Can I Drink Alcohol While Taking Metformin?

After Dulce was diagnosed with type 2 diabetes, her doctors prescribed her metformin to reduce her A1c. She became troubled when her metformin prescription kept going up and up, even as her blood glucose levels stayed elevated. Because of potential side effects, she didn't feel she could safely have a glass of wine on metformin. After joining Virta, Dulce came off metformin, reduced her A1c by a full point and lost 35 pounds in just seven months... all while being able to treat herself safely to the occasional glass of wine.

Drinking alcohol while taking metformin can carry health risks. Here’s what you need to know about the potential side effects of drinking while on this diabetes medication. 

Is It Safe to Mix Metformin and Alcohol?

Drinking alcohol while on metformin comes with health risks. If you are a heavy drinker, you should avoid alcohol altogether while on metformin because it can lead to dangerous health conditions like lactic acidosis or hypoglycemia. You also shouldn’t consume alcohol with metformin if you engage in binge drinking.

The American Diabetes Association defines an alcoholic drink as either 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor. While on metformin, alcohol is only safe to drink in moderation, defined as:

• Women: One drink per day,and no more than 7 drinks per week
• Men: Two drinks per day, and no more than 14 drinks per week

Despite the general recommendations, you should make sure to ask your doctor or health practitioner how much alcohol (if any) is safe for you to drink while taking metformin due to additional risks with other health conditions.

How Long After Taking Metformin Can You Drink Alcohol?

It is recommended that you should wait at least 12 hours after taking metformin before consuming alcohol. That means if you take metformin with your evening meal, you shouldn’t drink alcohol between dinner and the morning. 

Metformin and alcohol risks and interactions

Before drinking alcohol you should understand how drinking interacts with diabetes and your prescribed medication.

Lactic Acidosis

Your body naturally creates lactic acid when it breaks down glucose. However, too much of this acid in your bloodstream results in a medical emergency called lactic acidosis that requires treatment in a hospital. 

Drinking alcohol while on metformin increases your risk of lactic acidosis, especially for people who drink often or engage in binge drinking. You should consult with your doctor before drinking alcohol while taking metformin if any of the following items are true for you:

• You are 65 or older.
• You have severe kidney or liver problems.
• You drink alcohol very often or in large quantities.
• You are dehydrated.
• You have had a heart attack, severe infection, or stroke.

Risk of Hypoglycemia

Hypoglycemia occurs when there isn't enough glucose in your bloodstream for your cells to function properly. It can cause uncomfortable symptoms like lightheadedness, fatigue, or irregular heartbeats. At its most dangerous, hypoglycemia can cause a loss of consciousness.

Metformin works in part by reducing the glucose in your bloodstream. Drinking too much alcohol can sharply decrease your blood sugar too. That means, when combined with metformin, alcohol can bring on hypoglycemia. Keep in mind that not all alcoholic beverages are created equal. Some contain higher amounts of sugar that may lead to hyperglycemia (sweet wines, some mixed drinks, beers, ciders) whereas others (dry wines, distilled spirits) contain less carbohydrate to balance out the blood sugar lowering effect of the alcohol.

Vitamin B12 Deficiency

Your body requires vitamin B12 to keep its red blood cells, nerves, and even your DNA healthy. Without it, you can experience symptoms like paranoia, depression, memory loss, delusions, incontinence, neuropathy, and more. 

Your liver stores vitamin B12 and releases it when needed. Because excessive alcohol consumption can result in liver damage, drinking can contribute to a functional vitamin B12 deficiency as your liver becomes less able to store it. 

Studies have found that taking metformin is significantly associated with vitamin B12 deficiency. This means that mixing metformin and alcohol puts you at greater risk of not having enough available B12. The American Diabetes Association recommends patients taking Metformin should periodically measure their B12 levels.

Other Side Effects of Alcohol and Metformin

When mixed together, alcohol can interact to make metformin’s side effects worse:

• Alcohol impairs your judgment, which can make it more difficult for you to assess whether you’re putting your health at risk.
• Both metformin and alcohol can cause a variety of gastrointestinal symptoms like vomiting, diarrhea, indigestion, heartburn, and gas. 
• Liver damage can occur with long-term alcohol use and your liver plays a vital part in healing the effects of diabetes.

Alcohol and Diabetes Management

If you decide to drink alcohol while taking metformin, you should:

• Have a frank talk with your doctor about how much you drink so you both can understand exactly what’s at risk.
• Test your blood sugar before drinking alcohol.
• Drink less, drink slowly, and eat small amounts of low fat, protein-based foods while drinking to help your body to metabolize the alcohol. 

The Takeaway

Can you drink on metformin? Drinking alcohol with metformin exposes you to health risks – including some that could land you in the hospital. If you want to remove the risks posed by drinking while on metformin and improve your health overall, Virta Health can help you make lifestyle changes after a type 2 diabetes diagnosis that may allow you to eliminate diabetes medications like metformin altogether. 

Virta Health teaches you how to make healthy lifestyle changes in a medical setting with supportive resources like 1:1 virtual coaching, allowing you to regain control of your health and socialize like yourself again. See if you’re eligible for Virta Health here.