Idly looking over a pamphlet on insulin the other day, I noticed a warning that persons using it should moderate their alcohol usage. This didn’t surprise me, as I got a similar warning about taking glyburide (which stimulates my lazy ass pancreas to make insulin like a normal person’s, or rather would if I took any more) when I was first diagnosed with diabetes, years back. I didn’t pay much attention to that admonition back then, as I drink so little that it didn’t seem significant. But I’d assumed that the warning was to help avoid high blood sugar. Looking more carefully at the pamphlet, I was surprised to see that hypoglycemia, not hyperglycemia, was the concern here.
I was cautioned to never, ever, ever dose insulin for alcoholic drinks, but in my experience, that’s a sure fire way to end up with high blood sugar at the end of the night, not low. For me, at least, the blood-glucose-lowering aspect of alcohol is mild at best.
Of course, it depends on the drink (and the person). I drink almost exclusively beer & wine, rarely hard alcohol. The beer I drink tends to have about 1 carb per ounce, so your standard 12 ounce beer has about 12 carbs. If I don’t dose for beer, I’ll be well into the 250s after a couple beers. And no, I don’t crash later on. I’ve done extensive research into this Heck, beer so steadfastly leaves me with higher blood sugars that I’ve (close your eyes, Qadgop and other doctors!) used it occasionally as a correction for low blood sugars.
Wine… ah wine… lovely wine. It appears to have the perfect mix of blood-sugar-raising carbs and blood-sugar-lowering alcohol. At least, I don’t have to dose a bit for it, and at the end of a night spent savoring a nice bottle of wine (with friends, not all for me!) I always end up with nice blood sugar numbers. Before I was actually on insulin and was really struggling with high blood sugar, I used to call it “winsulin” because it seemed to have such a nice effect on my glucose levels.
Caveats: I rarely drink alcohol without eating as well, and though I drink most every day, I don’t drink to excess, and I never drink alone, and if I do screw up the wonderful Mr. Athena is there to cover me (that’s never happened, Thank God!) Everyone is different. I’m not a doctor, and you sure as heck shouldn’t listen to me about anything alcohol and blood sugar related. And it’s stupid as hell to correct a low with a beer. I never said I was smart.
I was just pondering something else related to alcohol & insulin.
I read on occasion blogs/forum posts from other diabetics on insulin, and some people have horrible problems with lows if they drink even one or two drinks. These people also tend to be people who don’t drink often - only on special occasions or whatever. I’ve often wondered if there’s a correlation between alcohol tolerance and the blood-glucose-lowering aspect of alcohol. I’ve never seen that mentioned, though.
It seems like it’d make sense, as someone who is not used to drinking gets tipsy after only one or two drinks. Whereas someone like me - who drinks regularly - can have the same number of drinks but not feel it. Could the glucose thing be similar?
Obviously this is completely anecdotal evidence. What I’m looking for is real evidence or studies. Anyone got any?
I just want to point out that this is really important: low blood sugar often leads you to act drunk, or, at least, it did my friend who has Type I. The symptoms could mimic each other, so you have to be really careful.
Research on me with my endocrinologist has shown that in my case alcohol with a meal seems to paralyze stomach emptying, which causes a short-term low (requiring juice or glucose to raise it), which then is followed by high blood sugar later when the stomach starts working again. As a result, I try to only drink between meals, and I do need to correct for the carbs in alcohol or else I will always go high.
There are a number of reasons why drinking alcohol is dangerous for someone who’s using insulin or taking a medicine like glyburide.
If the person gets drunk, their awareness of the early, warning symptoms of hypoglycemia can be impaired or unappreciated. In other words, in the setting of alcohol ingestion, hypoglycemia can become quite far advanced before the person becomes aware of it (if, in fact, they even do) and knows to take corrective measures.
Bystanders may attribute any change in the person’s behaviour as being from alcohol and not from hypoglycemia (and, as a result, they may not intervene, when such intervention may have possibly been life, or brain, saving).
Drinking alcohol may muddle a person’s mind to the extent that they forget to eat, or eat the wrong type of things. This can promote the development of hypoglycemia (and, of course, alcohol may also confuse a person about which or how much insulin or glyburide to take. Again, this can promote hypoglycemia).
Critically, alcohol impairs people’s ability to synthesize sugar in their liver in response to hypoglycemia. In other words, all of us normally have the ability to counteract hypoglycemia by virtue of our liver making sugar. In the presence of alcohol, the liver’s ability to produce sugar is blunted or even absent. As a result, hypoglycemia in such a circumstance can become protracted and severe (leading to brain damage or even death).
