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One of the most common questions posed about life with diabetes is on the subject of drinking alcohol, and how to do it safely.

Specific questions range from whether certain drinks are “blood sugar friendly” to carb counting for alcohol, and the effect on blood glucose levels hours later. The type of alcohol being consumed — wine, beer, mixed drinks or hard liquor — certainly plays a part in the answers.

Not surprisingly, curiosity seems to pique over the winter holidays, around St. Patrick’s Day in March, and during Alcohol Awareness Month in April each year. And with the global pandemic boosting alcohol sales significantly, it seems many have had “drinking and diabetes” on the mind much more than ever before.

It’s a universal topic that remains share-worthy at any point. Here’s a “flight” of resources compiled for DiabetesMine readers.

One helpful place to start is a resource created by fellow diabetes advocate Bennet Dunlap, who lives with type 2 diabetes and has two kids who live with type 1 diabetes (T1D). His Drinking With Diabetes website is a hub full of handy information and stories from the D-Community about personal experiences with alcohol.

This online guide isn’t exactly a “how to” on drinking safely with diabetes, but it offers real stories from people with diabetes (PWDs) who’ve dealt with various challenges, and allows visitors to start conversations about responsible drinking behavior. Whether it’s choosing not to drink, limiting consumption, or learning from what others say they “should have done,” the community voices are open and honest.

Dr. Jeremy Pettus

For more hands-on “how to” information, DiabetesMine turned to Dr. Jeremy Pettus, a practicing endocrinologist at University of California San Diego who has also lived with T1D himself since age 15. He regularly speaks on the topic of diabetes and drinking at virtual and in-person events around the country.

His message: Yes, PWDs can drink alcohol safely, as long as they do so mindfully and in moderation.

Pettus points to experts who say women should have no more than one drink per day, and men no more than two drinks per day. To be clear, one drink is: 12 oz beer, a 5 oz glass of wine or 1 ½ oz distilled spirits.

He also shared his own tips on drinking safely, based on his personal experiences (as there is a sore lack of clinical data about the mix of alcohol intake and T1D).

  • Always eat something before drinking.
  • Avoid sugary mixed drinks.
  • Bolus for alcohol, but half what you normally would for the carbs.
  • Check blood sugar levels often (before drinking, while drinking, before bed).
  • If not on an insulin pump, always take your basal insulin (maybe even before you go out).
  • Lower temp basal overnight or reduce your basal Lantus/Levemir dose by 20 percent or so.
  • Take smaller boluses the next day.
  • Set an alarm in the middle of the night (3 a.m.) to check glucose levels.
  • Don’t bolus right before bed.
  • If you don’t have one already, get a continuous glucose monitor (CGM) which helps gauge the impacts alcohol has on your diabetes over time.
  • Allow yourself to run a little high while drinking to avoid lows: target range 160-200 mg/dL.
  • In case you’re wondering (and in case of emergency), glucagon can still work while drinking, although the effect may be reduced.

Pettus says the bottom line is to avoid binge drinking.

Per Pettus, the general rule of thumb is the darker the beer, the more calories and carbs it contains.

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Just how many carbs and calories are found in beer? Some examples:

  • Amstel Lite contains 95 calories and 5 carb grams.
  • Dark beer like Guinness has 126 calories and 10 carbs.
  • Budweiser has 145 calories and 10.6 carbs.
  • A really “good beer” from a popular microbrewery probably contains about 219 calories and 20 carbs.

Microbreweries are a bit tougher to pin down on an exact carb and calorie count, because each one varies slightly — no single India Pale Ale (IPA) or stout is an exact replica of another, and craft brewers are renowned for adding in different ingredients to specialize their products.

DiabetesMine’s Mike Hoskins conducted his own personal study of craft beer consumption and the blood sugar effect. He tested a handful of local Michigan craft brews and found that each boosted his blood glucose levels (BGs) on average 75 to 115 points per glass, without any insulin or carbohydrates on board.

What he learned was that advance planning helps you enjoy a few brews without experiencing extreme high or low BGs. As an insulin user, you have to think hard about the food and physical activity that will likely accompany your imbibing.

If you’re celebrating St. Patrick’s Day in March, it’s helpful to know that the hallmark green beer doesn’t necessarily have any differing carb or calorie counts, because it’s typically food coloring that gives the drink a different color.

Diabetic Gourmet Magazine has a great roundup of different carb counts to remember for St. Paddy’s Day drinking, as well as the Irish food that often accompanies those who choose to drink on this celebratory occasion.

