Alcohol and Diabetes
Writer’s Note: Insight Diabetes does not encourage the purchase or consumption of any mind-altering substance. The information provided is for those who wish to do so despite warnings and possible health implications.
What is Alcohol?
When talking about alcohol, we usually refer to the alcohol found in beer, wine and spirits. Alcohol is the ingredient in these beverages that get you intoxicated.
The type of alcohol commonly found in these beverages is called Ethanol (Ethyl Alcohol). Alcohol is formed as a by-product when yeast ferments sugars found in many different vegetables and fruits and grains. For example, spirits like Vodka are made using the sugars found in potatoes whereas wines are typically made from the sugars found in grapes.
Alcohol is considered to be a drug and like many other drugs, it affects the way your body works. It can also be highly addictive and toxic to the human body.
When consuming alcohol typically makes you feel more relaxed, happy or energetic. However, alcohol is actually a depressant similar to opioids and actually slows down signals between your brain and body and also affects the way you behave, think and feel.
Consult a medical professional!
Before you start drinking, it is HIGHLY recommended that you speak with a doctor or your diabetes team to ensure you are healthy enough to drink alcohol and confirm any medications or insulin you take are not affected by the consumption of alcohol and that some very nasty side effects may occur.
The doctor may also advise you on how to adjust your insulin dosage while drinking, these conversations start with HONESTY, you will need to be honest with your medical professional about the amount of alcohol you are consuming or planning to consume.
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Alcohol and Hypoglycemia
Alcohol consumption can be tricky for most diabetics due to the way alcohol affects the way your liver works and its job in managing blood sugar.
This becomes increasingly difficult for those who are taking medications that lower their blood sugar levels such as insulin.
Your liver and alcohol: Your liver is responsible for more than just removing toxins from your body, it also plays a key role in releasing glucose in your blood. When not under the influence of alcohol your living stores some excess glucose (sugar) from the food you eat as a chemical called glycogen. The stored glycogen is then released as glucose in your blood through the day and night for your body to use, due to this some diabetics need to take basal insulin (background insulin) or commonly referred to as long-acting insulin to avoid high blood glucose (BG) levels.
Your liver also does this slow release of glucose during the night when you sleep, which in some cases for diabetics leads to something called the ‘dawn phenomenon’ which in short means your BG levels when you wake up can sometimes be higher than anticipated even though you have been fasting for the duration of your sleep.
When consuming alcohol your liver stops storing and releasing glycogen altogether, this is because your liver identifies alcohol as a toxin or poison and focuses on removing the substance from your body as quickly as possible, so the more you drink the longer your liver spends on removing alcohol from your body thus not storing and releasing glycogen as usual. This in turn can cause a hypoglycemic event up to 48 hours after your last drink in some cases depending on the level of consumption.
Your stomach and alcohol: When consuming alcohol it can slow down the rate at which you digest food meaning that if you have had alcohol and a meal you may see a delayed period before seeing your BG levels rise. With this in mind, it is important to note that if you are insulin-dependent and have injected insulin for a meal you ate with alcohol you may see your sugars go low a lot quicker than usual as the food consumed is still being broken down into glucose, which can increase your risk of a hypoglycemic event.
Alcohol-related hypoglycemia: Hypoglycemia also referred to as low blood sugar, is when a person’s BG levels drop below 3.9mmol/L (70mg/dl).
While drinking the risks of experiencing a hypoglycemic event are increased due to the combination of your liver temporarily not storing or releasing glycogen and digestion being slowed down due to the presence of alcohol in your stomach.
These reasons are why consuming alcohol as a diabetic can be very dangerous and possibly life-threatening.
For example, if you have been drinking until 2 am and go to sleep, it is possible to experience delayed low blood sugars through the night and in the morning. and depending on the amount of alcohol consumed meaning if you had a lot to drink you could experience an alcohol-induced hypoglycemic event up to 48 hours after.
While intoxicated it may become increasingly difficult to recognise the usual symptoms of a hypo, you maybe be liable to fall into a deeper sleep making it more difficult for you to hear or feel your CGM’s alarm thus increasing your risk of sleeping through the alarm and increasing the potential of experience a sever hypo which leads to seizures or death.
