Is It Safe To Mix Metformin and Alcohol?

You’re headed out to dinner with some friends. It’s been a long week and you’re looking forward to kicking back with a few drinks. But wait. You’ve just started this new medication called metformin to help you with your type 2 diabetes. Is it okay to drink alcohol, or should you avoid it? 

In this post, we’ll explore the potentially dangerous consequences of drinking alcohol while taking metformin. We’ll also look at how drinking alcohol isn’t good for diabetes in general, and what we can do to help manage the condition. Let’s get started.

What Is Metformin?

Metformin is used to treat high blood sugar levels that are caused by type 2 diabetes. To understand how it works, it’s helpful to understand what exactly we mean by “blood sugar” — which comes down to two things: insulin and glucose (sugar). 

Insulin is a hormone made by our pancreas that leads glucose into our cells. Glucose is important because it’s our body’s main energy source: we get it from the food we eat, which gives us fuel to function. It also plays a major role in our cognition, allowing us to think clearly and make complex decisions. Without enough glucose, we feel sluggish, irritable, and a bit out of it. 

With type 2 diabetes, our insulin doesn’t work properly, causing blood sugar levels to get too high. This can happen either because our pancreas makes less insulin than our body needs, or because our body stops responding to the insulin it does make. 

Metformin helps lower blood sugar levels by addressing both of these issues. It helps reduce the amount of glucose that our liver releases into our blood, and it helps our body respond to insulin better so that it uses more of the glucose in our blood. It’s used both alone or with other medications to treat type 2 diabetes.

Why Are High Blood Sugar Levels Dangerous?

What’s the big deal with high blood sugar levels, anyway? Controlling high blood sugar levels is vital for a number of reasons. Potential complications of high blood sugar levels from type 2 diabetes are wide-ranging and can be dangerous:

Simply put, high blood sugar levels put us at a significant risk for developing serious or life-threatening conditions.

Metformin and Alcohol Side Effects 

Now that we have a better understanding of what type 2 diabetes is and the risks associated with it, you might be wondering, “Should I skip metformin when drinking alcohol?” How exactly does alcohol interact with metformin? 

Experts generally recommend not mixing alcohol with any type of medicine or medication due to possible side effects, some of which can be life threatening. When it comes to metformin, though, drinking alcohol can be particularly harmful, especially if we’re consuming it regularly and excessively.

More specifically, mixing alcohol with metformin can lead to hypoglycemia and lactic acidosis — both of which can be life-threatening. This is true whether we mix metformin and beer, wine, or liquor. Here’s a closer look at each of these conditions:

Hypoglycemia

Hypoglycemia is dangerously low blood sugar levels. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter. Binge drinking or chronic, heavy alcohol consumption while taking metformin can cause this condition. 

Some symptoms of low blood sugar levels are similar to those we experience when we’ve consumed too much alcohol, such as drowsiness, dizziness, slurred speech, confusion, loss of coordination, fast heart beat, blurry vision, shaking, sweating, and headaches. 

Hypoglycemia is very serious and requires immediate treatment, which usually involves raising our blood sugar level quickly by consuming high-sugar foods or drinks. 

Because alcohol lowers our blood sugar levels, it can be challenging to get our levels back to normal if we’ve been drinking. In extreme cases, hypoglycemia can result in or seizures loss of consciousness.

Lactic Acidosis

Mixing alcohol with metformin can also lead to a condition called lactic acidosis, a buildup of lactic acid in our blood. Lactic acid is a chemical that is naturally produced by our body as it uses energy. When we take metformin, our body produces more lactic acid than usual. 

When we drink alcohol, our body isn’t able to get rid of lactic acid as quickly. Consuming large quantities of alcohol when taking metformin can cause a buildup of lactic acid, which can seriously damage our kidneys, heart, lungs, and blood vessels.

Similar to hypoglycemia, lactic acidosis requires immediate treatment and must be treated in a hospital. If it’s not treated right away, our organs can shut down, which can lead to death. 

Symptoms of lactic acidosis are also similar to those caused by alcohol, including weakness, tiredness, dizziness, lightheadedness, and a fast heart rate. It can also cause unusual muscle pain, trouble breathing, feeling cold, and stomach discomfort, such as a fluttering feeling, nausea, cramping, or sharp pains.

How Alcohol Affects Diabetes

In addition to interacting with metformin, alcohol can also affect our diabetes directly by lowering our blood sugar levels. In fact, it can cause low blood sugar levels for up to 24 hours after our last drink. How?

It all comes down to our liver. This vital organ is responsible for stabilizing glucose levels by storing carbohydrates and releasing them into the bloodstream between meals and overnight. It’s also our body’s detoxification center, breaking down toxins like alcohol so our kidneys can flush them away.

