A frequent question at this time of year for people with diabetes is: can I have a drink of alcohol? If the answer is yes, then what do I need to do to be safe?
The answer to this as a general rule is yes providing you have been managing your diabetes well and can drink in moderation. The guidelines for drinking with or without diabetes are the same: no more than two standard drinks per day with a maximum of up to 14 a week for men and up to nine standard drinks for women per week. However, with diabetes you must be more cautious because of how the alcohol interferes with diabetes management. Today, I want to discuss how we need to understand the role of alcohol on our management as it is a bit more complicated. A standard drink could be 12 ounces of 5% alcohol beer or 5 ounces of wine at 12% alcohol.
How does alcohol influence the management of diabetes? Under normal circumstances the liver’s job is to regulate the glucose production which helps stabilize and keep constant our blood glucose level. When you drink, the liver recognizes this alcohol as poison and responds by flushing the alcohol from your body, which results in the liver not being able to release glucose when required. Glucagon, that we might normally use for severe hypoglycemia, will not help treat alcohol-induced hypoglycemia. Hypoglycemia can happen immediately or up to 24 hours after drinking. People may think you are drunk when you are experiencing hypoglycemia.
Keep in mind that alcohol has no real nutritional value and adds calories to your daily eating plan. Alcohol interferes with the brain’s communication pathways, and this can interfere with the way the brain works. This disruption can change our mood and behaviour and make it hard to think clearly and move with coordination. (sounds similar to what hypoglycemia does to our brain).
Many symptoms of hypoglycemia and intoxication are the same. Some examples include: blurred vision, slurred speech, confusion, weakness, irritability, combativeness and unconsciousness (2). If you use insulin or oral medications that increase the production of insulin for diabetes management then the risk of hypoglycemia is increased because these medications will continue to work to lower your blood sugar. Remember, the liver can’t come to your rescue.
Hints on drinking safely are found in several references if you do a internet search.
I prefer to follow guidelines set out by respectable references based on scientific knowledge such as Diabetes Canada, The American Diabetes Association or many other health care institutions or referenced blog sites. Please note that the Canadian and American recommendations are not the same.
Some ideas for safe drinking:
Do not drink on an empty stomach. You should always eat your meal or at least have a snack. One idea is to ingest some slow acting carbohydrates or foods that have a low glycemic index. You will need the carbs later on to prevent hypoglycemia.
A lot depends on how much you drink and what else you are doing while you are drinking, for e.g. dancing, playing darts or pool all use up those extra carbohydrates.
Drink slowly. Alternate between an alcoholic and non-alcohol beverage.
Know your alcohol. If you are going to a bar ask what percent of alcohol it contains if you are not familiar with the product.
Pour your own drinks. This allows you to use less alcohol and dilute your drink more than if someone else was doing it for you. Pay attention to what the alcohol is mixed with, for example, orange juice, diet pop or one of the many other choices. If there are no carbohydrate foods available, then use a standard soft drink or juice to mix with your drinks.
If you are counting carbohydrates, do not take insulin for the carbohydrate content of the alcoholic drinks.
Have some form of hypoglycemic management with you at all times.
If you are thirsty choose another beverage and not alcohol to quench that thirst.
Check your blood glucose throughout the event. If you see a trend to either hypo or hyperglycemia you can act faster to prevent the 911 call.
If at all possible don’t drink or go alone. If this isn’t possible, be sure your host knows you have diabetes and what to do if any of the symptoms of hypoglycemia were to occur, ie. confusion, slurred speech, chills, clamminess, etc.
While you may think the low sugar alcohol drinks are better for you, they often contain more alcohol in them. Read the label or ask the server.
Be careful as there may be what is called hidden sugars in the product. It might only give the carbohydrate content, but remember that carbohydrates are converted to sugar(s).
Always wear or have some form of identification. I feel this is one of the most important things we can do for ourselves.
Have someone call you the next morning to be sure you do wake up and you can then check your sugar and eat your breakfast (maybe even go back to bed).
Talk to your diabetes health care team about drinking.
Avoid drinking large amounts and drinking often.
Alcohol may interact with diabetes medications or other medications you may be taking so always check with your pharmacist or physician if there is a risk of interference with the action of your drugs.
As always with diabetes, you must think and plan ahead. The extra effort is worth it and gives you the chance to enjoy events the same as those without diabetes.
Frequent drinking is not recommended for any population and can become a serious health problem. If you or you know someone who might fit this category please reach out to them and convince them to seek help.
Happy Holidays and please stay safe
My next blog will be on January 9th, 2021. If you have ideas for topics or a question you need answered please send it to me at: karenmaccurdythompson@gmail.com
“Note: The information provided here does not replace medical advice from your health care team of experts.
References:
1) Beyond Type 1- Alcohol and Diabetes Guide
2) Diabetic Emergencies vs Alcohol Intoxication GFR Training – accessed December 13th,2020
3) Diabetes Canada- accessed December 13th,2020
4) Healthline- accessed December 13th,2020
5) Living with Type 1 Diabetes knowledge