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Diabetes Standards of Care & Clinical Practice Resources

Alcohol and Other Substance Abuse

Substance abuse disorders can complicate the course of diabetes. American Indian/Alaska Native (AI/AN) people have high rates of alcohol and drug abuse disorders which take a significant toll on individuals, their families, and their communities. However, there are many effective treatment and support strategies to help individuals overcome substance abuse.

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Alcohol and Other Substance Abuse Sections

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Clinical Practice Recommendations

Recommendations for Alcohol and Other Substance Use


  • Screen for use of alcohol and other substances periodically. Use motivational interviewing when appropriate.
  • Be alert for behaviors, symptoms, signs, and laboratory test results suggestive of alcohol and drug abuse.

Treatment Considerations

  • Refer patients for behavioral health care and substance abuse treatment as appropriate.
  • Counsel patients on the proper prevention and treatment of hypoglycemia. Medications and doses may require adjustment due to safety risks in the setting of ongoing alcohol or substance abuse.
  • Advise abstinence from alcohol for women planning a pregnancy and during pregnancy.
  • Advise abstinence for people with medical problems such as:
    • liver disease
    • pancreatitis
    • advanced neuropathy
    • severe hypertriglyceridemia
    • known substance abuse
    • known alcohol addiction
  • For patients unwilling or unable to limit/abstain from alcohol or substance use, adjust medication choices and dosing schedules to minimize patient safety risks.
  • For those who choose to use alcohol, recommend:
    • Monitoring glucose levels before and after alcohol consumption, as well as bedtime
    • Avoid drinking alcohol on an empty stomach or when glucose levels are low
    • Avoid skipping meals
    • Advising patient and their family (if possible) on the proper identification and treatment of hypoglycemic events
    • Limiting alcoholic beverages to:
      • 1 serving* per day for adult women, and
      • 2 servings per day for adult men.

*1 serving = 12 oz. beer, 5 oz. glass of wine, or 1.5 oz. distilled spirits [e.g., vodka, whiskey, gin, etc.]

Individuals with alcohol and drug abuse disorders often present with wide fluctuations in their blood glucose in part due to inconsistent lifestyle behaviors as well as the physiological responses to alcohol and drugs.

Alcohol consumption causes a decrease in glucose production from the liver which may result in hypoglycemia. Hypoglycemia can occur shortly after drinking alcohol and can occur for up to 24 hours after ingestion. Patients are at increased risk for hypoglycemia when they consume alcohol on an empty stomach, skip meals, and/or take insulin or any other medications that increase insulin secretion.

Substance abuse with stimulants such as methamphetamine and/or cocaine may increase cortisol levels in the body. Increased cortisol levels inhibit endogenous insulin secretion contributing to hyperglycemia. Poor adherence to prescribed medications may also increase the risks of developing severe hyperglycemia. Stimulants and sedatives can also increase or decrease appetite and diminish awareness of hypoglycemia.