Alcohol Consumption and Diabetes Mellitus

Effects of Alcohol on Diabetes Risk

Chronic heavy alcohol ingestion (≥45 g/day or ≥3 drinks/day) causes deterioration in both long-term and short-term glucose metabolism, potentially leading to the development of type 2 diabetes 1, 3
Light-to-moderate alcohol consumption (1-2 drinks/day or 5-15 g/day) is associated with a decreased risk of developing type 2 diabetes in nondiabetic individuals, with studies showing a 33-56% lower incidence 1

Alcohol can have both hypoglycemic and hyperglycemic effects depending on the amount consumed, whether consumed with or without food, and whether use is chronic/excessive 3, 4, 5, 6
Moderate amounts of alcohol can enhance the glucose-lowering action of insulin and certain oral glucose-lowering medications by interfering with hepatic gluconeogenesis 1, 7
Alcohol-induced hypoglycemia is not ameliorated by glucagon because it impairs gluconeogenesis rather than being associated with excessive insulin secretion 1

For people who choose to drink alcohol, intake should be limited to moderate amounts: ≤1 drink/day for women and ≤2 drinks/day for men, with one alcoholic beverage defined as 12 oz beer, 5 oz wine, or 1.5 oz distilled spirits, each containing approximately 15 g of alcohol 3, 8
For individuals with diabetes who use insulin or insulin secretagogues, alcohol should be consumed with food to avoid hypoglycemia, and evening consumption increases risk of nocturnal and fasting hypoglycemia, particularly in type 1 diabetes 3, 8
Abstention from alcohol is advised for people with history of alcohol abuse/dependence, women during pregnancy, and people with medical conditions such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia 3, 9

Alcohol can blunt awareness of hypoglycemia in people with type 1 diabetes, increasing risk of severe episodes 1, 2
Excessive alcohol (≥3 drinks/day) consumed consistently contributes to hyperglycemia 3, 8
The effects of excessive alcohol consumption on glucose metabolism can be reversed after 3 days of abstinence 1, 4