Moderate drinking (of alcoholic beverages) can be either beneficial or harmful to people with diabetes. It depends on when you drink and - of course - on how much you drink.

The ADA has acknowledged that it's OK for most people with diabetes to consume modest amounts of alcohol with a meal. Alcohol has significant effects on glucose metabolism and has been associated with both hypoglycemia and hyperglycemia. Hypoglycemia occurs in people who have a drink when they have not eaten. In that situation, alcohol affects various glucose-lowering medications:

• Alcohol enhances the glucose-lowering activity of insulin and the sulfonylureas.
• Patients taking metformin should drink only moderate amounts of alcohol with meals.
• There is no contraindication for rosiglitazone or pioglitazone and alcohol. However, individuals who drink large amounts of alcohol may develop liver disease, which precludes use of these agents.
• There is no significant interaction between alcohol and the alpha glucosidase inhibitors.

Binge drinking predisposes people with diabetes to the development of alcoholic ketoacidosis, which may be dangerous. In general, experts recommend that people with diabetes follow the same guidelines as anyone else: don’t have more than 1 (women) or 2 (men) drinks a day. They should only be taken with meals and can be added to the regular meal plan. Avoid drinks with large amounts of sugar, and be sure to include the calories from alcohol as part of your total caloric intake for the day. Substitute alcohol for fat exchanges (2 fat exchanges for 1 drink; add 1 carbohydrate exchange for beer).

Related information Glucose control | Treatment - Oral Medications