| If you have diabetes and you drink, you’ve probably wondered at some point whether the two are affecting each other. They can, and the effects aren’t always obvious in the moment. Understanding the link between diabetes and alcohol can help you make sense of what’s happening and know when to ask for support. For personal medical advice, speak to your GP or diabetes team. |
What is the link between diabetes and alcohol?
Alcohol doesn’t directly cause diabetes. But heavy, regular drinking can raise your risk of type 2 diabetes by contributing to weight gain, raised blood pressure, and reduced insulin sensitivity.
According to Diabetes UK, when your liver is busy breaking down alcohol, it can’t release glucose into your blood as effectively, so your blood sugar can drop. This is part of why alcohol consumption and diabetes are closely linked.
Alcohol can also interact with your diabetes medication and have unpredictable effects on blood sugar. Castle Health doesn’t treat diabetes, but we do support people where drinking has become difficult to manage.
How does alcohol affect blood sugar levels in people with diabetes?
When you drink, your liver prioritises breaking down alcohol over releasing glucose into your bloodstream. This can trigger a hypo – a hypoglycaemic episode where your blood sugar drops below 4 mmol/L.
The risk is higher if you drink on an empty stomach or use insulin or certain diabetes medications. Diabetes UK note that your risk of a hypo can persist for up to 24 hours after you stop drinking.
Why hypos can be harder to spot after drinking
Some of the signs of a hypo (drowsiness, confusion, slurred speech, dizziness) look a lot like the effects of drinking, so it can easily be missed.
Diabetes UK recommend carrying hypo treatments and wearing medical ID. Make sure the people you’re with know what a hypo looks like and how to help.
A continuous glucose monitor (CGM) can alert you to low blood sugar while you’re drinking.
Can drinking alcohol contribute to type 2 diabetes?
Alcohol doesn’t cause type 2 diabetes like a virus causes an infection. But research in the Journal of Epidemiology and Community Health found that chronic, heavy alcohol use is an independent risk factor for type 2 diabetes.
Heavy drinking can contribute to insulin resistance – where your body’s cells stop responding to insulin as they should. A review in Molecular Medicine found that alcohol can cause insulin resistance and damage the cells in the pancreas that produce insulin. Both raise the risk of type 2 diabetes.
Type 1 diabetes is an autoimmune condition. It’s not caused by drinking.
Diabetes and alcohol: when is drinking more risky?
The risks of diabetes and drinking vary depending on your medication and how well your blood sugar is controlled. But there are some situations where alcohol and diabetes are a particularly risky combination:
- You use insulin or a sulphonylurea – medications that can lower blood sugar on their own.
- You drink without eating.
- You have frequent hypos or find it hard to tell when you’re having one.
- You have complications affecting your liver, kidneys, nerves, or eyes.
- You drink heavily or regularly.
- You have been advised by your diabetes team not to drink.
Research on diabetes medications and alcohol notes that combining alcohol with metformin can increase the risk of a rare but serious condition called lactic acidosis. Drinking with insulin can cause blood sugar to rise or fall unpredictably.
If you’re taking a GLP-1 medication such as semaglutide or tirzepatide, there’s no specific contraindication with alcohol, but your blood sugar can still be affected. Speak to your prescriber before drinking.
Choosing what to drink when you have diabetes
There’s no universally safe alcoholic drink for people with diabetes. University Hospitals Sussex NHS Foundation Trust advises that the same drinking guidelines apply whether or not you have diabetes: no more than 14 units per week, across at least three days, with several alcohol-free days each week.
There are also some diabetic-specific considerations.
- Avoid sweet wines, sherries, liqueurs, and sugary mixers.
- Use sugar-free or diet mixers and make short drinks longer.
- Avoid strong lagers, beers, or ciders above 5% ABV.
- Don’t substitute alcohol for a meal, and try to eat something starchy when drinking.
- Never drink on an empty stomach.
Low-alcohol options may be a viable substitute, but check the label. Some are higher in sugar than the full-strength version. Your diabetes team can give you more tailored advice based on your medication and how your blood sugar responds.
