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The main risk associated with combining alcohol with insulin or sulfonylurea is hypoglycemia. Alcohol can impair gluconeogenesis, which is the process your body uses to produce glucose from non-carbohydrate sources in the liver. When someone takes insulin or sulfonylureas, which are medications that lower blood sugar levels, drinking alcohol can lead to an unexpected drop in blood glucose. This happens because alcohol consumption can block the liver’s ability to release glucose into the bloodstream, resulting in hypoglycemic episodes, especially in individuals who may not be eating adequately while drinking.

In addition, while dehydration and lactic acidosis are potential concerns with alcohol consumption in general, they are not the most immediate or significant risk when paired specifically with insulin or sulfonylureas. Severe hyperglycemia, on the other hand, is more commonly associated with other factors related to diabetes management, such as consuming high-carbohydrate foods without adequate medication, rather than directly with alcohol interaction.