Building Competency in Diabetes Education THE ESSENTIALS

5-22 | CHAPTER 5

ALCOHOL

The same precautions regarding alcohol use that apply to the general population also apply to patients with diabetes. Abstention from alcohol should be advised for women during pregnancy and for people with medical problems, such as pancreatitis, advanced neuropathy, hypertrig lyceridemia or alcohol abuse. Alcohol consumption should be limited to ≤2 standard drinks per day and <10 drinks per week for women and ≤3 standard drinks per day or <15 drinks per week for men (35). See Table 5 for examples of standard alcoholic drinks.

Table 5. Examples of standard alcoholic drinks (10 g alcohol)

Drink

Ethanol content (%)

Quantity (mL)

Beer

5

341 (12 oz.)

Table wine

12

142 (5 oz.)

Spirits

40

43 (1.5 oz.)

Fortified wine (e.g. sherry, port)

18

85 (3 oz.)

Adapted from Diabetes Canada 2018 Clinical Practice Guidelines (35)

The effect of alcohol on BG levels depends on both the amount of alcohol consumed and the relationship to food intake, as well as whether use is chronic and excessive. Moderate amounts of alcohol (6-18 g/d) is associated with a 25-66% lower risk of total and fatal coronary heart disease in persons with type 2 diabetes (87) and does not cause acute hyperglycemia or hypoglycemia when consumed with food (88). Chronic heavy alcohol intake (>21 standard drinks/week for men and >14 standard drinks/week for women) is associated with increased risk of CVD, microvascular complications and all-cause mortality in people with type 2 diabetes (89), while light-to-moderate intake shows an inverse association with A1C (90). Although alcohol provides energy, it is not metabolized to glucose, and it inhibits gluconeogenesis, so it can cause delayed hypoglycemia in patients who are treated with insulin and/or insulin secretagogues. Some alcoholic beverages contain carbohydrate, but due to the potential for hypoglycemia, it is generally not recommended that people take insulin for the