Alcohol, pancreatitis, weight, and long-term diabetes risk
Heavy alcohol use puts strain on the pancreas – the gland that produces insulin. Research published in the Journal of Clinical Medicine notes that while both men and women can develop acute pancreatitis due to alcohol, it’s a more common cause in men.
Repeated episodes of acute pancreatitis can permanently damage the pancreas, raising the risk of developing diabetes. The NHS advise that if you have had acute pancreatitis, you should avoid alcohol completely for at least six months to give the pancreas time to recover.
Diabetes UK note that drinking to excess can increase your risk of type 2 diabetes partly because alcohol is calorie-dense, and regular drinking can gradually push up your weight. Excess weight is itself one of the main risk factors for type 2 diabetes.
"I contacted Castle Health [formerly CATCH] with a view to getting online support after a period in rehab. They recommended recovery coaching and arranged for me to meet my coach in person as the first of 10 meetings. I continued the coaching on Zoom as I live in France. I was very happy with my 10 sessions and feel I am in a good place to continue my recovery."
When to seek help with alcohol and diabetes concerns
If you’re unsure how alcohol is affecting your blood sugar levels, your medication, or your diabetes management, speak with your GP or diabetes team. They can give you guidance specific to your health and your treatment plan.
Sometimes the question goes deeper than blood sugar. There are signs that your drinking may be a problem in itself.
- You find it hard to stop drinking once you start.
- You drink despite medical advice or health concerns.
- You avoid checking your blood sugar when you have been drinking.
- Alcohol is affecting your sleep, mood, energy, or relationships.
- You feel like your drinking is getting in the way of managing your diabetes well.
How Castle Health can support you
Castle Health doesn’t treat diabetes. That’s a conversation for your medical team. But if alcohol has become harder to manage and it’s affecting your health or your diabetes care, we can help.
We offer a range of support options, including alcohol addiction treatment and online addiction treatment. If you’d like to talk through what that looks like, you can book a confidential addiction assessment. No pressure, no obligation, just a conversation.
If you’re not sure where you stand, that’s something we can talk through. You can read more about alcohol and its links to wider health concerns on our site.
Speak to our team about alcohol support
If alcohol is affecting your health or making diabetes harder to manage, you can speak to Castle Health in confidence. We’ll help you understand your options, without pressure and at your pace.
If someone in your life is drinking with diabetes
It can be hard to know whether to say something, particularly when both alcohol and a health condition are involved. If someone in your life is drinking heavily and has diabetes, the most helpful thing is usually a calm conversation.
Focus on your concern for their health rather than on their behaviour. Encourage them to speak with their GP or diabetes nurse, and let them know that support for their drinking is available.
You can also speak to us. We’re used to supporting families and people in someone’s life, not just the person who is drinking.
Frequently asked questions about diabetes and alcohol
Can alcohol affect HbA1c readings?
Regular heavy drinking can affect your longer-term blood sugar management and may show up in your HbA1c. Your diabetes clinician is the right person to interpret your readings in context.
Why can alcohol cause a hypo hours after drinking, not straight away?
The liver can take several hours to process alcohol, and while it’s doing that, it’s less able to release glucose into your blood. Blood sugar can keep dropping after you stop drinking, sometimes overnight. Diabetes UK note that this risk can last up to 24 hours. After drinking, eat something before bed and check your blood sugar. It can prevent a hypo while you sleep.
Should I stop drinking completely if I have diabetes?
It depends on your medication and what your diabetes team advise. Some people are advised not to drink at all. University Hospitals Sussex advises that standard safe drinking guidelines apply to people with diabetes as they do for everyone, though individual circumstances vary. Always check with your own medical team.
Can alcohol make diabetes complications worse?
Yes. If you have complications affecting your liver, kidneys, nerves, or eyes, alcohol can make those worse. Research in Annals of Internal Medicine links heavy alcohol use with direct effects on liver function and the risk of hypoglycaemia. Speak to your clinician about whether drinking is advisable.
Taking the first step
Diabetes care sits with your medical team. But if alcohol is making that harder, or you’re finding it more difficult to manage your drinking, seek professional advice.
