Let's educate me about ALCOHOL

Okay when I was diagnosed (when i was 16) Doctors always told me the horror stories of alcohol and diabetes- and how people pass out and go into comas etc. I always wondered if they were trying to scare me away from underaged drinking- now i'm 22 and out of college (somehow managed to survive without drinking) I am really sick of not drinking socially when everyone else is- especially at a bar or party. So what's the deal? I know plenty of diabetics drink.

That's not to say i've never had any alcohol. In the past when I've had beers they haven't had much impact on me. I once had a shot and it dropped my sugar like a brick and i needed over 60 carbs. I don't know if alcohol tolerance makes a difference or what. Can someone help me out? :)

Well, you already know that hard liquor will drop you. The biggest thing to remember is to never drink on an empty stomach and to test frequently! If I'm going to be drinking, I test probably every hour. Stay away from the sugary drinks (I had a margarita once and it shot my sugars up close to 500 - have NO idea how much sugar was in it, obviously a lot!). If I drink beer, I have a Lite one. My drink of choice is whiskey and diet cola. Again, I just test a LOT and usually don't have any problems. Also remember, your liver will not bail you out if you go low because it's too busy detoxifying your body from the alcohol, so food while drinking is a good thing. If you choose to drink, just be responsible about it.

As Putertech said above:

"your liver will not bail you out if you go low because it's too busy detoxifying your body from the alcohol"

This is the key "malfunction" if you will, when combining alcohol and carrying injected (or pumped) insulin on board. The liver becomes preoccupied with removing the alcohol from our system and at some point the alcohol can overwhelm the liver . . . an organ we're depending on to keep our glucose levels up and bail us out of a low.

Ideally our basal insulin levels are sufficient to deal with the regulated output from the liver and in the case of low blood sugar dump some extra glucose to boost us back up. Alcohol can impair and even shut down this regular output and yet we still have our basal insulin on board still chugging away . . . lowering our Bg's and the liver is essentially ignoring the situation. Non-d's generally don't have this issue because their body's can down regulate insulin output to compensate . . uuum, the body can change insulin resistance, I wonder if this occurs too? Unfortunately for insulin dependent diabetics our bodies can't control the insulin on board so a low becomes a concern. As you've noticed hard alcohol has bigger effect than beer. Beer has carbs . . hard alcohol in comparison doesn't. Also, the shot you tossed back . .. how long does a beer last?

As mentioned, sugary drinks contain carbs which of course go straight to the system by passing the liver. While in my "youth" I may have done some stupid things, but recommend not drinking on an empty stomach . . . test frequently . . . and not drink so much that you "forget" good practices.

Keep your wits about you and you'll be fine.

I am not a T1D, but my son is, my first husband is (not my son's father), and we know plenty of adult T1Ds. One of my good T1D friends only drinks wine, and she never boluses for wine. She said it has no affect on her and her BG stays steady - I've watched it one night on her dexcom too. I was with my first husband throughout college and into our 20's. He never took care of himself and drank constantly. He would go low in the middle of the night, but he always woke up, and he relied on me to pull him out of a low. He would also go low during class and while we were hanging out, and he relied on me always to save him.

I like the book Sweet Kids, because it talks about how alcohol, marijuana, and drugs may or may not affect a T1D. One thing they make clear is to always eat, since your liver is tied up with other things.

So - I think you need to understand how different types of alcohol affect you and then bolus - or not bolus accordingly. Maybe in a controlled environment? Sounds like a fun science experiment to me. Or get a girlfriend / boyfriend who will always save you, but not a course I would suggest, especially given that he was my "first" husband.

In addition to all of the other good advice you've received, I would pay attention to quantity. If you drink a beer or two over the course of an evening, you're not likely to have problems. I often have a beer or glass of wine with meals; I dose for the beer but don't dose for dry wine and no longer drink sweet wine. Sometimes I think a little bit of alcohol improves my control. AcidRock has been known to call red wine - red insulin.

I'm not a low carber and I can't stand light beers. A 12oz bottle of Guiness Stout has 12 carbs and in my experience doses true

I'm too new at all this to be an expert-- but my two cents worth is that I don't have any trouble managing glucose levels with reasonable alchohol intake. As mentioned before, sugary foo foo drinks are out. Lite beer has little or no effect on my levels, nor does wine or liquor mixed with diet cola. That being said-- moderation is definitely key. If you drink enough to be hung over the next day, you may well find that your glucose levels are erratic and unpredictable. If you are 22 years old and it sounds like haven't had more than a few drinks in your life, I would be very careful until you learn how your body / mind in general, and particularly your glucose levels react to different kinds of alchohol. The "bar or party" scenes you mention can easily lead people to drinking way more than is a good idea for someone in our shoes, particularly if they are less experienced with alchohol...

