, increase your risk of stroke, up your risk for a heart attack, trigger weight gain through multiple mechanisms, and can turbo-charge some cancers.
But back to diabetes and diabetes only, Rule One is kinda obvious. If you can't drink regular Coke, you can't drink Rum & Coke. You want to drink a Rum & Coke Zero? That's OK, as—contrary to popular myth—distilled spirits (a.k.a. hard liquor) actually have no sugar worth mentioning. They are nearly as carb free as water, but you'd be wise not to drink them like water, which rather smoothly brings me to Rule Two: How much drink is in a drink, and how many drinks can you have?
The answer is simple. For men, two drinks a day. For you ladies—sorry—your limit is one a day. Oh, and guys, once you are over the 65-year hump, you have to drink like a lady. Why the gender divide? Sexual dimorphism: Women, generally, are smaller than men, both in overall body mass, and in the size of their alcohol-filtering livers.
Can I supersize that drink?
No. That's cheating. But it's a good question, because trust me on this, when it comes to booze, not everyone agrees on what's an appropriate serving size. I learned that the hard way after I had been at my clinic for about six months. We've got this little place on our intake forms where we are supposed to make a note of alcohol use and abuse. Most people had been telling me that they were light social drinkers. That made sense to me, because at the time, I was the same. Now, after years in health "care" I drink quite a bit more, but back then, to me, light social drinking meant a margarita or two with red chili enchiladas once a month, a glass of wine with an Italian dinner every several of weeks, and maybe a Hot Toddy for cold and flu symptoms in the winter.
One day, one of my "light social drinkers" just REAKED of booze—that nasty, booze-heavy, morning-after foul sweat smell. So at first my unjust little mind thought: Well this lying son-of-a….. But then I got ahold of myself and simply said, "OK, I've got you down for light social drinking. Hey, if you don't mind my asking, how would you define "light" drinking?"?
"Oh, I can down thirty beers, no problem," the patient assured me, with a proud and confident nod of his head.
Picture me with my chin on the floor. I was aghast. If I downed thirty beers, I would die. Hell, if my whole family collectively drank thirty beers we'd all die.
Since that time, I've encountered any number of light drinkers who put Marine Corps Pilots to shame (no offense to our brave fliers intended.) Naturally, I've learned to ask more volume-specific questions of my patients because as it turns out, like a pirate poison in The Princess Bride, it's possible to develop a significant tolerance to alcohol over time by gradually increasing the volume consumed, although this does not reduce your impairment (or long-term damage to your body). It just makes it possible to consume more without dying… at that very moment. So that begs the question of what is a "normal" serving of alcohol?
Regardless of your developed tolerance, from the medical and nutritional standpoint, a "drink" is defined as a glass that contains 14 grams of alcohol. As most of us don't carry alcohol scales with us when out-and-about, as a rule of thumb, that translates into one 12-ounce can of regular beer or a 14-ounce light beer. So for you beer drinkers, the young men may have two cans and the ladies and older gents are limited to one. Per day, not per meal, and certainly not per hour. For those of us who lean toward wine, we can get that 14 grams of alcohol in a single five-ounce serving. Same as with beer, younger dudes get two glasses of vino and ladies and men over 65 must stop after the first glass. For you hard-core drinkers of spirits, the magic amount of alcohol is contained in a shot-and-a-half of 80-proof.
Diabetes-wise, if you keep to those volumes, alcohol and diabetes dance well together. The alcohol won't do anything weird to your blood sugar or to your control efforts.
But one word of warning. If you drink more than the allotted volume, in addition to the liver, blood pressure, stroke, heart attack, weight gain, and cancer risks, there's one special surprise that diabetes has in store for you. Drinking a lot tends to trigger low blood sugar, but it does so hours after drinking. If you tie one on, you're likely to drop like a stone when you are sleeping it off. And then you might never wake up.
So that's it. Eat (lowish carb), drink (in moderation), and be merry in abundance. Now, the bar's open, and I'm buying. But only two drinks for the guys, and one for the elder gents and the ladies.
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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