Alcohol & Hypoglycemia

Why Drinking Alcohol Can Cause Hypoglycemia

One of the liver’s key roles is steadily releasing glucose into the bloodstream throughout the day, and consuming alcohol can undermine this function. (6) For people taking insulin to reduce blood sugar, this can be significant because the liver isn’t releasing enough glucose to prevent blood sugar levels from becoming too low. As a result, long-term alcohol consumption by people with diabetes, particularly those malnourished, can result in perilously low blood sugar levels.

Severely low blood sugar is especially dangerous while a person is sleeping (also known as nocturnal hypoglycemia). (7) It can easily occur in those who haven’t consumed additional carbohydrates or eaten several hours before bed.

Alcohol consumption might also induce sustained hypoglycemia in people with type 2 diabetes being treated with hypoglycemic drugs with a long half-life. In addition, alcohol can interact with or reduce the effectiveness of many of these medications.

Furthermore, many people with alcohol dependence have liver cirrhosis, meaning this organ cannot react to hypoglycemia by releasing glucose. (8) Alcohol use can also exacerbate diabetes-related complications, such as disruptions in fat metabolism, nerve damage, and eye disease. (9)

What Is Hypoglycemia Unawareness?

People with hypoglycemia unawareness are unable to recognize when their blood sugar is low and address it accordingly. This can lead to a substantially higher risk of experiencing severely low, dangerous blood glucose levels and effects such as cardiac arrhythmia, myocardial infarction, and brain damage. Hypoglycemia unawareness is more common among people with long-standing diabetes or who have frequent episodes of low blood sugar, as they may be less likely to recognize its early warning signs. (10)

Critically, alcohol use can contribute to unawareness of low blood sugar due to intoxication and also because some of alcohol’s effects are similar to those of hypoglycemia.

Other Factors That Contribute to Hypoglycemia

Mildly low blood sugar is common for individuals with type 1 diabetes and averages about two episodes per week. (11) It occurs less often in those with type 2 diabetes who inject insulin or take specific medications. The following factors are also involved in the development of hypoglycemia:

Incorrect Insulin Use

Having too much insulin is a common cause of low blood sugar. Newer insulins are typically preferred because they’re less likely to cause low glucose than others. In any case, however, inadvertently administering the wrong type of insulin, too much insulin, or injecting it into the muscle instead of right underneath the skin can result in low blood sugar. 

Food Intake

Certain eating and drinking practices can cause low blood glucose, including the following:

• Intaking insufficient carbohydrates.
• Skipping or delaying a meal.
• Consuming foods and drinks with fewer carbohydrates than usual without decreasing the dose of insulin administered.
• Not timing an insulin injection based on whether carbohydrates are coming from solids or liquids can impact sugar levels. Carb-rich liquids like juice will cause blood sugar to increase faster than carb-rich solids such as bread. 
• Consuming meals with a significant amount of protein, fiber, and fat, as this will lead to slow carbohydrate digestion and a longer time for glucose to rise.
• Consuming smaller amounts of food, as these will not cause blood sugar levels to increase as much as large portions. (12)

Exercise

Being physically active has many health benefits, but for those with type 1 diabetes, it can reduce blood sugar short- and long term. The duration, intensity, and timing of activity can influence the risk of blood glucose becoming low. According to the National Institute of Health, nearly half (46%) of studied children who exercised one hour during the day had a low blood sugar reaction overnight. (13)