Diabetes and Alcohol: A Realistic Approach

It is unrealistic to think that all diabetics should only eat and drink what is good for them. We all need a little badness in our lives and this often comes from a drink or two (or three, or four or more!). But if you have insulin dependent diabetes it can be a difficult thing to achieve.

Diabetes and alcohol have a very strange relationship that is not easily controlled but with a little knowledge of the science behind it and a solid knowledge of how diabetes reacts to it, you should find that you can enjoy alcohol without worrying about side effects dangerous .

Alcoholic drinks contain varying amounts of alcohol and sugar and therefore different drinks will have different effects on the blood sugar level, some will cause a large increase, others will barely. The biggest side effect to consider is that alcohol can cause low-profile delays due to its ability to temporarily impair primary liver function - blood sugar regulation. The way alcohol affects you personally can only be discovered by monitoring the effect it has on blood glucose levels.

First, the obvious things: the (recommended) healthy limits for alcohol are

Up to 3-4 units per day for men

Up to 2-3 units per day for women

(1 unit = 1/2 pint of beer, 1 glass of wine or 1 pub measure (25 ml) of spirits). I would also recommend having at least 2 days without alcohol per week.

Obviously there will be times when you drink more than this, but it's still worth noting and using as a solid base.

Secondly, there is no "good" drink. Choose what you want based on what you like, not for some hearsay that it is better for your diabetes. I was once told that Pilsner beer was a better choice for diabetics because it was "low in sugar". I have a word for that little nugget of wisdom, bollocks. Alcohol is not good, but that's not why people drink it. Its main attraction and enjoyment lies in modifying consciousness in small or large measure. It may not be good for the body, but it can be good for the soul (let's be clear, I'm not claiming to go out and be swept all day. I'm just looking at it realistically).

Carbohydrate content

Wine - 0 g per glass

Spirits - 5 g per glass

Beer / Lager / Stout / Cider - 10 g per pint

Alcopops - 20 g per bottle

Liqueurs - 5 g per measure

Non-alcoholic drinks contain only carbohydrates and are similar to the consumption of normal sugary drinks (eg Coca cola). They will increase your blood sugar level and are not a great choice if you have diabetes (they also taste terrible!)

There are many strategies that can be used to maintain a balanced blood sugar level. One of the most common is not to act for the first 10 g of carbohydrates, so take 1/2 units of insulin for every 10 g of carbohydrates thereafter. It's all right, but if you use MDI therapy you'll end up getting a lot of injections on an evening out! No fun, ultra annoying. It may work better for pump users but even then I'm not a big fan of it.

Suppose you know that the background insulin is correct and that the carbohydrate ratios are also stable. I will share with you my method which I found very reliable for me.

The general pattern with alcohol is that when you drink your blood sugar level it will go up, sometimes quite high. Then several hours later he will come back almost alone (the delayed hypo effect). If you know, you can plan ahead. If you drink less than 2 units of wine / spirits or 1 unit of beer, you should find that you don't have to act at all.

So here's what I normally do. My MDI regimen is 2x doses of Levemir in combination with novorapid for meals. On a normal evening I would have 3-4 drinks (usually lager and sometimes a warm port!)

I will try when I get home and usually I will see that this combination will increase my levels in double digits and possibly up to 14 mmol. Now the initial thought would be to take novorapid to correct it up, but this would be a mistake as it is a false reading. Remembering the risk of late onset, I will consume 25-35 g of carbohydrates before going to bed without a novorapid bolus. Before repeating the test in the morning, around 7: 30-8: 00, my levels should be between 6-8 mmol. The extra carbohydrates have counteracted the hypoglycemic effect of alcohol and prevented serious minimums. The following morning I have always found that my insulin sensitivity increases and I will need 10-20% less insulin to cover any breakfast carbohydrates (this effect can sometimes last even longer than noon)

This is a method that works well and means that you can enjoy social life without diabetes being part of it. Follow some simple rules:

• know your reactions to alcohol by testing, recording the results and identifying the models.
• expect hypos, this way you will protect yourself from them. Also try not to exercise before drinking, the blood sugar lowering effect will be amplified.
• do not overdo it. The more alcohol you consume, the more unpredictable the result. And having a hypo is much more difficult to identify or deal with if you've been compromised by drinking too much.

So hopefully it's real-world help on what's often a difficult topic. If you need any advice on this, don't hesitate to contact me. And I'll end with a quote from one of the greatest minds of the past 100 years:

"To alcohol, the cause and solution of all life's problems!" Homer Simpson

Enjoy your health (and health!)

Chris
YD