Interactions and Side Effects of Alcohol and Metformin

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Metformin (brand name Glucophage) is a prescription medication that helps control blood sugar levels for people with type 2 diabetes. Those taking metformin are strongly advised to avoid excessive alcohol use, as heavy drinking on metformin can lead to a potentially lethal condition called lactic acidosis.

If you’ve been unable to control your drinking and are taking metformin or another drug that adversely interacts with alcohol, please contact Guardian Recovery and find out how we can help.

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Can You Consume Alcohol With Metformin?

Drinking alcohol while using metformin is not recommended, even in moderation. This is because even with safeguards, it is hard to predict how alcohol will impact blood sugar. People with type II diabetes are strongly advised to avoid drinking altogether, as even short-term light or moderate drinking can destabilize blood sugar

Metformin increases insulin sensitivity, which in turn lowers blood sugar released from the liver. Alcohol is also notorious for its adverse effects on the liver, and using metformin with alcohol can compound its impact. Liver insufficiency or damage progresses over time for alcohol users, which can be exacerbated by metformin use, increasing the risk of liver disease and cancer. 

Side Effects of Alcohol and Metformin

Drinking alcohol can worsen the side effects of other medications, such as metformin.

Side Effects of Metformin and Alcohol Can Include:

  • Stomach pain and discomfort
  • Chest pain
  • Muscle pain
  • Indigestion and heartburn
  • Bloating and gassiness
  • Appetite loss
  • Diarrhea

Risks of Combining Metformin and Alcohol

Combining alcohol and metformin can lead to potentially dangerous health effects. For example, people with diabetes who drink while using metformin are at an increased risk for several serious conditions, including the following: 

Lactic Acidosis

Lactic acidosis is one of the most dangerous conditions that can occur for a person with diabetes who drinks excessively. Lactic acidosis happens when a person’s blood pH decreases due to an accumulation of lactic acid and becomes overly acidic. 

Metformin increases the risk of developing this condition even when taken alone. Still, it’s even more likely for those who drink alcohol. As a result, the Food and Drug Administration (FDA) requires a black box warning on all metformin packaging that alerts users about its potential to cause lactic acidosis. If you or your loved one is experiencing the following symptoms after taking metformin, call 911 immediately.

Lactic Acidosis Symptoms Include:

  • Fast, shallow breathing
  • Severe stomach cramps
  • Muscle weakness
  • Extreme fatigue
  • Nausea and vomiting
  • Low blood pressure
  • Seizures
  • Muscle spasms
  • Fast or irregular heartbeat

Hypoglycemia

Hypoglycemia can occur when taking metformin, and alcohol has a similar effect. As noted, metformin is prescribed to lower blood sugar. And although alcohol can raise blood sugar temporarily, it will drastically reduce it long-term. Therefore, using metformin even as prescribed while consuming alcohol can lead to extremely low blood sugar. 

Individuals experiencing hypoglycemia can become so disoriented they cannot seek help themselves. For this reason, if you notice any of the following signs and symptoms in yourself or a loved one, seek medical help immediately.

Symptoms of Hypoglycemia Include:

  • Muscle weakness
  • Sadness
  • Anxiety
  • Dizziness
  • Extreme fatigue
  • Sleep disturbances
  • Headache
  • Pale skin
  • Rapid heartbeat
  • Confusion and disorientation
  • Slowed, shaky movement
  • Slurred speech
  • Blurry vision
  • Cold sweats
  • Poor concentration

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Side Effects of Alcohol Use & Vertigo

Alcohol use can directly cause vertigo due to dehydration and its effect on inner ear fluid balances. Or, if you have a damaged auditory cortex from chronic alcoholism or another underlying condition, you can make these problems worse by continuing to drink. 

Moreover, side effects caused by vertigo or alcohol independently may be amplified when occurring together.

