Drinking alcohol is a fact of life for many people in the United States. According to the 2022 National Survey on Drug Use and Health, almost 63 percent of Americans age 12 and older reported drinking alcohol in the past year, and 5 percent reported heavy alcohol use in the past month. For people with type 1 diabetes, and parents of teens with the condition, it's important to understand the impact of alcohol consumption on health.

For people with type 1 diabetes, drinking can significantly affect blood sugar levels and overall health, raising the risk of life-threatening complications.

Here are some risks of alcohol to consider. If you have a teenager with type 1 diabetes, you might want to share this information with them.

1. Alcohol Can Directly Lower Blood Sugar

Alcohol can interfere with the liver’s ability to release sugar (glucose) into the bloodstream. The liver, a large organ on the right side of your abdomen, is not great at doing two things at once. It’s responsible for clearing alcohol from your body, as well as maintaining your blood glucose. When it has to do both at the same time, it may neglect your blood sugar levels, lowering the amount of glucose in your blood.

A drop in blood sugar levels is called hypoglycemia. Hypoglycemia is a serious complication of type 1 diabetes.

2. Alcohol Can Cover Up Hypoglycemia Symptoms

Not only can alcohol cause hypoglycemia, but it can mask the symptoms of hypoglycemia. Symptoms include:

• Looking pale
• Feeling shaky, irritable, and anxious
• Sweating
• Having a headache, hunger, or nausea
• Having an irregular or fast heartbeat
• Being unable to concentrate
• Feeling dizzy or lightheaded

If these symptoms sound similar to drunkenness, that’s because they are. Many of these symptoms also mimic the effects of alcohol poisoning, including slurred speech, vomiting, confusion, pale skin, and trouble staying conscious.

Even light alcohol use can cover up the symptoms of hypoglycemia, or at least make you less likely to act on them. When you don’t treat hypoglycemia quickly, you’re at risk for more severe symptoms, including seizures, loss of consciousness, and even death if left untreated long enough.

3. Being Under the Influence Makes It Harder To Respond to Hypoglycemia

Alcohol consumption, especially binge drinking, makes it difficult to manage blood sugar levels effectively. There are a few reasons for this. The carbohydrates in certain beverages, such as a cocktail with a sweet mixer or glass of sweet wine, are nearly impossible to count at a bar or restaurant due to different pours and serving sizes. These drinks can initially raise blood sugar, but then later significantly lower your blood sugar. It can be complicated to take the correct dose of your short-acting insulin when drinking alcohol.

Other alcoholic drinks are carbohydrate-free, and drinking them on an empty stomach may quickly drop your blood sugar level. This can make insulin dosing and monitoring very challenging during an evening out.

Being under the influence might also impair your awareness of how you’re feeling and whether you need to take any medication. When your ability to respond to low blood sugar is compromised due to drinking, type 1 diabetes symptoms may become dangerous.

4. Alcohol Increases the Risk of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes, characterized by high blood sugar levels and ketones in the blood. Although alcohol may not directly cause DKA, excessive drinking can lead to problems with the intake of medications and thus increase the blood sugar level. Drinking multiple sugary alcoholic beverages without properly adjusting your insulin can raise your risk of DKA.

Symptoms of DKA to look out for include:

• Fast, deep breathing
• Flushed face
• Fruity-smelling breath and urine
• Headache
• Muscle aches
• Nausea and vomiting
• Fatigue
• Dry skin and mouth

DKA is a medical emergency. If you or someone you know with type 1 diabetes shows these symptoms, regardless of whether they’ve been drinking alcohol, go to an emergency room right away.

5. Alcohol Interacts With Some Diabetes Medications

Certain medications to treat diabetes are affected by alcohol use. For example, insulin mixed with alcohol may result in low blood glucose. One small glass of wine with a meal probably won’t lead to hypoglycemia, but this risk is especially present when drinking excessively or on an empty stomach. It's important to consult your doctor to understand how alcohol may affect your diabetes medications and any other medications you’re taking.

Guidelines for Safe Alcohol Consumption

If these side effects sound scary, that’s because they can be. But this isn’t to say that people with diabetes should never drink alcohol. Here are some tips to prevent type 1 diabetes complications while still enjoying the occasional alcoholic beverage.

Monitor Blood Sugar Levels Frequently

Before, during, and after drinking alcohol, monitor your blood sugar levels frequently. Aim to keep your blood sugar in the target range recommended by your endocrinologist. If you have a continuous glucose monitor (CGM), take a glance at your app or device every time you go to the bathroom or if you feel any of the symptoms discussed in this article. Many monitors will alert you if your glucose is dangerously low, so pay attention to those notifications. If you don’t have a CGM, bring a small bag with your diabetes supplies.

Eat Carbohydrate-Rich Foods

Consume food rich in carbs before drinking alcohol to reduce the risk of hypoglycemia. Avoid skipping meals or drinking on an empty stomach. Try to remember to eat a snack before you head out for a night when you know you’ll have alcohol.

Stay Hydrated

Dehydration is another cause of fluctuating blood glucose levels. Drinking a glass of water between every drink is a good way to prevent diabetes complications, and maybe even prevent a hangover the next day.

Make Others Aware

In case of a medical emergency, it’s important that others around you know that you have type 1 diabetes. Some people wear a medical alert ID bracelet or set up an emergency medical ID on their phone. This lets emergency responders know that you have diabetes and allows them to respond accordingly. If you feel comfortable, share your type 1 diabetes diagnosis with a close friend who you are going out with, so they know to look out for symptoms and what to do if you’re experiencing fluctuations in blood sugar.

Limit Alcohol Intake

The best way to prevent alcohol-related complications of diabetes is to limit the amount of alcohol you drink. Try to avoid getting drunk, as being under the influence can reduce your decision-making skills and ability to take care of yourself. Having just one drink, or a few slow-paced drinks, will limit these risks. If you can enjoy a social gathering without alcohol, even better.

Talk With Others Who Understand

On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 2,600 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Do you drink alcohol while living with type 1 diabetes? What tips do you have for glucose control with type 1 diabetes? Share your experience in the comments below, or start a conversation by posting on your Activities page.