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Diabetes Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 22, 2024.

Introduction

Alcohol can affect blood sugar levels in patients with diabetes. Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) may occur, depending on how much and how often you drink. Combining alcohol with medications that also lower blood sugar can result in serious interactions due to an additive effect.

Even modest amounts can lower blood sugar significantly and may last for 8 to 12 hours after you drink. Low blood sugar may be worse when the alcohol is ingested on an empty stomach or following exercise. Excessive alcohol use may also lead to weight gain or high blood pressure if you have type 2 diabetes.

Ask your healthcare provider if it's OK for you to drink alcohol. It is important to know how to recognize the symptoms of low blood sugar if you choose to drink. If your diabetes is not well controlled, you should avoid the use of alcohol. Do not drink if you are pregnant, driving or engaging in other hazardous activities, or being treated for alcohol use disorder.

Drinking, may make it more difficult to recognize low blood sugar signals due to the intoxicating effects.

Symptoms of low blood sugar include:

Can I drink if I have diabetes?

If you have type 1 diabetes or type 2 diabetes, have a discussion with your healthcare provider about drinking alcohol and its impact on your health condition. If you decide to drink, do so only in moderation.

Moderate alcohol consumption generally does not affect blood glucose levels if your diabetes is under control. You should not have high triglycerides, neuropathy (nerve damage), or pancreatitis.

Follow these guidelines for moderate alcohol consumption:

Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count, monitor your blood sugar before, during, and after drinking alcohol, and check your blood sugar levels before going to bed.

Do not drink on an empty stomach or after exercising as this may also lower blood sugar levels. Always wear a diabetes medical I.D. tag to help identify your medical condition if needed for emergency personnel.

Drinking more than three drinks daily can lead to higher blood sugar and A1C. Plus, drinking has been linked with increase risk for some types of cancer, pancreatitis, liver disease, gallstone formation, accidents, trauma, and alcohol use disorder, among other conditions.

Alcohol drug interactions with diabetes medications

Drug interactions with some diabetes medications can be serious or life-threatening. Consuming alcohol with some medications can lead to dangerously low blood sugar because the alcohol interferes with the liver’s ability to regulate blood sugar (called hepatic gluconeogenesis). Many type 2 diabetes medications are also available in combination, increasing the risk for multiple drug-alcohol interactions.

Some type 2 diabetes medications can be consumed with alcohol if your doctor agrees and you follow the guidelines for moderate alcohol consumption.

Semaglutide (Ozempic, Wegovy, and Rybelsus) or tirzepatide (Mounjaro and Zepbound)

Moderate alcohol consumption generally does not affect blood sugar levels if your diabetes is under control. But because alcohol use may change your blood sugar levels, you should ask your doctor first  if you can drink while taking these medicines.

The manufacturers do not list a specific contraindication or drug interaction for alcohol use with these medications. But you should avoid drinking alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or pancreatitis.

Your blood sugar levels may go up (hyperglycemia) or down (hypoglycemia), depending upon how much you drink and how often. If you exercise before you drink, or drink on an empty stomach, your risk of low blood sugar may increase. 

Talk to your doctor before using drinking alcohol together with semaglutide or tirzepatide. Limit your alcohol intake to one drink daily for women and two drinks daily for men (one drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits.). To reduce risk of low blood sugar, alcohol should be consumed with food. Do not drink on an empty stomach. 

Blood sugar levels can also be affected by stress, illness, surgery, other medicines or skipping meals. Tell your healthcare provider if you are taking other medicines to treat diabetes, including insulin or sulfonylureas.

Metformin

The mix of alcohol with metformin can increase the risk of a rare but dangerous condition called lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: fatigue, weakness, increasing sleepiness, slow or irregular heart beat, cold feeling (chills or shivering), muscle pain, shortness of breath, stomach area pain.

Insulin

When alcohol is combined with insulin, the glucose lowering effect of insulin may be increased or decreased. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may occur, depending on how much and how often you drink.

Chlorpropamide

A disulfiram-like reaction to alcohol has been reported with the use of chlorpropamide with symptoms such as flushing, headache, and nausea, but rarely with other drugs in the sulfonylurea class (for example, glipizide, glimepiride, glyburide).

List of diabetes drug classes:

Review: Drug Interactions with alcohol (ethanol)

Common Diabetes Medications

Generic Name Common Brand Names
canagliflozin Invokana
dapagliflozin Farxiga
dulaglutide Trulicity
empagliflozin Jardiance
ertugliflozin Steglatro
exenatide Byetta, Bydureon
glimepiride Amaryl
glipizide Glucotrol, Glucotrol XL
glyburide Diabeta, Glynase
insulin analogs Lantus, Humalog, Novolog, Levemir, Tresiba, Toujeo, Basaglar
linagliptin Tradjenta
liraglutide Victoza
lixsenatide Adlyxin
metformin, metformin ER Riomet (oral solution)
nateglinide Starlix
pioglitazone Actos
pramlintide Symlin
repaglinide Prandin
saxagliptin Onglyza
semaglutide Rybelsus, Ozempic, Wegovy
sitagliptin Januvia
tirzepatide Mounjaro, Zepbound

Note: View here for combinations agents and other brands

Note: This is not a complete list; always check with your doctor or pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

Types of Drug Interactions With Alcohol

Sources

  1. Alcohol and Diabetes. American Diabetes Association. Accessed Feb. 24, 2022 at https://www.diabetes.org/healthy-living/medication-treatments/alcohol-diabetes
  2. Mukamal K, author. Overview of the risks and benefits of alcohol consumption. Up To Date. Accessed Feb. 24, 2022 at https://www.uptodate.com/contents/overview-of-the-risks-and-benefits-of-alcohol-consumption
  3. Chiasson JL, Garg A, Holzmeister LA, et al; American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2003 Jan;26 Suppl 1:S51-61. doi: 10.2337/diacare.26.2007.s51. PMID: 12502619.
  4. Drug Interaction Checker. Drugs.com. Accessed Jan 22, 2024 at https://www.drugs.com/drug_interactions.html

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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