People with diabetes who have their physician’s approval to consume alcohol should remain aware of how alcohol can affect their body. Patients should be aware of the following factors:

Alcohol can worsen some medical conditions. Individuals with diabetes who suffer from certain conditions may be advised to avoid alcohol completely. These conditions include:

• High blood pressure. Heavy (more than three drinks a day) and regular use of alcohol can increase a person’s blood pressure.

• Neuropathy. Alcohol is toxic to nerves and can make nerve damage worse. Heavy or regular consumption of alcohol can increase the pain, burning, numbness and tingling associated with nerve damage. There is also evidence that even light drinking (less than two drinks a week) can lead to nerve damage.
  
  
• High triglyceride levels. Alcohol can affect how the liver clears fat from the blood. It can also encourage the liver to produce additional triglycerides. Even light drinking (fewer than two drinks a week) can increase a person’s triglyceride levels. Patients with a very high serum triglyceride level (around 500 milligrams per deciliter or more) should abstain from alcohol because it may raise levels even higher.
  
  
• Retinopathy. Heavy drinking (three or more drinks a day) can lead to the development of retinopathy or worsen the condition.

• Nephropathy. Even a minor rise in blood pressure can worsen kidney disease. Alcohol can increase a person’s blood pressure, a concern for people with renal damage.
  
  
• Liver disease. Over time, large amounts of alcohol can contribute to the buildup of toxins and other harmful materials in the liver, causing permanent damage. In patients with liver disease, consuming alcohol can worsen the damage to the liver and lead to cirrhosis, a condition characterized by scarring, fat clogs (also known as “fatty liver”) or impaired blood flow through the liver itself.
  
  
• Pancreatitis. Any amount of alcohol may aggravate pancreatitis (inflammation of the pancreas). Pancreatitis is a risk factor for developing secondary diabetes.
  
  
• Heart conditions. Periods of heavy drinking may cause disturbances in heart rhythm (arrhythmia) in some people. If the person has coronary artery disease, there may be at increased risk for a heart attack once the rapid and abnormal alcohol-induced rhythm develops.
  
  
• Certain cancers. Research has linked alcohol to increased risk of cancer of the lips, mouth, esophagus, larynx, breasts, liver, colon and possibly the pancreas and lungs.
  
  
• Gastric disorders. Alcohol can increase the discomfort of gastric problems such as diarrhea or constipation.
  

Alcohol can negatively affect a patient’s meal plan. Two light beers equal about 200 calories. These calories are considered “empty” because they do not provide any nutrients. For patients following a meal plan, the calories in alcohol will have to be counted as part of their daily intake. Alcohol contains 7 calories a gram. For patients following an exchange diet, alcohol is normally counted as fat servings. Generally, one drink equals 2 fat exchanges or 90 calories. Because regular beer also contains about 15 grams of carbohydrate, it is counted as one carbohydrate serving and half of a fat serving.

In addition, people will also have to count the calories added to their drink in the form of juice, fruit, syrups and other additives. People with diabetes should not omit food from their meal plan in exchange for alcohol. Doing so can increase a person’s risk of hypoglycemia.

Other conditions alcohol can cause or worsen include the following:

• Alcohol can increase the risk of hypoglycemia. Normally, the liver changes stored carbohydrate (glycogen) into glucose when blood sugar levels begin to drop. It then releases the glucose into the blood to prevent or delay a low glucose reaction. However, when alcohol is in the body the liver concentrates on clearing the alcohol from the blood instead of creating glucose because alcohol is a toxin. This can quickly result in very low glucose levels, especially when there is no food in the stomach. Severe hypoglycemia can result in convulsions, unconsciousness, brain damage or a potentially fatal diabetic coma.
  
  
• Alcohol can hinder treatment for hypoglycemia. The signs of hypoglycemia are similar to the signs of intoxication. Both can result in confusion and lack of coordination. The patient and the people around the person with diabetes may dismiss the signs of low glucose as intoxication. Without treatment, the glucose level could drop lower and the patient could lose consciousness. The loss of consciousness could also be mistakenly attributed to the consumption of too much alcohol.
  
  Hypoglycemic patients who cannot swallow or are unconscious normally require an immediate injection of glucagon. However, glucagon shots do not help severely low glucose caused by alcohol consumption because glucagon works by getting the liver to release more glucose. When alcohol is in the body, the liver will not release glucose. The patient will need to be treated with other means, such as consumption of sugar or, if unconscious, with a glucose injection administered by a healthcare professional.
  
  
• Alcohol can increase hypoglycemia unawareness. Alcohol affects the brain and can cause a person not to feel or notice the normal symptoms associated with low glucose.
  
  
• Consumption of alcohol can lead to hyperglycemia. Although this does not occur very often, drinking alcohol can lead to high glucose levels. This can be attributed to an increased consumption of carbohydrates. Carbohydrates can be found in alcoholic beverages such as beer and in mixers such as juice. Alcohol also stimulates the appetite, which can lead to an increase in food consumption. 
  
  
• Mixing diabetes medications and alcohol can increase the risk of hypoglycemia. Insulin and antidiabetic agents (e.g., sulfonylureas and meglitinides) work to lower the level of glucose in a person’s blood. To avoid low glucose, a physician may recommend not combining alcohol with these medications.
  
  
• Alcohol can affect a person’s motivation and thought process. People consuming alcohol may forget to perform glucose monitoring or ketone testing, or think it is acceptable to skip a self-test. It is important for diabetic individuals to keep a clear mind. They will need to think well enough to monitor their glucose, remember to take their medication and know how to react if they have dropped too low.
  
  
• Heavy drinking can make diabetes harder to control. Heavy drinking (more than three drinks a day) over time can damage the liver. As the liver becomes damaged it will not be able to make glucose as efficiently. As a result, a person’s diabetes may become harder to manage.
  
  
• Alcohol affects the body’s ability to overcome hypoglycemia. Alcohol can continue to affect glucose levels for eight to 12 hours after consumption.

In addition, people at risk for developing diabetes should be aware that alcohol abuse can increase a person’s risk of developing the disease. Heavy consumption of alcohol can result in pancreatitis. The pancreas is an organ that releases insulin to help the body turn glucose into energy. Pancreatitis can cause permanent damage to the pancreas. It can also impair the organ’s ability to release insulin, which can lead to diabetes.