American Diabetes Association Guide to Nutrition Therapy for Diabetes. Marion J. Franz

should be omitted. If consumed on a regular basis, calories from alcoholic beverages may need to be considered. Although regular beer does contain carbohydrate, because of the risk of hypoglycemia (likely due to reduced gluconeogenesis by alcohol), it is prudent that individuals not count the carbohydrate from alcohol when determining insulin boluses. Light beer may be a better choice. In addition, individuals with diabetes may not realize that wine and distilled spirits contain negligible amounts of carbohydrate.

      For people using insulin or insulin secretagogues, alcohol should be consumed with food to prevent hypoglycemia. Evening consumption of alcohol by insulin users may increase the risk of nocturnal and fasting hypoglycemia. Hypoglycemia during the morning after consuming alcohol the evening before can be avoided by awakening at the usual time, eating a usual breakfast, and frequently testing blood glucose levels.

      Drinking excessive amounts of alcohol and/or “binge” drinking can increase risk for lactic acidosis, which can be fatal. Although lactic acidosis associated with metformin is rare, patients who routinely drink more than moderate amounts of alcohol or with a history of binges of alcohol intake may not be good candidates for metformin therapy.

      For all people with diabetes, meals and snacks should be eaten on time and selected with usual care. Alcohol can have a relaxing effect and may dull judgment. The decision to drink or not drink alcoholic beverages must be made by the individual with diabetes. Individuals should be educated about the effects of alcohol on metabolic parameters and health if they are to make the best decision for their health and well-being.

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