A diabetes diagnosis isn’t a sentence to a life free of fun. People with diabetes can travel the world, climb the corporate ladder, show off their outfits on the ’gram, and be the life of the party.
But don’t break out the red Solo cups just yet. It’s important to consider how alcohol can affect diabetes management.
Metformin is the most commonly prescribed drug to treat type 2 diabetes. It helps regulate and manage blood sugar levels and may even extend your life.
However, combining metformin with binge drinking can cancel out the drug’s benefits and cause harmful side effects.
The National Institute on Alcohol Abuse and Alcoholism says binge drinking is a pattern of drinking that brings a person’s blood alcohol concentration to 0.08 grams percent or higher.
That’s about five drinks for men or four drinks for women within about 2 hours.
Long-term alcohol use while taking metformin can cause life-threatening issues related to diabetes and potentially permanent liver damage.
Your doctor should explain metformin’s possible side effects and interactions, including those with alcohol.
Unlike people with type 1 diabetes, people with type 2 can still produce insulin. But they may have difficulty doing so. Their cells also may not respond to insulin as well as they used to — this is called low insulin sensitivity.
Insulin allows your body to either use glucose as energy or store it for later use. This function keeps your blood sugar balanced.
Doctors often prescribe drugs like metformin to boost insulin sensitivity. Metformin works by reducing the glucose production in your liver while improving how glucose moves through your body.
Adding a lot of alcohol to the mix complicates things — it tinkers with your liver’s glucose production, possibly leading to very low blood sugar. Low blood sugar increases the risk of life-threatening conditions like lactic acidosis (more on that in a sec).
Your liver has its limits
When you’re binge drinking, your liver works to remove toxins from your body instead of producing and regulating glucose. This tires out your liver, reducing its ability to produce and circulate enough glucose.
Plus, excessive alcohol prevents your cells from absorbing glucose properly, so glucose levels in your bloodstream start to increase, putting stress on your organs and nerves.
Whether or not you have diabetes, long-term alcohol consumption can damage your liver, leading to dangerous complications like hepatitis and liver cirrhosis.
A cocktail from time to time may be no big deal, but the long-term combination of binge drinking and taking metformin could be potentially life-threatening. Here’s why.
Hypoglycemia: How low can you go?
Both metformin and excessive alcohol consumption lower your blood sugar, but they don’t work together. When combined, they overwork your system and cause more harm than good.
Hypoglycemia (insulin shock) happens when blood glucose reaches an unstable low — less than 70 milligrams per deciliter for most people. Those who use insulin to regulate their blood sugar know this is when they need to hold or decrease their insulin dosage.
While alcohol and metformin may be a recipe for hypoglycemia, it’s not the worst combination. Research shows that sulfonylureas, another type of diabetes medication, carry 4.5 times the risk for hypoglycemia that metformin does.
No matter how it happens, hypoglycemia is nothing to mess with. If you become hypoglycemic while drinking, it may be hard to distinguish the symptoms from your usual buzz.
The effects of low blood sugar can feel a lot like being tipsy
Some of these symptoms include:
- blurred vision
- slurred speech
Friends don’t let friends have low blood sugar
Hypoglycemia is treatable, so teach your friends (particularly your designated driver) how to recognize the symptoms. If they notice any symptoms, they should take the glass out of your hand and replace it with some food that will raise your blood sugar.
Although it’s not the trendiest accessory, bust out your blood glucose monitor to confirm your blood sugar reading.
Having glucose tablets on you is another good idea, but in a pinch, hard candy, regular soda, juice, or a tablespoon of honey or sugar can do the trick.
Check your blood sugar 15 minutes later. If you lose consciousness, someone should call 911.
If you’ve had severe hypoglycemia before and you’re on metformin, your doctor may suggest you carry a glucagon hypoglycemia rescue kit, which contains a syringe to inject glucagon. This quick-acting agent helps your liver make more glucose within 15 minutes.
Glucagon is also available as a nasal spray. Ask your doctor whether glucagon is necessary for you and which product is best.
Don’t mess with supercalifragilistic-lactic acidosis
Though it’s much more rare than hypoglycemia, lactic acidosis can happen if you drink alcohol while taking metformin.
Metformin increases your body’s natural production of lactic acid, and alcohol consumption makes it difficult for your body to dispose of it. The buildup of lactic acid can cause serious complications in your heart, lungs, kidneys, and blood vessels.
Lactic acidosis requires treatment in a hospital. If left untreated, it can be life-threatening.
If you spot the following symptoms, call 911:
- cramping in muscles that don’t typically cramp up
- difficulty breathing
- rapid heart rate
- sharp pains, nausea, or other stomach discomfort
- feeling chilly
What’s B-12 got to do with it?
Vitamin B-12 is a nutrient your body absorbs from food. Clams and beef liver have the highest concentrations of it, but if those aren’t on the menu, you can also get B-12 from fish, meat, poultry, milk, and eggs.
Most people get all the B-12 they need from food, but those who take metformin are at a greater risk of B-12 deficiency.
One study found that over the course of 4 years, metformin reduced people’s B-12 levels by 19 percent. Other studies have found reductions of up to 52 percent.
A B-12 deficiency can cause tiredness, weakness, or a loss of appetite. If left untreated, it can lead to nervous system damage.
When you have diabetes, it’s important to consume alcohol only in moderation.
What is “moderate” drinking?
For women, moderation is defined as no more than one drink per day. For men, it’s no more than two drinks per day.
It’s important to monitor your glucose levels before you drink, while you drink, before bed, and 24 hours later.
Alcohol can lower your blood sugar level for up to 24 hours after your first drink. Low blood sugar can make you feel lethargic, so don’t plan on doing anything other than Netflix and chilling after a night of drinking.
Metformin takes some getting used to — particularly its effect on your gut.
Many of the side effects are similar to those of binge drinking. When you mix the two, prepare for those symptoms to worsen.
The more alcohol you drink and the faster you drink, the more these symptoms will intensify:
- excess gas
- loss of appetite
- muscle cramping
- stomach discomfort
In rare cases, increased blood flow may cause facial redness and flushing.
You can drink alcohol while taking metformin, but there are side effects. Metformin and alcohol can both lower your blood sugar, putting you at risk for hypoglycemia and life-threatening lactic acidosis.
If your blood sugar levels are very unstable, it’s probably best to hold off on drinking until you get them under control.
Be sure to talk to your doctor about the risks and interactions of any medications you’re taking. While you’re at it, have your B-12 levels checked, since both metformin and alcohol reduce them.