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[IP] Alcohol consumption and diabetes -- from MedScape

What is the effect of alcohol consumption on blood glucose levels in patients 
with diabetes?



Alcohol consumption in patients with diabetes may cause hypoglycemia, which 
can occur at blood alcohol levels that do not exceed those associated with 
mild intoxication. The risk of hypoglycemia persists for several hours after 
drinking. Turner and colleagues[1] reported that moderate consumption of 
alcohol in the evening may predispose individuals to hypoglycemia the 
following morning. Alcohol may mask the symptoms of hypoglycemia and impair 
the counter-regulatory response to insulin-induced hypoglycemia.[2,3]

The American Diabetes Association (ADA) recommends that patients with 
diabetes follow the same guidelines as the general public with regards to 
limiting their daily alcohol intake to no more than 2 alcoholic beverages for 
men and 1 alcoholic beverage for women (1 alcoholic beverage = 12 oz beer, or 
5 oz wine, or 1.5 oz distilled spirits).[4] 

The main metabolic effect of alcohol is mediated by an inhibition of 
gluconeogenesis. The effect not only depends on the amount of alcohol 
consumed, but also on whether the patient has concurrently taken a meal, as 
food can counteract the alcohol's hypoglycemic effects. The ADA recommends 
that no food should be omitted from the meal plan because of the addition of 
alcohol to the daily intake as this could precipitate hypoglycemia. However, 
it is also recommended that when considering alcohol as part of the total 
daily caloric intake, it is best substituted for fat exchanges or fat 
calories (1 alcoholic beverage = 2 fat exchanges).

The 2001 ADA position statement states that "if [alcohol] is used in 
moderation with food, however, blood glucose levels are not affected by the 
ingestion of alcohol when the diabetes is well controlled,"[4] but adds that 
alcohol consumption should be avoided in pregnancy and by those with a 
history of alcohol abuse. In addition, avoidance or reduction of alcohol 
consumption is advised for those with comorbidities adversely affected by 
alcohol such as pancreatitis, neuropathy, or dyslipidemia 
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