Be smart about it. I'm 21 and in college and i do drink (much to my parents dismay). I have a few rules about drinking.
1. Have a full meal before hand and count the carbs right!
2. Make sure my BG is spot on (maybe a little high, but only a little) before I start.
3. No sugary drinks
4. Test test test
5. Pace yourself. I know that I cant handle more than 1 drink an hour, but everybody is different. I drink light beer and every time I have one I put the bottle cap or can top thing in my pocket so I can remember exactly how many I have had.
6. I always under bolus a little because I would rather be a little high than low.
7. Continue eating through out the night.
8. I always make sure I'm with people who know I have diabetes and know what to do in an emergency.
9. I also always make sure I have something to treat a low in case the need were to arrive.

Just be smart and careful and it will all work out!

I drink quite a bit, although not as much as I used to, and do ok but snack while drinking and bolus for the carbs in the alcohol. I haven't ever dropped like a shot from it and will have snorts of whiskey or vodka cocktails (e.g. diet squirt) and usually figure a few carbs, like 10-20, have a handful of something to munch on or a beer for some carbs.

I make sure I have a full stomach when I drink. I do not bolus for any alcohol, craft beer being my choicce beverage. I found out early after my diagnosis, that blousing for my alcohol was a bad idea FOR ME. I drop like a rock after drinking. YDMV of course. I tend to under bolus for the meal I have having while drinking as well. If I have any hard liquor it is usually with a diet mixer such as diet coke. Occasionally I will have a frozen beverage which usually are high in carbs, and then I will bolus for about half of the carbs I SWAG it for. I can always correct a high later. That is my theory.

Most of the "thicker" craft-type of beers have more carbs in them. I sort of like them, as they also have more booze but I try to cover them with some insulin.

shouldn't the carbs in more "surgery" drinks or in beer prevent the lows?

That's been my experience but there's sort of a range of carbs in beer...lighter beers, can run from a couple of carbs to what seems to be like 20 for the super carby ones but a lot of the really thick beers also have a lot of alcohol?

Hi Tom. There is a time lapse between drinking the alcoholic drink and blood sugar going up, and later when your blood sugar drops. You have to experiment, and keep in mind that recent exercise might speed up the time lapse.

I drink a gluten-free beer which has 14 carbs. I bolus for it and any food I might eat with it. Three hours later, I can count on my blood sugar dropping the amount of 5 carbs from the beer. A glass of wine has approx. 5 carbs; I don't bolus for it and just know that about 3 hours later, I'll drop the amount of that 5 carbs.

Moderation and paying attention are key, at least for me.

Michelob Ultra is my beer of choice - <3 carbs per 12 oz.

Agreed--watch your blood sugar before the drink, keep quantity down, and choose low carb drinks. For example, a mojito made with diet lemon lime soda, lime juice, rum and mint is pretty indistinguishable from the real syrupy sweet thing. I love beer, but have given it up. Just too many carbs, and I am afraid to bolus for booze. White wine is my go to at all times.

Just be careful....

As an ole hand on this topic, if you are using metformin, alcohol will override the metformin as well and stop its benefits.

I usually enjoy a drink once met not up to strength in blood system so the two - met plus booze are not doing tango in my liver.

T1 for 38 years, drinking for about 20 of them, I agree with most of the advice here. Perhaps one other thing worth noting is that the aftereffects of alcohol might come a long time later. I've been binge drinking on a Friday night and don't get a severe low until Sunday afternoon. I'm not sure on this, but I've heard that alcohol can stay with you up to 72 hours (3 days!) later.

This totally rings true for me. More than 2 drinks in a night and my basal is drastically reduced until afternoon the next day.

Are you taking long acting insulin by any chance?

I can only speak from personal experience of course, but I found the only occasions alcohol ever effected me in those stereotypical brick dropping ways was when I was on Lantus.

Now I'm on a pump. It hasn't happened in the whole 10 years I've been pumping.
In fact quite honestly it now works like any carbs do and I inject as I drink.

I don't ever drink heavily, but I certainly don't drink lightly either :D

Excellent advice. I think Lauren captured it perfectly! Some folks are fine just not drinking, but I generally follow what Lauren does and my caution has consistently paid off over the years.

Drinking and T1 requires a bit of testing. Experiment at home when you have someone (or in some other safe environment) around to find out what works and what doesn't.