Yes, these do exist!

Thanks to diabetes advocate and author Kerri Sparling who recently shared her findings on lower-carb beer options:

  • The lowest-carb beer on the market appears to be Marston’s Resolution, at 85 calories and 1.65 grams of carb per bottle. According to surveys, “it tastes refreshing and the double fermentation process makes its carb load almost undetectable.” While this UK beer is hard to find in the United States, it can be purchased online and shipped to the U.S. for a premium fee.
  • Michelob Ultra, at 95 calories and with 2.6 grams of carb per bottle, is found regularly at American bars. “It doesn’t boast a lot of flavor, much like its counterpart, Natural Light (95 calories, 3.2 carbs). But if you’re looking for options without the high carb load, it’ll do.”
  • A bottle of Amstel Light has 95 calories, 5 carbs.
  • Heineken Premium Light has 99 calories, 7 carbs. These are popular beers and are common in American bars.
  • More “light” options include Corona Light (109 calories, 5 carbs); Bud Light (110 calories, 6.6 carbs); or Sam Adams Light (119 calories, 9.7 carbs). “All three are readily available in most markets and are mellower on your blood sugars than your average high-carb beer.”
  • And if you’re living with diabetes and celiac disease, there are a few gluten-free beers on the market that might work for you: Omission Lager comes in at 140 calories and 11 carbs and is touted as a beer that “pleases all palates, including those of average beer drinkers and craft connoisseurs.” A pint of gluten-free Magner’s Irish Cider is another option, with 125 calories and 9 carbs. This import is now available for purchase at Beverages & More, and through Instacart in the U.S.

We’re glad you asked. DiabetesMine recently published this “Definitive Guide to Wine and Type 1 Diabetes” that includes a ton of detail.

Here are some of the most important things to know:

  • On average, wine contains 120 calories and 5g of carbs per glass.
  • Dry white has the least sugar, reds come in a bit higher, and dessert wines are sugary, “just like they sound,” according to Mary Ellen Phipps, a registered dietitian nutritionist who lives with T1D herself.
  • Lower alcohol wines often have more sugar for taste reasons, and you’re best off looking for a varietal with 12.5 percent to 16 percent alcohol to avoid added sugars, according to Keith Wallace, winemaker, sommelier, and founder of the Wine School of Philadelphia.
  • Location matters: Italian and French wines traditionally have less residual sugar, whereas wines from Oregon, for example, have more sugar added, Wallace said.
  • Don’t drink wine on an empty stomach, have fast-acting glucose on hand, and let at least one person in your party know about your diabetes and how to help in case of hypoglycemia.

“Wine is good, in so many ways,” Wallace told DiabetesMine. “PWDs have so much stress and wine is a great stress reducer. This doesn’t have to be a worrisome thing. Done right, it’s excellent.”

The snack defense

“The best way to offset the alcohol-infused blood sugar plunge is to eat a high-fat, lowish-carb snack right before you crash for the night. The idea is to have some carbs slowly infusing into your blood to stand in for the liver until it recovers from its hangover the next morning.”

— DiabetesMine’s popular “Uncle Wil” column about alcohol and diabetes

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Drinking cocktails and hard liquor with diabetes can be particularly tricky. That’s because festive cocktails often include fruit juice and flavored syrup that pack a BG punch. Mixers and liqueurs can be sweet and have higher carb counts that raise BGs, too. On the other hand, straight-up hard liquor hits the liver hard, which can lower BGs.

If you prefer mixed drinks, this cocktails website recommends the best options for PWDs: a Bloody Mary, Dry Martini, Vodka & Soda, or even an Old Fashioned or Mojito cocktail made with Stevia instead of real sugar.

If you opt for straight hard liquor, experts recommend whiskey, bourbon, scotch, and rye — all distilled spirits that don’t have carbs. Although beware of flavored whiskies, which may have sugar syrup added.

When drinking hard liquor with diabetes, it’s important to be prepared for potential hypoglycemia.

Remember that the main function of your liver is to store glycogen, which is the stored form of glucose, so that you will have a source of glucose when you haven’t eaten. Especially when you drink “pure” alcohol without additional ingredients, your liver has to work to remove it from your blood instead of working to regulate BGs. For this reason, you should never drink alcohol when your blood glucose is already low. And again, never drink on an empty stomach.

Cheers, friends!