Wil Dubois

Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil explores what's brewing (!) in the world of alcohol and diabetes, particularly when it comes to craft beer and the blood sugar effect. Depending on the time of day you're reading this, maybe you'll enjoy a brew of your own while reading along, or perhaps a cup of coffee or tea. Either way, hope you enjoy what Wil has on tap (pun intended) for this weekend.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

KC, type 1 from Idaho, writes: Hi, Wil, thanks for all the practical advice and support you give us PWDs!! My questions have to do with... alcohol! First off, what I can’t figure out is how and when to bolus for a pint of our loAsk-DMine_buttoncal microbrewery’s fine products. I like the Hefeweizen in summer and Dunkel in late fall/winter. I know that both these styles have more carbs than the average American lager... but how much? And is 20 minutes enough lead-time, assuming I’m at or near target? The other question has to do with alcohol metabolism. I’ve noticed that if I have a couple (or 3!) glasses of wine at a party or with dinner, my BG tends to drop early in the morning between 4 -7 a.m. and then I need more carbs for breakfast that morning and sometimes on through lunch (depending on my activity level). Any idea why this happens, and is it pretty normal for PWDs who use insulin? Is there anything I can do to avoid the early morning drop? Cheers!

Wil@Ask D’Mine answers: For all the practical advice and support: You’re welcome! And thanks for writing in with this great question. There’s no doubt at all in my mind that PWDs who are winos and whiskey hounds have the advantage over the beer lovers. That's because a good craft beer has the dual challenges of alcohol and carbs. Oh, and the better the beer (and the more of it), the greater the challenge.

But not to worry. I’ve got your back. At least until it hits the floor. 

Now, for readers who are winos like me, we need to set the stage on your preferred beer types. Your summer weapon of choice, the Hefeweizen, is a wheat beer, so it might entail a third challenge as wheat has a funny blood sugar effect on many type 1s, even those without celiac. BTW, the German Beer Institute informs us that we English speakers are to pronounce it, “hay-fuh-veyt-sssenn,” and NOT to mispronounce it “haffie-vi-zon!”

BeerAdvocate.com describes the taste of hay-fuh-veyt-sssenn as having, “flavors of banana and cloves with an often dry and tart edge, some spiciness, bubblegum or notes of apples.”

Except for the bubblegum notes and the cloves, it sounds like a lovely breakfast.

The alcohol level is 4.7%. Calorie King lists an ounce of typical Hefeweizen has having 13 calories and 1.1 carbs. Of course, how many ounces are in your “pint” of beer can be highly variable. A proper pub, being an English tradition, would use the Imperial Pint, which contains 20 imperial fluid ounces. An American pint, on the other hand, is 16 US fluid ounces. Adding to this confusion is the fact that the Imperial ounces and US fluid ounces are not the same size. The Imperial ounce is about 28 mL; while the US one is about 30 mL.

Well, it’s much too early in the morning for this level of math, and I haven’t had my Hefeweizen pancakes yet. So for the ease of comparison among various brews, let’s just split the difference and assume your glass has 18 US fluid ounces. One glass would have 234 calories and just under 20 carbs. Drink three and you are looking at 702 calories and 60 carbs, about what a good steak dinner would weigh in at.

You asked how that compares to the average American lager. I’m not sure what the average American lager would be, so instead, let’s compare it to an average American beer. Last year, by far the best-selling domestic beer in the United States was, believe it or not, Bud Light.

OK. I didn’t see that one coming, either.

Bud Light has 9 calories and one half of one carb per ounce. The same glassfull as above has 162 calories and 9 carbs. Put another way, the Hefeweizen has double the carbs of America’s leading brew, and about a third more calories. The Bud has an alcohol level of 4.2%, slightly less than the Hefeweizen.

The Dunkel is a darker lager with a higher alcohol content of up to 6%, which puts it at the higher end of the beer family. (Wine usually clocks in at 13.5% and spirits commonly at 40%.) Interestingly, however, it has the same number of calories as the wheat beer, coming in at 13 calories, but at 1 carb per ounce, it has a slightly lower carb count. Back to our one “pint” glass, we’re looking at 234 calories and 18 carbs.

So really, in terms of diabetes impact, the only practical difference between the two lagers is the alcohol content; and both have quite a few more carbs than a “typical” American beer. Of course, your microbrew may vary.

Now, on to how to bolus. Lager is a liquid carb. That means it’s likely to raise your blood sugar faster than your insulin can lower it. An ideal pre-bolus would be 30 minutes for carbs moving this fast, but it’s hard to time things that well in a drinking environment. I’d say a good functional rule of thumb would be to bolus each pint, based on its carb count, when you order it. It won’t be perfect, but it will at least keep a major excursion at bay.

Don’t forget to tip your kellnerin (waitress), but don’t over-tip. You don’t want her getting that pint back to you too quickly.

For more on beer boli, see the Great Beer Experiment from our own Mike Hoskins, who tried out a number of different craft beers and tested the blood sugar effect for each style.

As to the dawn drop in blood sugar, that’s what alcohol does 8 to 10 hours downstream to everyone, not just for people with diabetes, although for us it’s more profound. Why? Alcohol metabolism takes place in the liver, which is also the point for glucose production, and apparently when the liver has too much to drink it forgets to work on that whole glucose thing. This is where you need to think about the alcohol content of your weapon of choice for the night. The more alcohol, the greater the blood sugar drop downstream, often when you are asleep. So you need to think not only about how much alcohol is in each pint, but how many pints you are going to drink.

Said another way, if you are thinking about drinking a lot of pints, you’re better off drinking the ones with lower alcohol contents.

The best way to offset the alcohol-infused blood sugar drop is to eat a high-fat, lowish-carb bedtime snack right before you crash for the night. The idea is to have some carbs slowly infusing into your blood to stand in for the liver until it recovers from its hangover the next morning. This is one of those times when those vexing slowly-digesting fats can actually be deployed to your advantage.

Now that’s something to drink to!

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.