The Drinking Diabetic

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This was originally posted to my blog site, Diabetes Odyssey.

A little while back I posted a blip asking for ideas on some topics to discuss. I got several; thanks again to those who participated. A couple of people suggested I post something about alcohol and it’s effect on diabetics.

Well, I do have quite a bit of experience with being a type 1 and getting wasted regularly.

Oh, those were the days…

First, let me say that by no means do I recommend drinking to excess, to anyone, especially diabetics. But the choice is yours.

Is alcohol really all that much more dangerous for a diabetic than a non-diabetic? It depends on how you look at it.

I am not a doctor, scientist, or specialist on alcohol and diabetes. I am simply a type 1 diabetic who’s lived it. This post is my own personal take on the topic.

Diabetic or not, when you drink your body absorbs the alcohol into your bloodstream and your liver must work hard to process it. If you drink too much too fast the alcohol will build up in your system and just float around in there for awhile. The liver cannot process all of the alcohol and some of it is just urinated out.

While your poor liver is working overtime to take care of the alcohol, it is not able to regulate blood sugar nearly as well and will neglect to dump glycogen. In diabetics this can be dangerous because it can lead to hypoglycemia (low blood sugar).

Low blood sugar is not the only danger. High blood sugar is possible when drinking as well. Many alcoholic beverages are high in carbs…and not all beverages come with a nutrition label that lists carb count! (internet to the rescue! You can usually look up your drink(s) of choice carb counts on the web).

Rule of thumb is one or two drinks will probably raise your BG and getting drunk will lower it! But this is not very reliable (and depends on types of drinks, body weight, gender, etc.) so make sure you check your BG often and if you use a CGM pay attention to it!

A danger of getting drunk is that drunkenness and hypoglycemia have very similar symptoms, so even if your friends know you are diabetic they may mistake your low blood sugar for you just drinking too much. A CGM with a low alarm and at least one sober friend that knows what that alarm means is a very good idea.

In my past I spent many a weekend getting totally wasted. I never experienced hypoglycemia, however, because I was not controlled and my BG was always pretty high. So even though the alcohol lowered my BG, it didn’t lower it enough to cause trouble for me.

I will say however that just a bit ago I did some drinking. I didn’t get drunk, but I did get a bit tipsy. When I went to bed that night my BG was 186. When I woke up the next morning it was 67. The vast majority of nights I go up during the night, not down, so am going to assume this was the alcohol.

A big problem for diabetics (or anyone really) with getting drunk is the dehydration. Alcohol dehydrates you big time. If you do not drink a lot of water with your alcohol you are just about guaranteed to get sick. I think almost every morning after my drink fests I spent half the day suffering from the symptoms of dehydration. For a diabetic dehydration can lead to some very serious issues which includes life threatening DKA.

So when you drink alcohol make sure to eat food ahead of time, keep a close eye on your blood sugar, and drink plenty of water!

I also would suggest a snack and a BG check before you head off to sleep because the low blood sugar can hit several hours after you did your drinking! Another reason a CGM is good for drinking diabetics.

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Good post. Like most things moderation is the key. Fortunately there are now many low carb options that are very good. Lately I have been enjoying margarita’s with zero carb margarita mix. Other than a drink of my wife’s margarita when dining out, I don’t think I have ever drank one.

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I like a glass of wine (or two) with dinner sometimes but can’t figure out when to bolus for the carbs. Sometimes I end up going high-ish in the hour before bed and I don’t know if that’s poorly covered meal carbs or Lantus worn off already. Anyway, I don’t have a snack…and rely on my CGM to wake me for a low. But I’d like to avoid the rise in BG before bedtime and would appreciate any advice.

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Thanks for the post! I turned 21 a few days ago, and I’m slowly starting to figure out how alcohol affects me. Unfortunately, I found out that I am a huge lightweight (5oz of wine is enough to get me to start feeling too tipsy for comfort), but I haven’t experienced any lows yet from alcohol.

What seems to work for me is being really conservative with my insulin, which often means that I bolus for about 50% of the drink’s carbs (I haven’t done any zero carb drinks, but with those I anticipate having to eat 4-5g of uncovered carbs), eat while drinking, running a 15% reduction in my basal (if possible -there’s some segments where I physically can’t because I’m already at the pump’s minimum basal rate), and trying to keep myself at least 120ish. I’d much rather run myself a little higher than risk going super low, especially when glucagon will not work if I drank alcohol prior to going low.

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T2 not on meds-Yet. Controlling with diet and exercise. Red wine in the evening appears to be beneficial for my numbers–especially the dawn Phenom. So for me a couple or three glasses of red wine in the PM are fine…

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I did research and wrote a story about drinking for Diabetes Forecast.

