Patients who have their physician’s approval to consume alcohol will need to take certain steps to drink safely. Recommendations a physician may make to a diabetic patient who is going to drink:

• Drink moderately. A general guideline, which an individual’s physician may alter, is one drink a day for women and two drinks a day for men.
  
  
• Drink only when glucose (blood sugar) is under control. Patients should test glucose before they consume alcohol. People should not drink if their levels are low or they are experiencing unstable diabetes.
  
  
• Consume alcohol with food. Drinking alcohol on an empty stomach can lower glucose levels. Because the body cannot use alcohol as a source of glucose, it will require food. Patients can avoid hypoglycemia by having their drink with a meal or large snack. Diabetic individuals taking insulin, sulfonylureas or meglitinides should not consume alcohol without food.
  
  
• Do not omit food from a meal plan to make room for alcohol. People with diabetes should not sacrifice nutrition in exchange for alcohol. Doing so can increase a person’s risk of hypoglycemia. All alcohol must be included as an addition to a person’s meal plan.
  
  
• Choose alcoholic beverages and mixers that are lower in alcohol, calories, and sugar and other, carbohydrates. Dry wines and light beer are better choices for people with diabetes because they are lower in calories, carbohydrates and alcohol. Patients should also select sugar-free mixers including diet soda, diet tonic, club soda, seltzer and water.  People should avoid sweet wines, sweet vermouth, heavy beers and wine coolers that are high in sugar and carbohydrates. So-called energy drinks, which have recently become popular mixers, are typically high in sugar, may provide a false sense of increased alertness and should be avoided.
  
  
• Make drinks last longer. Patients can make spritzers by combining wine with mixers including club soda, sparkling water or diet soda. People can sip their drinks slowly to make them last.
  
  
• Choose nonalcoholic or alcohol-free beverages. Nonalcoholic beer, alcohol-free wine, and “virgin” drinks are smart choices for people who enjoy the taste of alcoholic beverages. Red wine that has had the alcohol removed may benefit people with coronary artery disease, recent research suggests.
  
  
• Wear a medical identification bracelet or necklace at all times. Patients can also carry a medical identification card in their wallet to alert people of their diabetes. Because the signs of low glucose levels and intoxication can be similar, people need to be able to identify a patient as diabetic.
  
  
• Educate other people about hypoglycemia. People with diabetes should inform their drinking companions about their medical condition. They should discuss the symptoms of low glucose as well as treatment methods.
  
  
• Discuss combining alcohol and medication with a physician. Patients should get their physician’s approval before combining alcohol with their medications. Patients who consume alcohol several times a week or more should discuss alcohol with their physician when being prescribed medication.
  
  
• Know the amount of alcohol in a drink. Patients should be aware of the proof of the alcohol they are drinking. People should also know the level of alcohol in their drink, or “strength” of their drink.
  
  
• Test glucose levels. Glucose monitoring can help a patient avoid hypoglycemia when drinking. People who are drinking alcohol should test their glucose as recommended by their physician, typically every two hours to eight hours. Patients with low glucose may need to treat it more than once as time goes on because alcohol can affect glucose levels for several hours. Patients should also test before going to bed and again at around 2 or 3 a.m. Detecting and treating dropping glucose levels can help a person avoid overnight lows, as well as hypoglycemia in the morning.
  

  

• Carry a fast-acting carbohydrate snack, glucose tablets or glucose gel. Patients should always be prepared to treat low glucose.
  
  
• Have an emergency plan. A physician-directed plan for emergencies such as severe hypoglycemia or diabetic coma may include treatments such as an injection of glucagon. It is important to note, however, that glucaon does not treat hypoglycemia that is caused by drinking alcohol.
  
  
• Test glucose levels before driving. A person with diabetes who has consumed alcohol may risk low glucose levels. As a result, people with diabetes should always test glucose levels before getting behind the wheel of a car. Patients whose glucose levels are low should eat something and/or have someone else drive.
  
  
• Eat a snack before going to bed. Patients may be advised by their physician to eat 10 to 15 grams of carbohydrate for each serving of alcohol consumed before going to sleep. For patients who normally eat a bedtime snack, the usual snack is eaten in addition to the extra snack. Patients may be advised to eat the snack even if their glucose level is within or above their target range. This can prevent overnight hypoglycemia and the Somogyi effect.
  
  
• Do not combine exercise with alcohol. Mixing exercise with alcohol consumption can increase a person’s risk of hypoglycemia. Physical activity lowers blood sugar by encouraging the transfer of glucose from the blood to the cells, where it is used for energy. Patients may need to avoid dancing while drinking or having an alcoholic beverage after participating in sports.