Alcohol and Diabetes Guide


#1

Editor’s Note: This content has been verified by Marina Basina, MD, a Clinical Associate Professor at Stanford University. She’s a clinical endocrinologist and researcher with a focus on diabetes management and diabetes technology. Dr. Basina is an active member of multiple medical advisory boards and community diabetes organizations, and she is on the Beyond Type 1 Science Advisory Council.

Alcohol and diabetes: do they mix? The short answer is yes, you can drink if you have diabetes. But before you drink, it’s a good idea to educate yourself on how drinking can impact your body and specifically your blood sugar management. Here are some tips on drinking responsibly with diabetes.

Alcohol + your body

The liver is the part of your body that stores glycogen (the stored form of glucose). Usually, your liver’s job is to steadily convert glycogen to glucose, regulating your blood glucose level (BGL). But when you drink, your liver sees alcohol, thinks “poison!”, and switches gears to detoxing your body of that alcohol. This means that your liver is no longer as focused on releasing glucose, which in turn affects your blood sugar management.

Alcohol-induced hypoglycemia with diabetes

Because alcohol decreases your liver’s efficiency at releasing glucose, drinking puts you at risk of a alcohol-induced hypoglycemia. Hypoglycemia, or a hypo, is when you don’t have enough glucose in your bloodstream so your BGL is dangerously low.

A hypo can happen immediately, or up to 12 hours after drinking. Plus, if you are on insulin for diabetes or you are taking diabetes medication that stimulates insulin-creation, your insulin will continue to work and drop your blood sugar further.

Add to that the fact that a hypo can look a lot like being drunk: drowsiness, unsteady movements, slurred speech, etc. A severe hypo can lead to mental confusion, unconsciousness, or seizures, which can all be extremely dangerous to your physical well being and ability to treat yourself. Learn more about the signs of hypoglycemia and how to treat it.

Alcohol-related hyperglycemia with diabetes

Since sugar or other carbs are often the vehicle that makes alcohol more palatable (think margarita mix, rum+coke, or other sugary chasers, etc.), these fast-digesting carbs will be quickly converted to glucose and enter the bloodstream, raising your blood sugar. The Joslin Diabetes Center indicates hyperglycemia occurs with a blood sugar above 160 mg/dL.

If you have Type 2 diabetes, it’s important to count your carbs and monitor your blood sugar while drinking. (Remember, hard alcohol by itself has zero carbs and will not raise your blood sugar but still can put you at risk for low blood sugar that can occur hours after hard liquor ingestion).

Read this to learn more about the signs of hyperglycemia and how to treat it.

Talk to your doctor

Ask your doctor if you are healthy enough to drink alcohol. Especially if you are on other medications, it is imperative you ask your physician if you’re able to consume alcohol while on them. If you are insulin dependent, your doctor may want to adjust your dosage recommendation while drinking. Be sure, to be honest about the amount of alcohol you drink on a daily basis and always ask your physician to explain your medication effects if you don’t understand.

Risks for drinking

There are always risks that accompany drinking alcohol. You may experience any of the following symptoms:

  • Decreased awareness
  • Lack of coordination
  • Impaired judgment, behavioral changes
  • Slurred speech
  • Fatigue
  • Malnutrition

Prolonged or chronic alcohol-use risks:

  • Liver, heart and pancreas damage
  • Shrinking of the frontal lobe
  • Heightened risk for cancer

Increased risks of damage to the body if you have diabetes:

If you have Type 2 diabetes and drink alcohol you may be at a heightened risk for diabetes complications.

  • Neuropathy - worsened nerve problems
  • Increased triglycerides - fatty acids that put you at risk for stroke
  • Increased blood pressure
  • Retinopathy or damage to the eyes
  • Liver damage or cirrhosis

If you’re having frequent trouble in managing your blood sugar levels, you should consider if it’s safe for you to drink alcohol.

Drinking with diabetes to-do checklist

Alright, you get it. There are risks associated with drinking alcohol with diabetes. But is there a way to drink with diabetes? Yes! Here are a few tips on how to drink responsibly.

  1. Talk to your doctor.

Ask your doctor how you can drink while staying safe. Talk about any medication that you are on, and if you are taking insulin, talk about how you should modify your dosages while drinking; they may want to lower your basal insulin.
2. ### Talk to the people drinking with you about your diabetes.

Don’t drink alone! Carry diabetes identification when you go out drinking and make sure you have friends who know about the risks of drinking with diabetes. Emphasize the fact that a hypo might look like you are drunk. Show them the hypoglycemia handout on this page before going out so that they know how to help you.
3. ### Don’t drink alcohol on an empty stomach.

