Q&A: Alcohol, Marijuana and Type 1 Diabetes

Managing Type 1 diabetes involves much more than taking insulin. What are some everyday lifestyle factors people may overlook?

Dr. Igudesman: Thanks to advances in continuous glucose monitors (CGMs) and automated insulin delivery systems, people with Type 1 diabetes have much more flexibility today than they did years ago. That's wonderful because it allows people to live fuller lives, but it also means lifestyle choices become even more important. Things like nutrition, physical activity, sleep, stress, alcohol, and cannabis can all affect blood sugar and long-term health. We want people to have the knowledge they need to make informed decisions while still enjoying life.

Why is it so important for healthcare providers to have open, judgment-free conversations about alcohol and marijuana?

Dr. Igudesman: The reality is that people with Type 1 diabetes use alcohol and cannabis just as often as people without diabetes. If we avoid the conversation, we're missing an opportunity to help people stay safe. Our goal isn't to judge anyone—it's to provide practical guidance so people understand the risks and know how to reduce them.

Can someone with Type 1 diabetes safely drink alcohol?

Dr. Igudesman: If someone doesn't currently drink, we don't recommend starting because alcohol carries health risks for everyone. But for people who do choose to drink, moderation is key. Current dietary guidelines recommend no more than one drink per day for women and two for men, with limits on binge drinking as well. More importantly, people with Type 1 diabetes need to plan ahead because alcohol affects blood sugar differently than many people realize.

Many people think alcohol raises blood sugar. Why isn't that the whole story?

Dr. Igudesman: It depends on what you're drinking. Hard liquor contains virtually no carbohydrates, so it won't raise blood sugar immediately. Wine contains only a small amount of carbohydrate, while beer can vary dramatically depending on the type. Sugary cocktails can cause blood sugar to spike because of the added sugars. The challenge is that even if blood sugar rises initially, alcohol itself can increase the risk of low blood sugar several hours later, especially overnight.

Why is delayed hypoglycemia such a concern?

Dr. Igudesman: Alcohol interferes with your liver's ability to release stored glucose when blood sugar begins to fall. That means several hours after drinking—often overnight—your body has a harder time correcting a low blood sugar on its own. That's why planning ahead is so important. Eat before drinking, make sure your diabetes technology is working properly, and take care of things like changing an infusion set before you start drinking rather than afterward.

Is marijuana a safer choice than alcohol for people with Type 1 diabetes?

Dr. Igudesman: I wouldn't call it safer. Cannabis comes with its own risks. One concern is that it often increases appetite. If someone eats significantly more carbohydrates but forgets—or underestimates—the insulin they need because they're in an altered mental state, blood sugar can rise dramatically and potentially lead to diabetic ketoacidosis, or DKA. Heavy cannabis use has also been associated with severe nausea and vomiting, which can create additional complications for people with Type 1 diabetes.

Is the biggest danger the substances themselves—or the way they affect judgment?

Dr. Igudesman: It's really both. Alcohol and cannabis affect blood sugar differently, but they also impair judgment. Someone may forget to take insulin, forget to eat, ignore a CGM alert, or delay treating a low blood sugar. Alcohol also reduces a person's ability to recognize the symptoms of hypoglycemia, while cannabis can make it harder to recognize both high and low blood sugars. That combination can become dangerous very quickly.

How do continuous glucose monitors and insulin pumps improve safety?

Dr. Igudesman: They're incredible tools, but they aren't a substitute for planning. I encourage people to make sure their pump is working properly before they go out, replace infusion sets or refill insulin reservoirs if needed, and consider discussing temporary glucose targets or alert settings with their diabetes care team if alcohol is going to be part of the evening. Some people also choose to temporarily raise their CGM low alert and share their glucose data with someone they trust.

Are there people with Type 1 diabetes who should avoid alcohol or marijuana altogether?

Dr. Igudesman: Yes. We recommend avoiding both during pregnancy. They should also be avoided by anyone recovering from alcohol or substance use disorders, by minors, and by people with certain medical conditions, such as liver disease, where these substances can increase health risks even further.

What advice do you give young adults with Type 1 diabetes who are heading off to college?

Dr. Igudesman: Have a plan before you go out. Eat beforehand. Make sure your diabetes devices are working. Wear your CGM. Let at least one friend know you have Type 1 diabetes and teach them what low blood sugar looks like. Those simple steps can make a tremendous difference if an emergency occurs.

What's the one message you hope every person with Type 1 diabetes remembers?

Dr. Igudesman: Less is more. Less alcohol. Less cannabis. Fewer risks. Fewer side effects. Better long-term health outcomes. If someone chooses to drink alcohol or use cannabis, planning ahead and having an open conversation with their healthcare provider can help them do so much more safely. The goal isn't perfection—it's making informed decisions that protect your health while allowing you to live your life.