Risks & Safety Tips: Drinking Alcohol with Type 1 Diabetes

Editor's Note: While this article explores the risks and strategies for drinking alcohol safely with diabetes, this is not a substitute for medical advice. Always consult a healthcare professional before making decisions about alcohol consumption.

If you plan on raising a glass this St. Patrick’s Day (or any day), here’s what you need to know about drinking alcohol with type 1 diabetes (T1D), along with five essential tips to keep you safe.

Alcohol and T1D: A Quick Overview

Before we dig into the finer details of T1D, let’s take a broader look at the latest research related to alcohol consumption for the mainstream population, regardless of diabetes.

Alcohol affects blood sugar in unpredictable ways, sometimes leading to delayed and dangerous lows. It also interferes with the liver’s ability to release glucose, making nighttime hypoglycemia especially risky. While people with T1D can still enjoy a drink or two, understanding how alcohol interacts with diabetes is essential for avoiding situations that could put your health in danger.

At the start of 2024, the U.S. Surgeon General proposed adding warning labels to alcohol, much like those on tobacco products, highlighting the links between alcohol and increased cancer risks. Research continues to show that excessive alcohol consumption is a significant contributor to liver disease, heart disease, and multiple cancers — including breast, liver, and esophageal cancer. 

The CDC’s current guidelines recommend that men consume no more than two drinks per day and women no more than one drink per day — limits that can be especially important for those managing T1D.

Adding to the concern is the rise in popularity of high-alcohol, sugar-laden beverages marketed to young adults. Drinks like BuzzBallz, which contain 15% alcohol per serving, and other pre-mixed cocktails can make it easy to drink more than intended, increasing the risk of dangerous blood sugar drops.

At the same time, a cultural shift is happening. 

Mocktail bars are popping up everywhere in Los Angeles and other major cities, offering complex, alcohol-free drinks that provide the social experience without risks. More people — especially younger generations — are choosing alcohol-free options in favor of overall well-being. 

For those with T1D, mocktails can be a great alternative that lets you enjoy a night out without worrying about unpredictable blood sugar swings or the long-term health effects of alcohol.

Some Cautionary Tales of T1D Close Calls

St. Patrick’s Day: Ginger’s Lucky Break

It was a night of green beer, laughter, and music blasting from a too-loud speaker in her boyfriend’s house. The kind of night where you don’t check your watch because the only thing that matters is refilling your cup before it’s empty.

Somewhere between drinks, Ginger had the foresight to take her long-acting insulin dose early — maybe it was instinct or just a small sliver of responsibility shining through the excitement. Hours later, she wasn’t standing anymore. The party buzzed on, but she was curled up on the cold tile of the bathroom floor. Her boyfriend, though clueless about diabetes, at least got her to bed.

The next morning, before the sun had fully risen, she pricked her finger in the dim light. The number flashed: 150 mg/dL. Relief washed over her. She had blacked out. But she had made it through the night safely. That moment stuck with her — not just because of the hangover but because she knew it could’ve ended very differently.

Ginger’s 21st Birthday: The Night That Almost Went Wrong

Turning 21 is supposed to be a night to remember, but for Ginger, it was mostly a blur. She had no idea what her alcohol limit was. So she drank with her friends, assuming she could keep up. She couldn’t. At some point, a friend put her in a cab and sent her home. What she doesn’t remember is whether she checked her blood sugar, whether she had taken her insulin, or whether she was safe.

She woke up at 2 a.m. to the unsettling feeling of nausea rising in her throat. She leaned over and threw up on the floor. No water. No blood sugar check. She just climbed back into bed. Morning came. The cleanup was gross, but what haunted her most was the realization that she had been completely unaware of her diabetes the entire night. She had been lucky again. But luck was not a plan.

Grown-Up Ginger: A Different Kind of Wake-Up Call

At 38, Ginger had long since figured out how to drink responsibly. But vacations have a way of allowing people to let their guard down. She and her partner were in the Bahamas, enjoying the only sunny day of their trip. The swim-up bar was calling, and with the trip coming to an end, she let herself relax a little more than usual.

What Ginger didn’t realize? The resort glasses were huge — easily 1.5 servings of wine each. By the time they made it back to their room, it hit her. Hard. The nausea, the dizziness, the unsettled feeling in her stomach.

