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Submitted by PatientsEngage on 21 December 2018

This is a common question for people with diabetes. Dietitian Gerard Wong shares his inputs on whether persons with diabetes should have wine or alcohol and what to watch out for if they are on metformin or insulin. 

Can red wine have adverse effects on persons with type 2 diabetes on metformin medication?

Metformin is an oral anti-diabetic drug used to treat high blood sugar levels caused by type 2 diabetes. Let’s see how metformin works. It enhances the available insulin in your body and also decreases the amount of glucose the liver puts out in the morning. It does not increase insulin production. Therefore the risk of a hypo-event (hypoglycaemia or low blood glucose) with metformin is low. This risk is, however, greatly increased with other medications such as glicazide (also known as sulphonylurea) and insulin.

You are at much greater risk of these effect if you frequently drink a lot of alcohol or you binge drink (drink a lot in short periods). These effects include an extremely low blood sugar level, called hypoglycaemia

The occurrence of lactic acidosis for someone with no pre-existing conditions such as kidney problems, drinking 1-2 standard drinks is extremely rare. Lactic acidosis is when lactic acid accumulates in the bloodstream and results in major metabolic dysregulation.

Lactic acidosis

Lactic acidosis is rare, but it is a serious side effect. It’s caused by a buildup of lactic acid in your blood. This buildup can cause damage to your kidneys, lungs, heart, and blood vessels. If lactic acidosis is not treated right away, it can cause these organs to shut down. If you notice any of the following symptoms of lactic acidosis, see your doctor right away:

  • weakness/tiredness
  • dizziness/ lightheadedness
  • sudden and severe pain in muscles that don’t usually cramp
  • trouble breathing
  • stomach discomfort, such as nausea, a fluttering feeling, sharp pains,, cramping
  • feeling cold

It is important to note that

  • 1 standard serve of red wine is 100ml (so a bottle has 7-8 standard drinks).
  • 1 standard drink of spirit (vodka, rum, gin) is 30ml

If someone does not drink I do not advocate that they start. However, given a patient with type 1 diabetes, going out to celebrate their 21st birthday, their chances of a hypo are much greater. I am not going to turn them away by telling them all the bad effects of drinking and not to drink. Chances are they are still going to drink anyway. But, at least, I can help them by working out strategies to decrease mishaps from happening.

  • Don’t drink alcohol on an empty stomach.
  • Don’t drink alcohol when your blood sugar is low.
  • Don’t binge drink or drink more than 1-2 servings
  • Eat food before or after drinking alcohol.
  • Stay hydrated by drinking plenty of water while drinking alcohol

Related Reading: High Blood Pressure Tips

In addition, I might find out –

  • How much carbs they will have with dinner?
  • Is there exercise going to be involved (such as dancing)?
  • How much alcohol is involved?
  • Setting some boundaries.
  • Looking at a reduction in their short acting insulin and/or long acting insulin pre-bed.
  • Checking their BGLs (blood glucose level), etc.

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The interaction of alcohol is greatest with sedatives and painkillers but, generally, with most medicine. You can have your usual medication- diabetes, cholesterol, blood pressure as prescribed, with the meal and have a glass or 2 of red wine or the equivalent without mishap.

But as we always add, each person is different so discuss your particular situation with your doctor who should know you best medically.

(Gerard Wong graduated from Flinders University, South Australia with a Bachelor’s degree in Nutrition and Dietetics and obtained further certificates and specialization in renal and sports nutrition. He plays a key role in helping patients with type 1, type 2 and gestational diabetes and kidney failure, and guiding them and their families understand the dietary strategies needed to get the best outcome.)

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