Alcohol

Alcohol moves very quickly into the blood without being broken down (metabolized) in your stomach. Within five minutes of having a drink, there's enough alcohol in your blood to measure. Thirty to 90 minutes after having a drink, the alcohol in your bloodstream is at its highest level.

The greatest risk to diabetics is the risk of hypoglycemia when drinking alcohol. If you have diabetes and take insulin shots or oral diabetes pills, you risk low blood sugar when you drink alcohol. To protect yourself, never drink on an empty stomach. Plan to have your drink with a meal or after eating a snack.

Normally, when your blood sugar level starts to drop, your liver steps in. It goes to work changing stored carbohydrate into glucose. Then it sends the glucose out into the blood, which helps you avoid or slow down a low blood sugar reaction.

However, alcohol is a toxin, and when alcohol enters your system, this system changes. Your body reacts to alcohol like a poison. The liver wants to clear it from the blood quickly. In fact, the liver won't put out glucose again until it has taken care of the alcohol. If your blood glucose level is falling, you can quickly wind up with very low blood sugar.

This is why drinking as little as 2 ounces of alcohol (about 2 drinks) on an empty stomach can lead to very low blood sugar.

When you mix alcohol and exercise, you increase the risk of going low. This can happen because exercise helps lower your blood sugar levels. Let's say you just played a couple of hard sets of tennis. You have a beer after the match. But in the hours after the game, your body is still working. It is replacing the energy your muscles used up. To do this, it clears glucose from the blood and adds it to the muscles' store. This is why exercise can cause your blood sugar level to go down.

If you take insulin or diabetes pills, they too are working to clear glucose from your blood. Unless you eat or your liver adds glucose to your blood, you could be heading for a low blood sugar level. If you drink a beer, the alcohol will stop your liver from sending out any glucose. Your chances of going low are even greater.

Check with your health care provider to see if it's OK to combine alcohol with your diabetes medications.

Low blood sugar when drinking is less of a risk for those with type 2 diabetes who control their diabetes with meal planning and exercise alone.

• Never drink alcohol on an empty stomach.
• Limit yourself to 1 drink if you're a woman or 2 drinks if you are a man.

Alcohol affects your body's ability to get over a low blood sugar level. If you have low blood sugar, you may need to treat it more than once as time goes by. If you've been drinking, check your blood sugar before you go to sleep. Eat a snack before you retire to avoid a low blood sugar reaction while you sleep.

A warning: glucagon shots don't help severe low blood glucose caused by drinking. Glucagon shots treat very severe low blood glucose reactions caused by too much insulin. Glucagon works by getting your liver to release more glucose into your blood. But alcohol stops this process. You need to be able to treat your reaction with a carbohydrate, such as oral glucose tablets or gels. So you need to avoid letting a low blood glucose level become severe. If you pass out, you will need glucose injected into your bloodstream by a health care professional.

Heavy drinking over time can hurt your liver. It won't be able to make glucose as well. When this happens, your diabetes is harder to control.

Some of the signs of drinking too much, such as confusion or slurred speech, are similar to the effects of a low blood sugar reaction or ketoacidosis (most common in people with type 1 diabetes who have taken too little insulin). You may be asked to take a blood or a breath test for alcohol if you have some of these signs. Don't worry. Diabetes will not affect the results of a test for alcohol, even if you are having a reaction or have a fruity smell to your breath because of high ketone levels. If you are asked to take a test for alcohol and you have a choice, choose a blood test. That way, health care providers can check your levels of glucose and ketones, too.

Some people with diabetes should not drink alcohol. Alcohol can make some diabetic problems worse.

If you have nerve damage from diabetes in your arms or legs, drinking can make it worse. Alcohol is toxic to nerves. Drinking can increase the pain, burning, tingling, numbness, and other symptoms found with nerve damage. Some studies show that even regular light drinking (less than two drinks per week) can bring on nerve damage.

Heavy drinking (3 or more drinks per day) may make diabetic eye disease worse. If you have high blood pressure, you can lower it if you stop drinking alcohol.

Many people with diabetes have high levels of the fat called triglyceride in their blood. If you do, you should not drink alcohol. Alcohol affects how the liver clears fat from the blood. Alcohol also spurs the liver on to make more triglycerides. Even light drinking (two 4-ounce glasses of wine a week) can raise triglyceride levels.

Smoking

Smoking is never recommended, especially not for diabetics. Smoking can aggravate many problems that people with diabetes already face, such as heart and blood vessel disease.

• Diabetes can cause blood flow problems in the legs and feet, which can lead to amputations (loss of limbs). Smoking can decrease your blood flow even more.
• Diabetes can cause sexual impotence in men. Smoking can make it worse.
• Diabetes can cause high levels of LDL or "bad" cholesterol, which can lead to hardened arteries. Smoking also damages blood vessels.
• Heart disease is the major cause of death among people with diabetes. Smoking makes your risk of heart attack even greater.