Eat something with slow-acting carbs before you go out drinking alcohol. This will help prevent an alcohol-induced hypo, and it will also help your body process the alcohol more effectively.
4. ### Know your alcohol.

Keep track of how much you are drinking, the alcohol content, the sugar/carb content, and pace yourself.
5. ### Test, test, test your blood!

Before you drink, while you are drinking after you drink and do not drink if your blood sugar is low. Before you go to bed and after you wake up. Alcohol does funky things to your BGLs.
6. ### Come prepared.

Bring your blood testing kit, glucose tabs, a snack, etc. And remember: glucagon won’t help an alcohol-induced hypo.


#2

Has anyone here ever used glucagon while intoxicated?

I find the “glucagon won’t help” to be a strange statement… won’t work at all? Won’t work as well? At what exact point does it go from 100% effective to 0%?


#4

I bet you could NEVER find anybody who would be willing to run such a test.

:smiling_imp:

(As I think of which Adult relatives I could snooker into this…)


#5

@Sam19

There was a recent study done which appeared to address this. The study is listed as completed but I am unsure how to access the study results?

https://clinicaltrials.gov/ct2/show/study/NCT02516150


#6

@Mila - Not sure if I missed something or did I just read this wrong?


#7

The study you linked references a BAC of 0.10%.

That part of the self-test is not significant, I can get to that without too much trouble. But the bigger part of the self-test is wasting a glucagon vial. Once the shelf-stable glucagon becomes available, I’d be happy to run some tests for you.


#8

I once had a pretty annoying low after a few glasses of wine and did not use glucagon because I had heard about it not working as well.
At my next appointment with my endo he was surprised and said that it probably would have helped. Maybe not as good as if i hand’t had any alcohol at all, but at least a bit.


#10

Sure, that would be cool.

But here is the thing. The link you provided above that mentioned 0.10% BAC, I can tell you that level of BAC would have absolutely no impact for me. I already know this to be true for myself.

How much do you want me to drink? Do you want me to get to the three sheets level of drinking and then try the glucagon?

The 0.10% just seems like silliness.


#11

I’d say at least a fifth of bottom shelf tequila


#13

The other thing to consider is how much liver glycogen you have. So a proper experiment would need to control for this with enough food to be consumed between tests, and to do it at the same time each day, so you have consistent amounts of glycogen available.

I have posted at other times about the differences I have seen with glucagon when my liver glycogen was depleted. After 12 miles I took an entire 100ml dose and it did absolutely nothing. My liver just laughed at me.


#14

.05 is not a significant level. I’d say 1.0 which is where people might be pretty tipsy after consuming several drinks… the legal limit to drive in even the most lax states as far as I know…

And at 2.0, which is pretty thoroughly intoxicated, we’re talking stumbling drunk… anything above that would just be ridiculous binge drinking that’d be unreasonable even if not planning to inject glucagon

Of course we’ll have to have an IV started so we can inject D50, or corn syrup, or whatever is handy, in case the glucagon really doesn’t work…

Or there’s that other way…


#16

Would you need a consistent amount of glycogen or would you only have to have above a minimum?

It makes sense if it is depleted then it is depleted.

Assume that a fully charged liver (for a given individual) would provide a 75 point BG bump on 15 units of Glucagon. Would a half-charge still provide the same as it is over a minimum threshold? Or would the liver respond at half intensity and only provide half the bump?


#17

Must I warn you guys to be careful.


#18

It is relative to how much glycogen you have. Maybe not a direct linear relationship, but I definitely saw less of a bump on micro-doses when my liver was fairly well-depleted.

When I was not totally depleted, but just partially, I still got a bump, but just much less.


#19

I actually participated in the clinical trial which attempted to find out if glucagon would be effective when someone was intoxicated. For me, glucagon was equally effective regardless of my state of intoxication. I don’t know if Steven Russell has published the results yet though. The study was done because Ed Damiano and Steven Russell are working on a dual hormone insulin/glucagon pump and there had not been any real study of the question previously. It was just assumed that if your liver was busy metabolizing alcohol it would be too busy to do anything else.


#20

This is the link that did not got pasted

https://beyondtype1.org/hypoglycemia-and-how-to-treat-it/


#21

Drinking chart

BT1-DRINKING-CHART copy.pdf (2.9 MB)


#22

Does that really show 4-1/2 ounces for a Pina Colada?

:stuck_out_tongue:


#23

I would admire anyone who can only drink 4 1/2 ounces of piña colada! I grew up with it as a weekend treat in Puerto Rico, at every single beach, restaurant, bar, hotel, etc.


#24

@Mila No lie. I am disciplined though and stay away from the piña coladas delicious as they are. My compromise of choice is a diet coke, shot of rum, and a lime wedge. I’d rather splurge on a mofongo!