Side Effects of Alcohol and Vertigo Include:

  • Impaired coordination and balance
  • Dizziness
  • Feelings of tilting, swaying or shifting
  • Feelings of motion sickness
  • Nausea and vomiting
  • Impaired hearing
  • Lethargy
  • Reduced inhibitions and impulsivity
  • Memory loss
  • Slurred or slowed speech

Severe Effects of Alcohol Intoxication Include:

  • Cyanosis (pale or bluish skin, fingers, and toes)
  • Profound confusion
  • Slowed, labored, or stopped breathing
  • Seizures
  • Continuous vomiting
  • Stupor or lack of responsiveness
  • Unconsciousness or coma

Vitamin B12 Deficiency

Taking metformin can also cause vitamin B12 deficiency, which can be a medical emergency in extreme cases. Contact your doctor or call 911 if you experience the following.

Symptoms of Vitamin B12 Deficiency Include:

  • Extreme fatigue
  • Muscle weakness
  • Painful, red tongue
  • Mouth ulcers
  • Vision problems
  • Pins and needles feelings
  • Pale or yellow skin, or changes in skin color
  • Yellow eyes

In most instances, your doctor can check your vitamin B12 serum levels and prescribe supplements if they are too low.

Is It Possible to Manage Diabetes While Drinking Alcohol?

It is not possible to manage diabetes when consuming alcohol in excess. Most alcoholic drinks are full of carbohydrates, which convert to sugar in the body. Binge drinking or heavy drinking over a prolonged period will adversely affect blood sugar and contribute to other conditions associated with diabetes, such as high blood pressure and weight gain.

Overall, alcoholic drinks are high in calories which quickly add up. As a result, drinking alcohol can make it more challenging to lose weight or maintain your current weight. It also hinders your body from burning fat, contributing to weight gain. Alcohol also lowers inhibitions, and it’s not uncommon to be drawn to fatty, high-calories foods while drinking.

Alcohol consumption can also potentially worsen other diabetes-related medical complications, such as fat metabolism disturbances, nerve damage, and eye disease.

According to the Centers for Disease Control and Prevention (CDC), excessive drinking is defined as:

Binge drinking, or having at least 4 or 5 standard drinks in one sitting (2-3 hours) for women and men, respectively.

Heavy drinking, or having eight standard drinks per week for women and 15 for men.

Standard Drinks Are Described As:

  • 12 oz of 5% ABV beer or hard seltzer
  • 8 oz of 7% ABV malt liquor
  • 5 oz of 12% ABV wine
  • 1.5 oz of 40% ABV liquor 

Keeping all of this in mind, those who choose to drink alcohol should do so in mild-moderate amounts and consider the following:

Avoid Drinks High in Sugar

Some alcoholic beverages have as much added sugar as some desserts. Avoid mixing alcohol with soft drinks, punches, and sweet liqueurs like Kahlua, Irish cream, or Schnapps.

Have Fast Access to a Continuous Glucose Monitor (CGM) and Diabetic Supplies 

If you aren’t going to be at home while drinking, bring a CGM if you have one, and if not, a glucose test kit. Have enough supplies at the ready to test frequently, such as strips, lancets, emergency glucagon, etc. and do the following:

  1. Ensure your electronic supplies are working correctly and aren’t low on power.
  2. If you use an insulin pump, fill it with insulin.
  3. If you have a CGM and need to change the sensor, do so in advance.

Avoid Drinking on an Empty Stomach

Eat an appropriate amount of food before drinking, and keep track of your carb count. According to the Cleveland Clinic, “Too much alcohol can block production and release of glucose from the liver, causing your blood sugar levels to drop.

Avoid Exercise After Drinking

The Cleveland Clinic also advises, “Don’t drink immediately before, during, or after exercise.” This includes dancing. Physical activity can lower blood sugar, and if the liver cannot adequately maintain glucose production, you may be at an increased risk of hypoglycemia. 

Know Your Limit

Above all, avoid drinking to excess. And before you start, make sure your glucose level is in range. Your healthcare provider can advise you on how much alcohol is safe to drink. Depending on your health status, that may mean no alcohol at all. Or in some cases, people with diabetes may be able to have 1-2 alcoholic beverages a day, but no more than that.

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If you have diabetes and are struggling with alcohol addiction, you are urged to seek professional help as soon as possible. At Guardian Recovery, our integrated residential, partial hospitalization, and intensive outpatient treatment programs provide those we treat with the support and tools they need to reclaim the addiction-free lives they deserve. 

Please contact us today for a free, no-obligation health insurance benefits check and to learn more about how we can help.

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

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Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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