Alcohol, Marijuana and Type 1 Diabetes:

What You Need to Know to Stay Safe

Whether it's a backyard barbecue, a football game or dinner with friends, alcohol and marijuana are common parts of social life. For people with Type 1 diabetes (T1D), understanding how they affect blood sugar can help prevent serious complications.

"People with Type 1 diabetes have much more flexibility today than they did years ago because of advances in automated insulin delivery systems and continuous glucose monitoring," says Daria Igudesman, PhD, RD, a postdoctoral research fellow at AdventHealth's Translational Research Institute (TRI). "But because people have more freedom in the choices they make, it's even more important that they understand which lifestyle factors still require careful planning."

That conversation is becoming increasingly important. Research presented at the American Diabetes Association's 2026 Scientific Sessions found that people with Type 1 diabetes use alcohol and marijuana at rates similar to the general population. Rather than simply telling people not to drink or use cannabis, experts say the goal is to help people understand the risks and make safer choices.

That said, if you don't already drink alcohol, health experts do not recommend starting. In 2025, the U.S. Surgeon General issued an advisory highlighting alcohol as a leading preventable cause of cancer, noting that alcohol consumption increases the risk of at least seven types of cancer. The advisory reinforces that, when it comes to alcohol, less is better for overall health.

Alcohol: The Risk May Come Hours Later

Many people assume alcohol always raises blood sugar, but that's only part of the story.

Beer and sugary cocktails can raise blood sugar because of their carbohydrate content, while wine and distilled spirits generally contain fewer carbohydrates. Regardless of the drink, however, alcohol itself can increase the risk of delayed hypoglycemia—low blood sugar that may occur several hours later.

"The biggest concern is delayed hypoglycemia," Dr. Igudesman explains. "Alcohol prevents the liver from producing more glucose, which normally helps correct a low blood sugar."

That means someone can feel perfectly fine while they're out with friends, only to experience a dangerous drop in blood sugar later that night or while they're sleeping.

⚠️ THE BIGGEST RISK ISN'T WHILE YOU'RE DRINKING...

It's While You're Sleeping.

Here's why:

🍷 When you drink, your liver shifts its focus to breaking down alcohol.

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🩸 If your blood sugar begins to drop later, your liver can't release stored glucose as efficiently to help bring it back up.

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🌙 The result? The risk of hypoglycemia can remain elevated for up to 24 hours after drinking, with some of the greatest danger occurring overnight while you're asleep.

Planning ahead can make a big difference. Dr. Igudesman recommends eating a meal that includes protein and healthy fats before drinking, making sure your insulin pump is working properly before going out, and wearing a continuous glucose monitor (CGM), which can alert you if your blood sugar begins dropping overnight.

What About Marijuana?

As marijuana has become more widely available, many people wonder if it's a safer choice than alcohol.

"I certainly wouldn't call it safer," says Dr. Igudesman.

One of the biggest concerns is appetite. Cannabis often causes "the munchies," making it easy to eat more carbohydrates than planned. If those carbohydrates aren't matched with enough insulin, blood sugar can rise quickly, increasing the risk of diabetic ketoacidosis (DKA), a serious medical emergency.

Researchers have also linked heavy cannabis use to cannabis hyperemesis syndrome, a condition that causes repeated nausea and vomiting, which can further increase the risk of ketosis and hospitalization in people with Type 1 diabetes.

⚠️ THE BIGGEST RISK ISN'T THE MARIJUANA...

It's What Happens After.

Here's what can happen:

🍕 Cannabis can increase your appetite, making it easy to eat more carbohydrates than you planned.

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💉 If you forget—or underestimate—your insulin, blood sugar can climb quickly.

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📈 Without enough insulin, your body begins producing ketones.

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🚨 The result? An increased risk of diabetic ketoacidosis (DKA)—a serious medical emergency that requires immediate treatment.

Stay Safe: Plan Ahead

Whether you choose to drink alcohol or use marijuana, preparation is one of the best ways to reduce your risk.

Before heading out:

• Eat a balanced meal before drinking.
• Wear your CGM and consider raising your low-glucose alert for the evening.
• Make sure your insulin pump is working properly and your infusion set or reservoir doesn't need changing.
• Count carbohydrates and take insulin as needed.
• Tell a trusted friend you have diabetes and what to do in an emergency.
• Talk with your diabetes care team if you regularly drink alcohol or use cannabis.

Today's diabetes technology offers more freedom than ever before—but it works best when paired with a plan.

"My main message is less is more," Dr. Igudesman says. "Less alcohol, less cannabis, fewer risks, fewer side effects and better long-term health outcomes.