Background Eight percent of the U.S. population has been diagnosed with diabetes mellitus ( DM ), while another large percentage has gone undiagnosed. As the epidemiology of this disease constitutes a larger percentage of the American population, another factor presents a dangerous dilemma that can exacerbate the hazardous effects imposed by DM . Excessive alcohol consumption concerns the health of more than 50% of all adults. When this heavy‐alcohol‐drinking population overlaps with DM and its complications, the effects can be dangerous. In this review, we term it as “double trouble.” Methods We provide evidence of alcohol‐induced exacerbation of organ damage in diabetic conditions. In certain cases, we have explained how diabetes and alcohol induce similar pathological effects. Results Known exacerbated complications include those related to heart diseases, liver damage, kidney dysfunction, as well as retinal and neurological impairment. Often, pathophysiological damage concludes with end‐stage disorders and even mortality. The metabolic, cell signaling, and pathophysiological changes associated with “double trouble” would lead to the identification of novel therapeutic targets. Conclusions This review summarizes the epidemiology, diagnosis, pathophysiology, metabolic, and cell signaling alterations and finally brushes upon issues and strategies to manage the “double trouble.”