Does having diabetes mean you can’t enjoy a glass of wine with dinner or a cold beer with friends? Not necessarily. Moderate drinking may even reduce the risk for heart and kidney complications. But drinking too much may lead to serious problems, including dangerously low blood glucose and harmful interactions with your diabetes medication. If you have diabetes and drink alcohol, it’s especially important to do so responsibly. Talk with your doctor about how alcohol fits into your diabetes care plan. Here are four effects of drinking that you may want to discuss. 1. Moderate drinking may have health benefits. A published study in Diabetes Care included more than 11,000 people with type 2 diabetes from 20 countries. All were at least 55 years old and had either heart disease or a heart risk factor in addition to diabetes. When the study began, participants reported how much alcohol they drank during a typical week. During the next five years, those who said they drank alcohol in moderation had a lower risk for heart attacks, strokes, and early death than those who abstained completely. Other studies have shown that moderate drinking is associated with a lower risk for unhealthy cholesterol levels and kidney disease in people with diabetes. The key word here is moderate. That means no more than two drinks per day for men and one drink for women. Heavy drinking can cause a host of health problems, including high blood pressure, liver damage, and several types of cancer. 2. Drinking alcohol can cause hypoglycemia. When you have diabetes, drinking alcohol can sometimes lead to hypoglycemia—abnormally low blood glucose. To help prevent this, don’t drink alcohol on an empty stomach or when your blood glucose isn’t under control. For added safety, your doctor might recommend testing your glucose level before, during and after drinking. 3. Alcohol can interact with many diabetes pills. Mixing alcohol with diabetes pills may increase the risk for harmful side effects: If you take sulfonylureas, which help the pancreas produce more insulin, it’s more likely that alcohol will cause hypoglycemia. Examples of sulfonylureas include chlorpropamide (Diabinese), glipizide (Glucotrol), and glyburide (DiaBeta, Glynase, Micronase). The combo of sulfonylureas and alcohol occasionally causes flushing, nausea, vomiting, headache, rapid heartbeat, or sudden changes in blood pressure. Combining the medication metformin (Glucophage) with alcohol raises the risk of developing lactic acidosis. This rare but very serious side effect may cause weakness, tiredness, dizziness, chills, trouble breathing, muscle pain, stomach problems, and sudden changes in heart rate or rhythm. Be honest with your doctor about how much alcohol you drink, because that might affect which diabetes medication you’re prescribed. This also applies to clinical decisions regarding the newer injectable non-insulin diabetes medications. Discuss the possible side effects. Know what to watch for and how to react if a problem occurs. 4. Drinking may lead to slacking on self-care. Overindulging in alcohol can weaken your resolve to make healthy choices. In a study of more than 3,900 men with diabetes, those who abused alcohol were less likely to follow a meal plan and more likely to smoke than nondrinkers. In other studies of diabetes patients, heavy drinkers were less likely to consistently check their blood glucose, take their diabetes medication, get A1c tests, and exercise. This is one reason heavy drinkers with diabetes often have a lot of trouble controlling their glucose levels. For help with cutting down on drinking, talk with your doctor or visit the Rethinking Drinking website, sponsored by the National Institute on Alcohol Abuse and Alcoholism. Key Takeaways: Moderate drinking may have health benefits for people with diabetes, including lower risk for heart attack and stroke. Drinking alcohol can lead to hypoglycemia—abnormally low blood glucose. Don’t drink on an empty stomach or when your blood glucose isn’t under control. Mixing alcohol with diabetes pills may increase the risk for harmful side effects. Overindulging in alcohol can weaken your resolve to follow your meal plan, take your medication, and make other healthy choices.