The short answer is that moderate drinking can actually promote heart health and we know most about the affect in T2D’s because the data is from big population studies.

The concern is drinking more that 1 drink a day for women and 2 a day for men, and for PWD who are taking either insulin or sulfonylureas that can cause low blood sugars. There are more details in the feature.

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Hi, I have been having a sprit about every other night, home brewed alcohol so there is know impurities or carbs. A couple shots of bourbon know change in BG just have to make sure have a small snack before bed and a good test in the morning. Very Morrish.
With know hangovers but a nice feeling. Time for a sip.

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All (drinking) alcohol has carbs.

And I think you’re mixing up “know” and “no”.

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@rgcainmd, I’m not sure about this, I think you mean calories. All alcohol has calories, but distilled spirits like vodka have zero carbs.

I find that dry red wine which has just a couple of grams of carbs is neutral for me, but a shot of two of vodka (which I don’t recommend) and I can see my blood sugar drop.

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I see my blood sugar drop between 3 and 6 am after a couple of glasses of wine with dinner the night before. Why does it drop then? Ideas, anyone?

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Brian, you are right!

I stand corrected. Thanks! :slight_smile:

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Thus why Vodka is my drink of choice…
When I was starting high school, beer was starting to show up at gatherings in small amounts. I was seeing my endo and asked her (mind you I had only been dx’d for about a year), “can I exchange a slice of bread for a Miller lite as they are the same amount of carbs and calories?” She looked at me like I was insane for asking then started to laugh as my question was well thought out and valid aside from me being underage…

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Alcohol is metabolized by your liver, which is also responsible for producing glucose to sustain your blood sugar. My understand is that your liver has limits and it will prioritizes alcohol metabolization over glucose product and that causes the drop overnight. I would note this explanation doesn’t jibe with other information I’ve seen which suggests that the liver can metabolize 1 ounce of alcohol per hour. Unless you’ve had about like 3-6 drinks at midnight then something doesn’t figure. Despite that I’ve experienced the same thing and tried to use it to control overnight DP but found drink a couple of glasses of red wine before brushing my teeth was just too hard to do all the time.

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My preferred alcoholic drink is Scotch or low-carb wine, so carbs are not much of a factor. I have noticed that a moderate amount of alcohol drops my BG not too long after consumption (but not by all that much). However, if I have a bit more from time-to-time, there’s a second, bigger drop that can happen 7-8 hours later. I believe this may be due to the liver’s being “preoccupied” with filtering the alcohol from the blood and not releasing needed glycogen as a result. And yes, careful planning can use this effect to help preempt DP to some degree.

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Tequila shots with salt and lemon (not too much lemon, though cuz it has a bit of carbs…5 carbs per whole lemon.)…diabetics sure fire way to a good night that they may not remember in the morning. :stuck_out_tongue: Just be aware…the shots will not hit you for a while, then SMASH YOU all at once after you’ve consumed another 5 or so shots beyond what you should have. hehehehe…I’m not speaking from experience, mind you. :: whistles innocently ::

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As of late I have been enjoying rum and diet coke.

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I’m a bourbon or whiskey man myself and notice a slight drop in BG when I have a shot or two. I’ve also noticed I “feel” the effects of the alcohol much more acutely and quicker than I did years ago. I guess I’m what you’d call a cheap date now. :slight_smile:

Wheelman

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I just learned an interesting factoid about alcohol and diabetics that most of you probably already knew…but for those of you who don’t.

Hyperglycemia isn’t the only concern with drinking (drinks with high carbs). Hypoglycemia is an even bigger concern since alcohol prevents the liver from producing glucose, so it’s possible for your sugar to drop low enough to cause “dead-in-bed” syndrome since you’ll be too inebriated to correct the low BG.

Food for thought! Be responsible if/when you drink. Have someone with you that knows you’re diabetic…someone who knows how to help, what to do and someone to pull you away from those drinks if you are having too many!

Everything in moderation!

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@Tamra11, thanks for this interesting and informative post! One thing caught my eye that I thought should be mentioned:

[quote=“Tamra11, post:1, topic:54216, full:true”]
Diabetic or not, when you drink your body absorbs the alcohol into your bloodstream and your liver must work hard to process it. If you drink too much too fast the alcohol will build up in your system and just float around in there for awhile. The liver cannot process all of the alcohol and some of it is just urinated out.
[/quote]I’m pretty sure this is not the case – kidneys remove alcohol and excrete it in the urine.

Rather, I believe it is all metabolized by the liver, regardless of how much you drink.

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Yes, that goes for everyone diabetic or not.

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