Metformin is one of the most popular prescription drugs, with over 92 million active prescriptions in the United States alone (as of 2020).
It is used to help people with prediabetes and type 2 diabetes better manage their blood sugar levels, and helps both manage insulin resistance as well as weight maintenance and loss.
But there are many questions around taking Metformin and incorporating the medication into your daily life, like what you can eat and not eat while taking the drug, and if you can (and should?) drink alcohol while taking the drug.
This article will investigate all you need to know about drinking alcohol while taking Metformin.
What is Metformin?
Metformin is often sold under the brand names Glucophage, Glumetza, Glucophage XR, Riomet, or Fortamet.
Metformin lowers blood sugar levels by stopping the production of glucose from the liver, and also increases insulin sensitivity by prohibiting the body from absorbing all the glucose in foods.
It can be taken once or twice per day, most often with dinner. It is an extremely safe drug that is usually well-tolerated with minimal side effects.
What are the side effects of Metformin?
Most of the side effects people experience while taking Metformin are mild and include:
- Stomach cramps
- Loss of appetite
- Weight loss
- Some patients do gain weight, but this is rare
- Low blood sugar
You can learn more about the potential side effects of Metformin in our guide: Metformin Side Effects: What You Need to Know.
What happens if you drink alcohol while taking Metformin?
Low blood sugar
Drinking alcohol can cause blood sugars to drop fast in people who live with diabetes, and taking Metformin can also lower blood sugar, so combining the two increases your risk of hypoglycemia.
This can be dangerous because the symptoms of drunkenness are similar to the symptoms of low blood sugar, so you need to be careful when drinking and keep a close eye on your blood sugars while doing so.
Symptoms of low blood sugar include:
Taking Metformin and drinking alcohol can also cause a rare but serious complication called lactic acidosis, which will need immediate medical attention.
Lactic acidosis happens when lactic acid production exceeds its clearance in the body. The increase in lactate production is usually caused by impaired tissue oxygenation, from either decreased oxygen delivery in the body or a defect in its utilization.
This may happen because Metformin causes the body to create more lactic acid and alcohol prohibits the body from getting rid of lactic acid as quickly as usual.
Symptoms of lactic acidosis include:
- Stomach pain
- Decreased appetite
- Shallow breathing
- Rapid heart rate
- Muscle cramps
Not treating lactic acidosis quickly can lead to damage to the blood vessels, heart, lungs, and even kidneys, which can be extra damaging for someone already living with diabetes.
If the condition is not treated at all, it will lead to organ failure and death.
Should you drink alcohol at all if you’re on Metformin?
Alcohol can have negative interactions with many different drugs and medications, so it is best to always talk with your doctor before drinking alcohol if you’ve recently started a new medication or prescription drug.
Follow all guidelines and instructions on any prescription medication, and act accordingly.
Many people, however, do drink alcohol while taking Metformin. As with anything if you live with diabetes, moderation is always key.
General guidelines are the following: for women, a moderate amount of alcohol is no more than one drink per day, and for men, a moderate amount is no more than two drinks per day.
How to make drinking safer if you have diabetes
There are some additional guidelines for drinking alcohol if you have diabetes to make sure you’re imbibing in a safer way:
- Do not drink alcohol while your blood sugar is low
- Do not drink alcohol on an empty stomach (eating a snack with fat and protein before drinking can help stabilize blood sugar levels)
- Pace your drinking with water so you do not dehydrate
- Always carry low blood sugar snacks with you
- Have a snack after drinking
- Test your blood sugar before, during, and after drinking, and especially before you go to sleep
- Wear a continuous glucose monitor (CGM) to track your blood sugars better while drinking, with low alarms on
- Stay with people who know you have diabetes and who know how to treat a low blood sugar (and even administer glucagon, if need be)
- Wear a medical ID bracelet in case of an emergency
- Always let someone know where you’re going and when you expect to be back, with a way to reach you
- Always keep your cell phone near with your ringer on
Many people with diabetes take Metformin for better blood sugar levels, and many people with diabetes who are on Metformin are also curious as to whether or not they can enjoy alcohol, or if there are any negative side effects to combining alcohol and Metformin.
While patients should always heed their doctor’s advice, there are a few dangers of combining alcohol and Metformin that are important to know.
The risk of both lactic acidosis and low blood sugar levels are increased if Metformin and alcohol are combined. In serious cases, these conditions will need emergency medical attention and can be life-threatening.
The symptoms of lactic acidosis, low blood sugar, and drunkenness can be similar, so it’s best to be aware of your surroundings and drink smart, if at all.
Moderation is key for anyone with diabetes who wants to drink alcohol. Moderate drinking for women is no more than one drink per day, and moderate drinking for men is no more than two drinks per day.
People with diabetes should never drink alcohol on an empty stomach (you should snack on something with protein and fat beforehand to help stabilize low blood sugar levels) or while blood sugar is low. They should be with people who know how to treat low blood sugars, and keep low snacks with them at all times.
Wearing a CGM (with low alarms set to ON) can help track blood sugars better while drinking, and checking your blood sugars before, during, and after drinking can help prevent a low blood sugar.
It’s important to note that drinking can cause low blood sugar levels for up to 24 hours afterward, so be extra vigilant if you decide to drink alcohol and have diabetes.
As always, ask your doctor if you’re concerned or have questions about drinking alcohol and taking Metformin for diabetes management.
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