Using alcohol intentionally to manage dawn phenomenon?


#1

I’m Type 1, on MDI (Lantus split-dosed and Novolog) and metformin, with a CGM. I have a somewhat variable but usually present dawn phenomenon (DP) that has been lessened some by my metformin, but not entirely. One alcohol drink in the evening tends to eliminate it and result in much more stable levels throughout the morning; more than two tends to drive me into sustained, gradual lows overnight, thanks to alcohol’s effect of suppressing liver glucose output. Currently, I drink occasionally (maybe once a week, very rarely more than 2 drinks; sometimes will go a few weeks without, occasionally more frequently); however, I’ve been considering trying to implement a nightly alcoholic beverage as an intention component of diabetes management, since it’s the only thing I’ve ever found to reliably get me to wake up around 80 (adjusting insulin doses inevitable provides variable results at best). I don’t see major downsides to this, as someone with no evidence of any organ problems other than my diabetes and no personal or family history of alcohol problems, and given that I’m able to see this effect with a minimal amount of alcohol. My guess is that, for me, elevated glucose levels due to my DP represent a greater health risk than the alcohol.

I realize a pump would be the other obvious option, but I really don’t think I need a variable basal rate otherwise, and, as mentioned, my DP doesn’t seem very consistent anyway, so not sure how effective even that would be, vs something that removes it from the picture. Also, admittedly, I just really don’t really want a pump if I can avoid it.

I’m curious if anyone else uses alcohol in this way or has considered it?


#2

LOL. Well, I’ve never used it as a deliberate strategy, but I have observed that it can have the effect you describe.

You mentioned metformin. Don’t know whether you are interested in considering alternatives—and this is something that would obviously need to be discussed with your doc—but one possibility would be to adjust the metformin dose to deal with the DP. Another would be to switch from regular metformin to the extended-release version. Just tossing out ideas.


#3

I am actually using Metformin ER already, currently taking 1500mg a day (split-dosed, 750mg bid). I’m considering going to 2000mg, because why not (I tolerate it well enough), although it has never had anything like the degree of effect of alcohol on my DP. It has been very helpful for lowering my doses (while improving my A1c) and losing previously stubborn weight though!


#4

I have actually been told to consider having a glass of red wine or a single shot of spirits in the evening to reduce or control DP by a doctor – so it isn’t a crazy idea. I have done so, but find it somewhat unreliable - for me. If you try the idea, just be cautious - and don’t overdo it! :slight_smile:


#5

Yet another option to consider and discuss with your physician is switching your Lantus to Tresiba. Many PWDs are experiencing some positive results with this “ultra-long” lasting basal insulin.


#6

I’d go with whatever works best as long as it doesn’t harm us. “They” say a drink a day is good for healthy people (and we are pretty healthy besides the darned T1D). We have to deal with this self management condition the best we can.

My husband was away for a couple of weeks and my bg ran high the whole time he was gone. I thought it was him. Maybe it was the missed “happy hour” each evening. Food, or drink, for thought.


#7

I’ve observed the effect of one or two drinks depressing liver glucose output while processing the alcohol in the middle of the night. For me, this effect is not dependable. If you can depend on this metabolic effect and not suffer any bad consequences when it doesn’t appear, then I think it’s a reasonable tactic to try. I would keep a written record documenting a trial of at least two weeks but 30-days would be better. This would provide evidence and talking points when you see your endocrinologist.


#8

FWIW, I could not drink wine (or other alcohol) while I was on Metformin. I had some very bad hypos. On the basal/bolus regimen only, I can have a glass or two of wine with dinner but even with a small snack at bedtime generally experience lows into the 60s from 4 am onward (as alerted by my CGM). I do find that the following morning I have less insulin resistance and need either less bolus or more carbs. I’ve been wondering whether or not to redice my evening basal at bedtime on wine-with-dinner nights. This is where good record-keeping will come in handy. :wine_glass:


#9

Shhh, it’s a secret, there is a study about reducing DP through booze. it is real and will google up.
whether it’s a good idea?

I would like to see a similar study with fructose, that’s toxic too.


#10

this might help you party people :grin:
http://www.healthline.com/diabetesmine/d-teens-and-alcohol-no-bull-from-uncle-wil


#11

I didn’t know glucagon shots might not work if I get hammered. That’s scary - a “designated driver” wouldn’t be able to help me.


#12

I didn’t have a drop of alcohol for two years before diagnosis. I started to have a beer or.two.over the weekend after diagnosis. For me. I wake up with better numbers and do better the next day. So I’m attributing this to less stress from work and having a few over the weekend.


