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Diabetes Download: Will Alcohol Affect My Blood Sugars?

In Diabetes Download, Nalani Haviland, a board-certified physician assistant and diabetes expert who has type 1 diabetes herself, answers the Mighty community’s questions.

Editor's Note

If you have diabetes, you may worry about the safety of drinking alcohol. In this column, Nalani Haviland, PA-C, explains how to manage your blood sugar levels if you choose to drink alcohol.

This column is solely for general education and information. It is not intended to provide any medical advice and cannot replace or be a substitute for your relationship with your healthcare provider. Always talk to your clinician for any issues or questions.

The Mighty community asked: “Will drinking alcohol affect my blood sugars?”

When it comes to diabetes, alcohol consumption is a big topic of controversy.  Is it OK? Is it not OK? And why or why not?

First and foremost, I’d like to say that it is important to consult your clinician regarding alcohol use. That being said, I am personally a firm believer in the “everything in moderation” philosophy when it comes to my diabetes. I don’t like being told that I “can’t” do things or that am restricted by my diabetes in any way. I especially don’t like being told I shouldn’t do things without being given an explanation as to why. I also try to avoid this with my patients as much as possible…

With that in mind, there are many things to consider regarding blood sugar control if you do choose to drink alcohol from time to time.

First, understanding how alcohol affects your body and therefore your blood glucose (BG) level is imperative. There is a common misconception that alcohol causes hyperglycemia due to its high sugar content, however it is frequently the opposite. Alcohol has been known to cause very serious hypoglycemic events.

Why?

The liver’s job is to regulate BG levels by releasing “emergency stores” of glucose when our BGs drop below certain levels. The liver’s other job is to process alcohol. High ingestion of alcohol can therefore block the liver’s production of glucose (the liver is too busy processing the alcohol to make new glucose stores). Therefore, when someone is on insulin or an insulin stimulating agent like a sulfonylurea (glipizide, glimepiride, etc.) they can experience very severe lows up to 24 hours after alcohol ingestion. Additionally, if you are taking medications that are processed by your liver, drinking alcohol can increase your risk of liver
damage.

Now, if you are thinking about using alcohol to lower a high BG (I know some of you are)… don’t! Alcohol’s effect on BG levels is unpredictable. It therefore should not be used in this way!

Here are some sipping tips… never drink alcohol on an empty stomach. This increases your risks of lows while drinking. If you do decide to drink alcohol, make sure that you have not skipped any meals and do not plan to skip them the following day (remember alcohol can affect your BGs for up to 24 hours).

Also, remember to moderate! One drink of alcohol/day may be OK, but more than one could put you at serious hypo risk. It is recommended that women should not have more than one drink of alcohol/day and men two drinks/day.
So, drink slowly! It’s not a race!

Make sure to test your BG before, during, and after you drink alcohol. Do not go to bed with a low BG. Also, keep in mind that the symptoms of hypoglycemia can easily be confused with the symptoms of alcohol intoxication (confusion, fatigue, dizziness). It is always a good idea to wear a medical alert bracelet while drinking, that way if you do have a hypo event, you will not be perceived as drunk, but will instead receive proper medical attention. Avoid mixed drinks high in sugar (opt for low carb or diet mixers).  And lastly, don’t drink and drive!

Glossary of Terms

Type 1 Diabetes: A chronic condition that occurs when the pancreas produces little to no insulin. As a result, the body is unable to properly process glucose for energy. It is primarily managed with frequent blood glucose monitoring, diet, exercise, and either insulin pump therapy or multiple daily injections.

Type 2 Diabetes: A chronic condition resulting from insulin resistance and/or an inadequate response to insulin secretion. This results in the body’s inability to properly process glucose. It is managed with frequent blood glucose monitoring, oral or injectable medications, diet, exercise, and sometimes insulin.

Blood Glucose: Another name for blood sugar. Having blood glucose levels that are too high or too low is the hallmark sign of diabetes.

Insulin: A hormone produced by the pancreas. Insulin allows for the regulation of blood glucose and without it, the body cannot process glucose for energy. People with diabetes must get their insulin either through injection or insulin pump therapy.

Diabetic Ketoacidosis (DKA): A complication of uncontrolled diabetes caused by an insufficient amount of circulating insulin. This usually leads to high blood glucose levels and a buildup of blood ketones, byproducts of the breakdown of fatty acids. Untreated diabetic ketoacidosis can lead to coma and death.

PWD: Person with diabetes

Basal Insulin: Also called “background insulin.” In people without type 1 diabetes, the pancreas supplies consistent basal insulin to maintain blood glucose levels between meals. People with type 1 diabetes must inject long-acting insulin to maintain correct blood glucose levels.

Bolus Insulin: Insulin made by the pancreas in response to glucose consumed in food. People with type 1 diabetes must inject rapid-acting insulin immediately before a meal to maintain correct blood glucose levels.

Glucagon: A hormone that treats severe low blood sugar.

Continuous Glucose Monitor: A system that allows PWD to track their glucose levels throughout the day. A small sensor wire is inserted under the skin, and a reusable transmitter connects to the wire and sends readings in real-time to a receiver and/or smartphone app.

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