CHAPTER 32 — ALCOHOL, SMOKING, CAFFEINE & RECREATIONAL SUBSTANCES Lifestyle substances — alcohol, cigarettes, caffeine, and recreational drugs — all influence glucose, heart health, medication safety, and long-term outcomes in Type 2 Diabetes. This chapter explains their effects clearly so you can make informed decisions. SECTION 1 — ALCOHOL AND TYPE 2 DIABETES Alcohol can raise OR lower glucose depending on:
- Type of drink.
- Whether it is consumed with food.
- Liver function.
- Medications taken.
- Quantity.
HOW ALCOHOL AFFECTS GLUCOSE 1. SHORT-TERM EFFECTS
- Beer, cider, sweet wine, cocktails, and liqueurs raise glucose.
- Spirits (vodka, whiskey, gin, rum) mixed with sugar-free mixers have less effect.
- Alcohol can block the liver from releasing glucose → risk of low blood sugar several hours later (especially if using insulin or sulfonylureas).
2. LONG-TERM EFFECTS
- Raises triglycerides.
- Increases abdominal fat.
- Disturbs sleep.
- Lowers motivation for good food choices.
- Affects liver, especially in people with fatty liver.
SAFER ALCOHOL STRATEGY FOR DIABETES
- Never drink on an empty stomach.
- Pair alcohol with protein + vegetables.
- Choose:
- Dry red/white wine.
- Spirits with soda water / sugar-free mixers.
- Limit:
- Cocktails.
- Sweet wines.
- Beer and cider (high carb).
Suggested limits (general guidance):
- Men: up to 1–2 standard drinks/day, not every day.
- Women: up to 1 drink/day, not every day.
ALCOHOL RED FLAGS — SEEK MEDICAL ADVICE IF:
- Blackouts occur.
- You drink to cope with stress or sleep.
- Your liver tests are abnormal.
- You have trouble stopping after one or two drinks.
SECTION 2 — SMOKING AND TYPE 2 DIABETES Smoking dramatically increases the risk of:
- Heart attack
- Stroke
- Peripheral artery disease
- Kidney damage
- Vision loss
- Erectile dysfunction
- Poor wound healing
- Foot complications and amputations
Why:
- Smoking reduces circulation.
- Increases inflammation.
- Increases insulin resistance.
- Damages small and large blood vessels.
GOOD NEWS: Quitting smoking rapidly reduces risk:
- Within weeks: circulation improves.
- Within months: lung function improves.
- Within 1–2 years: heart attack risk drops sharply.
HELPFUL QUITTING STRATEGIES:
- Nicotine patches, gum, or lozenges.
- Prescription medicines (if suitable).
- Support groups or counselling.
- Identifying triggers (stress, alcohol, certain people).
- Avoiding situations that encourage smoking in early weeks.
SECTION 3 — VAPING Vaping is often marketed as “safer,” but:
- Nicotine still increases insulin resistance.
- Chemicals can irritate airways.
- Long-term effects are still unknown.
If vaping helps quit cigarettes, it can be a step — but aim to reduce nicotine over time. SECTION 4 — CAFFEINE AND GLUCOSE Caffeine affects people differently. POTENTIAL EFFECTS:
- Can increase cortisol → temporarily raise glucose.
- May cause jitters, anxiety, or poor sleep.
- Black coffee has almost no calories but can still trigger a glucose rise in some.
Better choices:
- Limit strong coffee on an empty stomach.
- Avoid late afternoon/evening caffeine.
- Try green tea or herbal teas if sensitive.
If you notice glucose spikes after coffee, reduce dose or timing. SECTION 5 — RECREATIONAL DRUGS Recreational drugs can interact dangerously with diabetes and medications. 1. CANNABIS (MARIJUANA) Effects:
- Can increase appetite → overeating.
- Can reduce motivation.
- May impair glucose awareness.
- Smoke still harms lungs.
2. COCAINE / AMPHETAMINES Dangerous because:
- Raise heart rate and blood pressure.
- Increase risk of heart attack or stroke.
- Can cause extreme dehydration.
- Create chaotic eating/sleeping → glucose instability.
3. MDMA (“ECSTASY”) Risks:
- Severe dehydration.
- Overheating.
- Dangerous interactions with medications.
- Reduced appetite → risk of hypo in medicated individuals.
4. OPIOIDS Risks:
- Respiratory suppression.
- Constipation.
- Sedation.
- Impaired ability to monitor glucose or take medication.
GENERAL WARNING: Recreational drugs + diabetes + alcohol = significantly increased emergency risk. SECTION 6 — SLEEPING PILLS, ANTI-ANXIETY MEDICATION, AND OVER-THE-COUNTER SUBSTANCES 1. SLEEPING TABLETS (Z-drugs, benzodiazepines)
- Affect coordination → fall risk.
- Can mask signs of low blood sugar.
- Can interact with alcohol.
2. OVER-THE-COUNTER PAINKILLERS
- NSAIDs (ibuprofen, naproxen) can affect kidneys.
- Paracetamol/acetaminophen is safer for most but can affect CGM sensors.
3. HERBAL SEDATIVES
- Valerian, chamomile, lavender can help but vary in strength.
Always check with a healthcare provider for interactions. SECTION 7 — LIVER PROTECTION Because alcohol, medicines, diabetes, and fatty liver overlap, protect the liver by:
- Reducing alcohol intake.
- Avoiding binge drinking.
- Minimising unnecessary supplements.
- Losing abdominal fat.
- Eating fewer sugary and refined foods.
SECTION 8 — BUILDING A “SMART SUBSTANCE PLAN” Create clear personal rules. Examples: 1. ALCOHOL RULES
- No drinking without food.
- Max 1–2 drinks on any occasion.
- No sweet cocktails or sugary drinks.
2. SMOKING/VAPING RULES
- Set a quit date.
- Use nicotine replacement.
- Avoid smoking areas.
3. CAFFEINE RULES
- No caffeine after 3 p.m.
- Max 1–2 cups/day.
- Avoid coffee on an empty stomach.
4. RECREATIONAL DRUG RULES
- Avoid completely — especially if on glucose-lowering medication.
- Never mix with alcohol.
- Seek support if use feels hard to control.
SECTION 9 — RED FLAGS: SEEK HELP IF
- You use alcohol or substances to cope with stress, anxiety, or sleep.
- You have tried to quit smoking many times without success.
- You hide use from family or doctor.
- You have blackouts or memory gaps.
- You notice chest pain, palpitations, or breathing difficulty after using substances.
- Substance use disrupts your diabetes management.
SECTION 10 — KEY POINTS SUMMARISED
- Alcohol, smoking, caffeine, and recreational drugs all influence glucose, heart health, liver function, and safety.
- Alcohol can raise OR lower glucose; use cautiously and never drink on an empty stomach.
- Smoking massively increases complication risk; quitting is one of the most powerful health decisions.
- Caffeine affects glucose and sleep in some people.
- Recreational drugs can cause severe glucose instability, dehydration, and heart/stroke risk.
- A personal “substance plan” helps maintain control and reduces risk.
- When in doubt, seek medical or professional support.
This chapter helps people make safer, clearer decisions about alcohol, cigarettes, caffeine, and recreational substances while living with Type 2 Diabetes.