Okay, friend, the issue of diabetes and drinking is definitely a concern for many people with diabetes. I have quite a few friends around me who are confused about this, so let's talk about it plainly today.

Can People with Diabetes Drink Alcohol? How Does Alcohol Affect Blood Sugar?

The simple, direct answer is: Yes, but it's highly discouraged and comes with very strict conditions.

This is absolutely not something to be done casually. For people with diabetes, drinking alcohol is like walking a tightrope – extreme caution is needed.

How Exactly Does Alcohol Affect Our Blood Sugar?

Many people think alcohol is "the essence of grain" and assume drinking it will definitely raise blood sugar. This idea is only half right. Alcohol's effect on blood sugar is actually a "rise-then-fall" or "direct fall" process – it's quite sneaky.

Think of our liver as a multifunctional factory. One of its key jobs is to produce and release glucose to keep our blood sugar stable and prevent low blood sugar (hypoglycemia).

When alcohol (ethanol) enters the body, it's treated as a toxin. The liver makes breaking it down its "top priority," diverting all its resources to this task. It's like the factory suddenly getting an extremely urgent VIP order; all other production lines (including glucose production) have to stop and make way.

This leads to two possible scenarios:

Initial Rise (Possible): If you drink beer, sweet wine, cocktails, or alcohol mixed with sugary drinks, these beverages themselves contain carbohydrates (sugar). After drinking, these sugars are quickly absorbed, causing your blood sugar to rise rapidly initially.
Subsequent Drop (Very Dangerous!): No matter what type of alcohol you drink, as long as it contains alcohol, the liver has to work overtime to break it down. This process suppresses the liver's production of glucose. Especially in the hours, or even up to a dozen hours after drinking, the liver is still busy "detoxifying" and has no time to produce glucose. During this time, if you haven't eaten extra food, or if you are using insulin or insulin secretagogue medications (like sulfonylureas or glinides), you are very likely to experience hypoglycemia, particularly at night!

In a nutshell: Sugary drinks can cause blood sugar to rise first and then fall. Sugar-free drinks (like hard liquor) may cause blood sugar to drop directly. And this "drop" is the most dangerous part!

What Are the Main Risks of Drinking for People with Diabetes?

Severe Hypoglycemia: This is the biggest risk! Especially nocturnal hypoglycemia (low blood sugar during sleep). If it happens while sleeping, a person might not notice, and severe cases can lead to coma or even be life-threatening.
Difficulty Distinguishing Hypoglycemia from Drunkenness: Dizziness, heart palpitations, sweating, weakness, slurred speech... these are symptoms of hypoglycemia, but don't they sound a lot like being drunk? Both you and the people around you could easily mistake low blood sugar for intoxication, missing the critical window for treatment.
Interference with Medication: Alcohol can interfere with the effects of many diabetes medications (especially sulfonylureas and glinides) and insulin, making blood sugar levels even more unpredictable.
Weight Gain: Alcohol is very high in calories and provides "empty calories" with little nutritional value. Long-term drinking can easily lead to weight gain, which is detrimental to blood sugar control.
Long-Term Damage: Long-term alcohol consumption increases the burden on the liver and may worsen diabetes-related nerve damage (neuropathy).

If You Absolutely Must Drink, How Can People with Diabetes Drink "Safely"?

If you really can't avoid it due to work events or special occasions, you must remember these "non-negotiable rules":

Ask Your Doctor! Ask Your Doctor! Ask Your Doctor!: Important things need to be said three times. Your doctor knows your health condition best. Consult them first to see if your situation allows for limited alcohol consumption.
Stable Blood Sugar is a Prerequisite: If your blood sugar has been fluctuating a lot recently (highs and lows), or if you have serious complications, ABSOLUTELY avoid alcohol.
Strictly Limit Quantity:
- Women: Maximum of 1 standard drink per day.
- Men: Maximum of 2 standard drinks per day.
- What is "1 standard drink"? Approximately equivalent to:
  - Beer: 350 ml (about one can)
  - Wine: 150 ml (one standard glass)
  - 40% ABV spirits (like vodka, whiskey): 45 ml (one shot)
NEVER Drink on an Empty Stomach: This is the cardinal rule! Before and while drinking, you MUST eat food containing carbohydrates (like starches, potatoes, etc.). Food slows alcohol absorption and provides glucose for later, helping prevent hypoglycemia. Remember: "Alcohol with food, blood sugar stays good."
Choose Your Drink Wisely:
- Better Choices: Dry red/white wine, pure spirits (like vodka, whiskey), light beer.
- Avoid: Sweet wines, pre-mixed cocktails, flavored beers, rice wine (high in sugar), and any drinks mixed with sugary sodas like cola or Sprite.
Check Blood Sugar Frequently: This is your lifesaver. Check your blood sugar before drinking, 2-4 hours after drinking, and before bed. If your blood sugar is low before bed (e.g., below 5.6 mmol/L or 100 mg/dL), eat something before sleeping.
Be Prepared: Tell the friends or family you're drinking with that you have diabetes and let them know what to do if something happens. Carry candy, crackers, or glucose tablets with you for emergencies.

To Summarize

Friend, overall, for us with diabetes, it's best to avoid alcohol if possible. The risks it brings far outweigh any small enjoyment.

If you absolutely must drink, treat it like a carefully planned and strictly executed "task," not an indulgence. Remember, your health always comes first.