Then came the panic.

She had insulin on board from earlier. She felt awful, but what scared her the most was not knowing what her blood sugar was going to do. Would she drop dangerously low in her sleep? Would she wake up at all? Desperate to clear the alcohol from her system, she forced herself to throw up. Then, as a safety measure, she grabbed her emergency glucagon injection.

They say glucagon may not work when alcohol is in your system. She didn’t care — she took it anyway.

It worked. Her blood sugar spiked to 250 mg/dL, but she let it sit there for hours, knowing it was the safest option. This time, she hadn’t just been lucky — she had been prepared.

Travel, Holidays, and the Blood Sugar Rollercoaster

Whether it’s a weekend getaway, a holiday celebration, or an all-inclusive resort vacation, being out of your usual routine can throw off even the most dialed-in diabetes management. The excitement, stress, change in time zones, and shift in daily activity levels can all impact blood sugar levels. 

Add in unfamiliar foods, spontaneous plans, and — if you’re drinking — alcohol’s unpredictable effects. It’s easy to see how things can get tricky fast. Holidays and vacations often come with indulgent meals, late nights, and packed schedules, making it harder to stay on top of blood sugar trends. 

The key is preparation. Pack more diabetes supplies than you think you’ll need, keep emergency snacks or glucose sources on hand, and if you’re planning to drink, make sure you have a plan to check in on your blood sugar. Whether raising a glass at a holiday party or sipping cocktails on the beach, a little planning can go a long way to keep you safe while still having fun.

5 Tips for Drinking with Type 1 Diabetes

Drinking alcohol with T1D doesn’t mean you can’t enjoy a night out — it just means you have to be intentional and prepared. Here are five essential tips that may help you stay safe while drinking:

1. Make sure someone knows you have diabetes.

Friends might know you have T1D, but do they know what to do if something goes wrong? If you black out, have a severe low, or become unresponsive, your friends need to know:

• How to check your blood sugar
• How to give emergency glucagon (yes, even though it’s not guaranteed to work in the presence of alcohol, they should still give it – and call 911!)
• When to call for help

Never assume the people around you will just know what to do. A simple conversation ahead of time could save your life.

2. Plan ahead.

Before heading out, check in with yourself:

‍
✔ Do you have enough insulin in your pump?
✔ Have you taken your long-acting insulin dose?
✔ Is your CGM sensor about to expire?
✔ Any other medications you should take?

The smallest overlooked detail can make all the difference in how your body responds to alcohol.

3. Know your limits.

Alcohol affects everyone differently, and it can hit harder and faster when you have T1D. Even if you think you know your tolerance, be mindful of the following:

• How much you’re drinking. Pacing yourself is key.
• How alcohol affects your blood sugar. Beer, wine, and cocktails can all impact your glucose differently.
• When to stop. If you start feeling off, don’t push your luck.

4. Carry emergency glucagon — always.

Alcohol interferes with the liver’s ability to release glucose, which can make low blood sugars more dangerous and more likely. Even though glucagon may not always work when alcohol is present, it’s still worth trying.

• Keep a glucagon kit or nasal glucagon with you.
• Make sure someone around you knows how to use it.
• Eat food when you drink! Food can help prevent lows in the hours after drinking, when your liver no longer produces as much glucose while filtering the alcohol.

5. Learn how your drinks affect your blood sugar.

Sugary cocktails, beer, and wine all impact blood sugar differently. Some drinks cause an initial spike followed by a later crash, while others may have a delayed effect.

• Test different drinks at home first to see how your body responds. Do you need a small dose of insulin with a glass of wine or no insulin at all? These little details take time.
• Beware: Flavored liquor can contain a lot of sugar without a nutrition panel, and flavored liqueurs contain even more sugar. If you're drinking the sweet stuff, keep an eye on your blood sugar and take insulin thoughtfully!
• If you’re unsure, opt for a drink you’ve had before and already know how to manage.

Enjoy Responsibly, Stay Safe

Drinking with T1D isn’t about avoiding fun — it’s about being mindful. Whether it’s a casual glass of wine or a big night out, preparation, awareness, and moderation make all the difference.

T1D doesn’t mean saying no to experiences — it means learning how to enjoy them safely. Knowing your body, trusting your instincts, and having a plan can turn a risky situation into just another good memory.