The problem is that our liver isn’t great at multitasking: because alcohol is a toxin, the liver prioritizes breaking down the alcohol and isn’t able to do its other jobs as effectively, including regulating the amount of glucose in our blood. This is why our blood sugar levels can drop while drinking — even when we eat foods high in sugar or carbohydrates.

Our liver can only process about one standard drink — one glass of wine, pint of beer, or cocktail — per hour. So the more alcohol we consume, the longer it takes for our blood sugar levels to get back to normal. 

Tips for Drinking With type 2 Diabetes

Given the potential complications that could arise from mixing alcohol with metformin (or with diabetes), it’s probably best to avoid drinking. However, if those of us who do choose to drink should take these precautions:

• Don’t drink alcohol on an empty stomach
• Don’t drink alcohol when your blood sugar is low
• Eat food before or after drinking alcohol
• Stay hydrated by drinking plenty of water while drinking alcohol
• Limit yourself to one to two drinks

Furthermore, perhaps you’ve heard about certain vodka for diabetics. While vodka is one of the safer alcohols for diabetes (since it has no added sugars), it’s also a pure concentrated alcohol, so drinking too much of it can have a blood sugar lowering effect. 

Keep in mind that it’s always important to check your blood sugar levels before you drink, while you drink, before you go to bed, and 24 hours after you drink. If your blood sugar levels are dangerously slow, seek medical attention right away. 

Tips for Managing type 2 Diabetes

While it’s important to take the right medications for managing blood sugar levels, we can also help manage the condition through certain lifestyle changes. Here are some of the most important:

• Eat healthy. There’s no specific “diabetes diet.” However, if we have type 2 diabetes, experts typically recommend focusing on whole, minimally processed foods, high-fiber foods, such as fruits, non-starchy vegetables, complex carbohydrates in moderation, lean protein, and healthy fats. When cooking, we should try to use healthy cooking oils such as olive oil or canola oil instead of butter. We should also try to limit added sugars and refined grains. 


  
  We can always contact a health care provider to recommend a dietician to help us identify healthy food choices, plan well-balanced, nutritional meals, and monitor carbohydrate intake to keep our blood sugar levels more stable. 
• Get moving. Exercise is good for helping lose or maintain a healthy weight, and it also helps with managing blood sugar. We should aim for 30 minutes or more of moderate aerobic exercise on most days of the week, or at least 150 minutes a week. Try to choose something you enjoy, even if it’s just walking. 


  
  It’s also important to incorporate resistance training into our routine, as it increases our strength, balance, and ability to perform daily activities. Resistance exercise includes things like weightlifting, yoga, and calisthenics. We should aim for 2-3 sessions of resistance training each week. 


  
  It’s important to move throughout the day. Breaking up long periods of inactivity, such as sitting at the computer, can help control blood sugar levels. Try to take a few minutes to stand, walk around, or do some light activity every 30 minutes. 
• Lose weight. With type 2 diabetes, it’s important to either lose excess weight or maintain a healthy weight. Weight loss results in better control of blood sugar levels, cholesterol, triglycerides, and blood pressure. If we’re overweight, we may begin to see improvements in these factors after losing as little as 5% of our body weight. But the more weight we lose, the greater the health benefits. A healthy diet and regular exercise can help with weight loss. 
• Manage stress. Stress can make managing our blood sugar levels more difficult. While exercise can be a great stress reliever, stress management techniques also help. This might include guided meditations, mindfulness, progressive muscle relaxation, or deep breathing exercises. Getting at least 7-8 hours of quality sleep each night is also important for stress management. 
• Monitor your blood sugar. This might seem obvious, but it’s important not to overlook it. We should consult our health care provider to determine how frequently we should check our blood sugar level to make sure we’re within our target range. For instance, we might need to check it once a day or a couple times a day. Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood. Be sure to keep a record of measurements to share with your doctor.
• Stay hydrated. Finally, choose water over sugary drinks such as sodas, juices, sports drinks, and sweetened coffees and teas. Experts recommend drinking at least six 8-oz glasses of water each day, but we should consume more than that if we’re physically active. 

The Bottom Line

Type 2 diabetes is a serious condition that can cause dangerously high blood sugar levels. Metformin is often prescribed to help lower and manage blood sugar levels in people with type 2 diabetes. While consuming a small amount of alcohol every now and again while taking metformin may not be harmful, chronic, heavy drinking can put us at risk for developing hypoglycemia and lactic acidosis — both of which can be life-threatening.

If you want to get your health on track, consider trying Reframe. We’re a neuroscience-backed app that has helped millions of people cut back on their alcohol consumption and develop healthier lifestyle habits.