Hypoglycemia and intoxication
The symptoms of a hypoglycemic event can look and feel a lot like being intoxicated with the symptoms being:
- Unsteady movements
- Slurred speech
- Feeling weak
- Diluted pupils
A severe hypoglycemic event can be extremely difficult to treat alone which is why it is advised to have someone with you to assist in treating the hypo or calling medical emergency services, symptoms of a severe hypo are very few but ferocious and can lead to death, severe hypos typically display the following symptoms:
- Mental Confusion
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Teach your friends and family: While intoxicated as we’ve discussed it can be difficult to recognise a hypo by yourself and a second opinion from a friend that’s abstaining from alcohol can help you manage your sugars better. Also tell your friends that should they feel uncertain about your current condition especially if you are ever throwing up or showing signs of a hypo, they should encourage you to check your BG Levels either through your CGM (Continuous Glucose Monitor) or BGM (Blood Glucose Monitor) and call an ambulance (999) if your condition is not improving.
Some diabetics may carry an emergency glucagon kit, but these kits may not be as effective or completely ineffective while intoxicated. This is because Glucagon is a hormone that signals your liver to release large amounts of stored glycogen, however as you can imagine with the presence of alcohol, the liver would be preoccupied with removing the alcohol from your body, thus interfering with the way the liver interacts with the glucagon. This is also another reason why diabetics need to exercise caution when drinking.
Hyperglycemia and Alcohol
Most commonly to make alcohol more palatable, sugars/carbs such as rum+coke or lemonade and even a bloody mary can have added carbs. These added carbs are usually ‘fast-acting’ meaning they can be converted into glucose much faster than other forms of carbohydrate thus raising your BG levels. When referring to high blood sugar I’m referring to any levels above 10mmol/L (180mg/dl).
Regardless of which type of diabetes you have, it is extremely important to count and monitor your carb intake and BG levels while you are consuming alcohol. Hard alcohol such as Vodka and Rum alone tend not to have any carbs in them alone meaning you will not see any rise in BG levels after consumption, however shortly after consuming a margarita or cocktail with added juices, sodas or sweetened liquors you may see your BG levels spike up and then over a longer period dramatically drop, this usually occurs once you’ve stopped drinking and have gone to sleep.
While it is important you have some insulin when consuming such carbohydrates, after a consultation with a medical professional they may advise that you reduce your usual insulin-to-carb ratios to help prevent Hypoglycemic events later on.
Throwing up while intoxicated
We have all been there and it’s horrible. If you have drunk so much that you have started throwing up, this is your body’s way of dealing with the overdose of alcohol. As a diabetic especially if you are insulin-dependent it is imperative that you closely monitor your BG levels and ketones for the following hours after throwing up.
Throwing up can lead to hypoglycemia if you have thrown up any food you’ve injected insulin for or you could potentially go into diabetic ketoacidosis (DKA) even if your blood sugar levels are within normal range. Throwing up for obvious reasons leads to dehydration which in turn can lead to DKA which is potentially life-threatening and may need emergency medical attention.
Teach your friends to never let you ‘sleep it off if you have been throwing up and gone to sleep afterwards as the hours after can be potentially life-threatening.
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What are the risks?
Whenever drinking alcohol there are potential risks to anyone. While drunk you may experience the following symptoms:
- Slurred speech
- Lack of coordination
- Behavioural changes
- Impaired judgement (This is why you need a sober friend)
- Malnutrition (Removing alcohol from your body requires energy)
Chronic alcohol use risks:
- Permanent damage to the Liver, heart and pancreas
- Shrinking of the frontal lobe (Brain)
- Increased risk of developing various cancers
The risk of damage to your body as a diabetic:
Anyone with diabetes that consumes alcohol regularly has a heightened risk of developing diabetes-related complications:
- Liver damage or cirrhosis
- Retinopathy (Damage to the blood vessels in the eyes which impair sight)
- Neuropathy (If you already have a form of neuropathy you may experience even worse symptoms of it)
- Increased level of triglycerides (More free fatty acids in the blood which can put you at risk of a stroke)
- Increased Blood Pressure
If you are a newly diagnosed diabetic or have some trouble managing your sugar levels effectively, you should seriously consider whether drinking alcohol is safe for you, if you are uncertain ALWAYS talk to a medical professional that knows you and your history for advice.
What diabetics can tell you…
If you or a friend has a chronic illness and wishes to contribute to this section of the blog post be it publicly or anonymously please feel free to do so via our Contact Us form (if you want to remain anonymous you can just fill in your name as ‘anon’) and don’t spare the details on the advice even if it feels very specific, it could help someone somewhere.
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