As a type 1 diabetic who loves a good IPA, I often get asked how alcohol affects blood glucose. The answer I give is not what most would expect.
Alcohol does not equal Carbohydrates
Most people lump alcohol in with carbohydrates. They expect alcohol itself to act as sugar and raise blood glucose. Many alcoholic beverages contain carbohydrates and may raise blood glucose; however, alcohol itself is not a carbohydrate. Yes, alcohol is made from carbohydrates, but the process of fermentation converts sugar into ethyl alcohol and CO2, neither of which is a carbohydrate and therefore neither is metabolized by the body as a carbohydrate.
Alcohol is a completely different nutrient, although use of the word nutrient is controversial. Alcohol provides energy (7 kilocalories/gram); however, it performs no essential functions in the body. Basically we can get energy from it, but we don’t need it to function as we need fat, carbohydrates, and protein.
Takeaway: Your body doesn’t recognize the alcohol in your drink as carbohydrate molecules, so it sends it to a different location and down a different metabolic pathway.
How then is Alcohol broken down?
Alcohol mostly gets broken down in the liver. Our bodies cannot store alcohol in its original form, so it works very hard to rid itself of it and of the toxic intermediate of alcohol metabolism acetaldehyde. There a number of pathways, but the most common involves the two enzymes alcohol dehydrogenase and aldehyde dehydrogenase. Alcohol breakdown takes priority over the breakdown of carbohydrates, protein, and fat. Liver cells detoxify alcohol, and one of the end products acetate may be converted to Acetyl CoA and used primarily to synthesize fatty acids, which are then assembled into fats.
Alcohol and Blood Sugar
The effect of alcohol on blood sugar is complicated.
We’ve learned that alcohol differs from carbohydrates and so does not in itself cause blood glucose to spike. We’ve also mentioned that alcohol breakdown takes priority over the breakdown of other nutrients. Another thing to add is that heavy drinking suppresses gluconeogenesis (GNG), which is the body’s process of synthesizing glucose to maintain blood glucose levels and avoid dangerous hypoglycemia.
This means that people with diabetes should be wary, as it becomes more difficult to raise your blood sugar as you ingest more alcohol. Because your body focuses on breaking down alcohol over other nutrients you are also more likely to become hypoglycemic, if you drink on an empty stomach or post workout.
Hyperglycemia may also be a risk, as many alcoholic drinks are sweetened with juices and simple syrup.
Tips to Safe Drinking for the Type 1 Diabetic
That being said, there are a few ways to drink responsibly as a diabetic, and minimize the risks associated with alcoholic consumption.
- Make sure to check blood sugar before beginning to drink
- Don’t drink on an empty stomach
- Never drink alcohol when your blood sugar is low
- Always carry glucose
- Know what’s in your drink
- Beer and wine are better for blood sugar control
- Drink in moderation
- Don’t drink pre or during workout
What if you’re not Diabetic? Is hypoglycemia still a risk?
Hypoglycemia is still a risk, even if you are not a diabetic. Although it’s extremely rare, people without diabetes can become hypoglycemic if they drink excessively without having eaten for days or if they were to conduct extreme exercise under the influence.
Generally the advice is the same: be smart, be safe, and enjoy that IPA