Type 1 Diabetes and Alcohol

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Did you know alcohol (ethanol or EtOH) is a macronutrient, just like protein, fat, and carbohydrates? So when we ingest it, it interacts with all the same complex metabolic pathways, influencing blood sugar (BG), insulin resistance (IR), and more.
As you can imagine, this gets super complicated. And the effects vary based on how much you drink, how often, and whether or not you have type 1 diabetes or type 2 diabetes.
So, as a person with type 1 diabetes (T1D), what do I need to know about what happens when I drink? ⁣⁣

Type 1 Diabetes & Alcohol: The Cycle 

🍷 EtOH becomes the preferred source of fuel for our bodies, meaning that we stop carbohydrate metabolism (blood sugar rises ⬆️). ⁣⁣

🍺 EtOH metabolism causes insulin resistance in our muscles, fat cells, and liver (more blood sugar increase ⬆️)⁣⁣!

🍹 But after EtOH metabolism is over, these tissues then experience increased insulin sensitivity (blood sugar decreases ⬇️)⁣⁣. 

🥃 EtOH metabolism in our liver uses up the same enzymatic resources that would otherwise go to baseline glucose production and release (more blood sugar decrease ⬇️). ⁣⁣

🍸 EtOH inhibits the overnight growth hormone spike, aka dawn phenomenon (even more blood sugar decrease ⬇️)⁣⁣
This is the technical cycle of alcohol being metabolized in a body with type 1 diabetes, but how much you experience it as someone with type 1 diabetes varies depending on so many individual factors, mostly because we each use insulin a little differently.

Type 1 Diabetes & Alcohol Pro-Tips

You may notice that the last three all decrease blood glucose. It’s pretty common for T1Ds to experience lows after drinking, particularly if you have lots of insulin on board to compensate for the initial blood sugar spike. ⁣⁣
To help prevent hypoglycemia after drinking (especially overnight when glycogen release and dawn phenom is inhibited), consume carbs with the EtOH!

Lots of T1Ds drink sugar-free cocktails and low-carb beer to curb the initial spike, but if that’s your thing make sure you eat a minimum amount of carbs at some point to avoid an overnight low.

This should not be confused with mandatory nacho, pizza, double-decker sandwich, or large fry intake! Instead, opt for some peanut butter or a few handfuls (3-4) of popcorn. The alcohol will make sugars drop overnight (hence the small carb snack), but you don’t want to overdo it so that you’re high while sleeping.

The key 🔑 here is consuming a small amount of slow-release carbs before bed so you don’t crash during the night.

Also important to note: as a good rule of thumb, you can -- typically -- think of beer as raising blood sugar and liquor (straight liquor, not mixed with any juices, tonics, or liqueurs) as lowering blood sugar.

This does vary person to person, but it’s a safe assumption for many.
Finally, drink responsibly. Moderate alcohol use has been associated with a decrease in cardiovascular risk and an increase in insulin sensitivity.

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Jordan Hoese, MD, MPH
Sep 10, 2019

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