From the Guidelines
Alcohol causes hypoglycemia primarily by interfering with the liver's ability to produce glucose when blood sugar levels fall, and individuals with diabetes should limit their daily intake to one drink for adult women and two drinks for adult men, while being aware of the risks of delayed hypoglycemia, especially when using insulin or insulin secretagogues 1. When you drink alcohol, your liver prioritizes metabolizing the alcohol over its normal function of releasing glucose into the bloodstream. This is particularly dangerous during fasting states or when someone hasn't eaten, as the liver normally releases stored glucose to maintain blood sugar levels. Some key points to consider:
- Alcohol inhibits gluconeogenesis, the process by which the liver creates new glucose from non-carbohydrate sources.
- For people taking insulin or certain diabetes medications, alcohol can enhance their blood-sugar-lowering effects, creating a dangerous situation where glucose levels drop too low.
- The risk is highest when alcohol is consumed on an empty stomach or in large amounts.
- To prevent alcohol-induced hypoglycemia, always eat carbohydrate-containing food when drinking, limit alcohol consumption, monitor blood glucose levels if diabetic, and be aware that symptoms of hypoglycemia can be mistaken for intoxication, potentially delaying life-saving treatment. It is essential to educate people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, and to emphasize the importance of glucose monitoring after drinking alcoholic beverages to reduce hypoglycemia risk 1.
From the Research
Mechanism of Ethanol-Induced Hypoglycemia
- Ethanol inhibits gluconeogenesis, which is the process by which the liver produces glucose from non-carbohydrate sources 2, 3, 4.
- Ethanol also inhibits glycogenolysis, which is the breakdown of glycogen to glucose 2.
- The inhibition of gluconeogenesis and glycogenolysis can lead to a decrease in blood glucose levels, especially in individuals with depleted glycogen stores or those taking sulphonylurea 2.
- Ethanol can also impair hypoglycemia awareness, making it more difficult for individuals to recognize the symptoms of low blood sugar 4.
Effects of Ethanol on Glucose Metabolism
- Ethanol can stimulate glucagon secretion, which can help to increase blood glucose levels 3.
- However, in individuals with insulin-dependent diabetes, ethanol can lead to an increased risk of hypoglycemia due to its inhibitory effects on gluconeogenesis and glycogenolysis 5, 6.
- Moderate ethanol consumption may improve insulin sensitivity, which can help to reduce the risk of hypoglycemia 2.