Any gathering is a good opportunity to talk about drinking alcohol with diabetes and the effect on blood sugar, right?
You can probably imagine it. Some snacks to nibble on, a live DJ spinning the (digital) wheels of steel, and some tasty adult beverages. In a situation like that, It’s all too easy to get caught up in the atmosphere and not think about your blood sugar. That’s totally natural - who wants to think about diabetes when you're having a good time? I certainly don’t. But does drinking alcohol affect your diabetes and blood sugar? Is it something to be concerned about?
Here’s the deal. If you don’t pay some attention to alcohol and learn how it interacts with your diabetes, it will stop your party in one way or another, either during the dance-off or perhaps more commonly, hours later when you're sound asleep and dreaming about your fancy moves. Cruelly, that’s when you're least expecting it and when you're at your most vulnerable.
Having diabetes is no reason to avoid drinking if it’s something you'd like to do. But you should understand how it works so you can do so safely. I'm not personally a big drinker, but I've done some digging and hope to share a few bits of useful information to help keep you safe.
We're all different, but basics are basic...
One of the most important things I can share is that we're all different, especially when it comes to our diabetes. Many people also differ in how they respond to alcohol. So like everything – your mileage may vary.
In any case, there’s no harm in talking about some of the basic ways alcohol affects metabolism, and what it does to blood sugar. Ready?
Alcohol inhibits glucose release from the liver. So what?
The presence of alcohol in your system can cause low blood sugar. Why? Because it plays games with your liver. How? Your liver is a big reserve of sugar, and throughout the day and night, it normally releases glucose (sometimes even when we don't want it to).
But when alcohol is present it switches focus to clearing alcohol from your bloodstream and forgets all about releasing glucose. That liver is no good at multitasking.
If there’s less sugar in the blood, you'll need less insulin (or you'll need to eat more). Aha! Makes sense, right?
And the time delay...
Each alcoholic beverage takes between 1 to 1.5 hours to process through the liver. During that entire time, your risk for lows is increased. So if you have two drinks, you're looking at three hours. Three drinks and it could be more than four hours. Can you see how quickly the hours add up? If you're not planning way ahead, this can easily sneak up and catch you off guard during the middle of the night.
Many alcoholic beverages (beer, wine, mixed drinks, etc.) contain carbohydrates, which will quickly increase your blood sugar and usually require a bolus. But the bolus should be calculated very carefully, because although your blood sugar may go up quickly, the alcohol is also setting the stage for a fall later on.
A tip from Gary Scheiner.
Gary Scheiner, award-winning Certified Diabetes Educator and author of "Think like a pancreas" offers a guideline for insulin pump users. He suggests that the basal rate should be reduced by 30-50% for 2 hours for each alcoholic drink. Meaning if you had three drinks, you'd set this temp basal rate for six hours.
Ok, at first glance this might sound a bit complicated. Actually, you're right, dealing with diabetes and alcohol is a bit complicated. And as mentioned at the beginning, everyone reacts differently, which means it can be really hard to find clear and simple instructions on what to do. So like almost everything else with diabetes, you have to start with some basic knowledge (which I hope I've given you here) and experiment (safely).
Things to Remember:
- Be very conservative and cautious if you use insulin to lower your blood sugar when drinking, and test often.
- Have a meal or snack with carbohydrates when you consume alcohol.
- Remember to keep glucose tabs or other fast-acting glucose with you at all times.
- Dancing? Oh yeah! But remember, it counts as exercise, which also lowers blood sugar.
- Consider going to bed with a blood sugar higher than normal if you've been drinking. Keep in mind that the drop in BG is often dramatically delayed and you'll want to play it extra safe when sleeping.
- Alcohol can make it hard to notice symptoms of a low. Check your blood sugar often. Check more often than you think you need to. Have I mentioned that you should check often?
- Drunkenness and lows have similar symptoms. It makes sense for a few of your closest party buddies to know about your diabetes and how to help in case of trouble.
- Wear your medical ID at all times (you do have a medical ID, right?).
A few more things that are good to know:
- When you've been drinking, a glucagon rescue shot may not work!
- I am going to repeat that - a glucagon shot may not work when your liver is busy clearing alcohol from your system!
- You might need to hear that a third time... glucagon may not save you if you pass out from a low while drunk.
- If you're a woman, you typically process alcohol a bit slower than your male counterparts.
There is much more to know about diabetes and alcohol, but I hope that this has been a helpful start. There seem to be precious few community-based resources out there that cover drinking with diabetes.
I'd love to hear if you know of any other helpful resources.
If so, please leave a comment. Have fun out there, and stay safe!
And here is where I am also obliged to officially advise you to discuss your specific situation with your doctor.