#13

I actually tried to get Tresiba after reading about people’s experiences with it here, but ran into difficulties with insurance coverage. I may still push for it and to see if my endo can make it happen (my endo is fantastic in many ways but not the best at folllow through for things like that), but one concern I’ve had in the meantime is that sometimes I do adjust my Lantus for either intense activity (especially if in the heat) or alcohol consumption, and it seems much more difficult to do so with an ultra-long acting insulin. I may still give it a try though!


#14

Re: lows, I find that I am more prone to lows, but I’ve never in my 25 years of being diabetic (including my 20s when I drank less cautiously than I do now) have I ever had a low where I needed glucagon or emergency medical intervention. Not only do I now have a CGM, but I reliably sense and wake up for lows, thanks to having a very reactive sympathetic nervous system. So to be honest, I’m just not THAT worried about lows, although I get why others would be! I’m a lot more concerned about knocking out my DP. Also definitely not planning on getting hammered—just as someone else said, likely either a glass of wine or a single shot of bourbon or the like. I think I’m likely to try it and see—will have to document and report back!


#15

This is a good post to share, thanks! I can’t imagine coping with the drinking culture as a teen/young adolescent with diabetes. Sometimes it’s good to be “my age”! LOL!


#16

I’m a newer T1D so I’m a tad confused. First, what is dawn phenomenon and I thought Metformin was for Type 2? I’m just coming out of the honeymoon so I"m starting to see erratic numbers and am working fast and furiously to get control of it all.


#17

I highly recommend that you read Think Like a Pancreas by Gary Scheiner. This incredible book will answer your questions, plus many more you didn’t know you had. Much like my daughter’s Dexcom CGM, this book changed our lives for the better.


#18

There are whole threads on this if you search for metformin and T1, but the short version is that it can be used in addition to insulin for T1s if they also have some insulin resistance and/or want to reduce liver glucose output. My doses were never that high for my body weight, but over the past few years I went from a bottom-heavy hourglass shape (suggestive of low insulin resistance) to also having a bit of a gut (a red flag for resistance) and was having difficulty losing weight and getting my A1c down. Metformin helped with all of that—my total doses lowered, now if I restrict calories a little I actually lose weight, and my shape is getting back to where it was. I suspect my IR was just secondary to having a bunch of years with not well controlled T1 (better now!) and being a bit overweight—it doesn’t seem to run in my family. Also studies increasingly suggest metformin is not only relatively benign, but it may have a bunch of health benefits like anti-aging/anti-cancer. Seems like a win all around to me! I bet it’s going to be used more and more for T1s as time goes on.

Dawn phenomenon occurs when the liver releases glucose, raising blood sugar in the early morning. In non-diabetics, this is a nice energy boost for waking up. For us, it’s a HUGE pain in a**, since it just raises blood sugar, often starting at a time when we may be sleeping. A lot of people as a result having different insulin needs in the morning than the rest of the day, which depending on how you manage your diabetes, can be varying degrees of challenging to accommodate. (That’s my quick explanation, but definitely worth reading up as suggested for more detail!)


#19

KellyW - as rgcainmd suggested, get Scheiner’s book… it’s an excellent guide in layman’s terms to the management of D (of either type) when using insulin, especially for T1’s. Besides being a CDE (Certified Diabetes Educator), Scheiner is a T1 himself.

On the DP issue… this is actually an absolutely normal response in all mammals… as we wake, our liver releases glycogen (stored glucose), converting it to glucose and inserting it into the bloodstream… raising our BG. This is part of the body’s “wake up” process. In non-D’s, insulin is immediately released, and the newly-inserted glucose is transferred from the bloodstream into the body’s cells, allowing them to begin functioning at a waking pace (sleeping pace is much lower).

BUT… besides DP, which occurs in all of us, there is something called the Somogyi effect… this is relatively rare, and generally only occurs in D’s using BG lowering meds - like insulin. In this case, what happens is that the victim (er, I mean patient) experiences lows in the middle of the night, which the body responds to by releasing glucogon, the hormone that stimulates the release of glycogen from the liver, raising the BG. The difference between this and DP is that this is a reactive high triggered by the body’s own glucose homeostatic “up” mechanism. The way to know which you’re experiencing is that DP occurs near wake-up time, with no preceding low; Somogyi effect is a response to a low somewhere in the middle of the night - like, 2 to 4 am for people on a “typical” night-time sleep cycle. So setting an alarm in that time frame and testing is the way to identify which is causing your morning high… DP or Somogyi.

w.


#20

Thanks for the info…I"ll get that book. I’ve heard others mentioning it but haven’t ordered it yet. I haven’t really experienced either effect until this past month. My sugar was always rather stable but now that the honeymoon is over, I’m starting to experience some morning highs, all day highs, and a few normal numbers. I haven’t had any kind of low in a while. So, I need to further study and have tighter management as I move in to this next forever phase. I appreciate your info!