I was delighted to attend the TCOYD conference in Santa Clara on March 7, and give a talk about online resources. But even better for me was the chance to attend some of the excellent Type 1 Track sessions, including Dr. Jeremy Pettus’ talk on Alcohol and Diabetes – and how to mix them safely.
He kindly gave us the green light to share his tips on this sensitive subject just in time for St. Patrick’s Day, a holiday closely associated with imbibing.
Note that Jeremy is both an endocrinologist at UC San Diego and a longtime type 1 himself. (You may remember him as TCOYD director Dr. Steve Edelman’s colleague helping create that online community for professionals living with and working in T1D.)
Jeremy reminds us heartily that these are his own tips based on his personal experiences, as there is a sore lack of clinical data about the mix of alcohol intake and type 1 diabetes (Hello researchers – huge opportunity here!)
Dr. Jeremy Pettus, Endo with T1D, on Diabetes & Alcohol –
First off, don’t go looking for scientific studies on alcohol consumption with type 1 diabetes -- there’s just no data to go by. So here’s what I know:
Obviously, consuming large amounts of alcohol is BAD, and can lead to: liver disease, heart disease, high blood pressure, pancreatitis, and/or horrible decisions (that can end in divorce, jail time, etc.)
But we’re talking about moderate alcohol consumption here. How is that defined? Experts say women should have no more than one drink per day, and men no more than two drinks per day.
To be clear, one drink is: 12 oz beer, a 5 oz glass of wine or 1 ½ oz distilled spirits.
It’s important to know what you’re consuming as well. So how many carbs and calories are found in beer? Some examples:
- Amstel Lite contains 95 calories and 5 grams carb
- But a dark beer, like Guinness has 126 calories + 10 carbs
- Budweiser has 145 Calories + 10.6 carbs
- A really “good beer,” from a popular microbrewery, probably contains about 219 calories + 20 carbs
The general rule of thumb is: the darker the beer, the more calories and carbs it contains.
Wine is on average 120 calories + 5g carbs. White wine is thought to be a little higher-carb than red, especially the sweeter-tasting varieties.
Hard alcohol, straight up = 69 calories + 0g carbs.
That’s right, hard liquor contains zero carbs. But when we’re talking mixed drinks (which are sugary!!), the average skyrockets to 526 calories + 61.3 carbs per drink.
Apps like Calorie King can help you look up your favorite beers, btw:
So generally speaking, one beer is about one of those old-fashioned carb servings -- or 15 grams of carbs – and one glass of wine is about 1/3 carb serving, or 5 grams of carbs.
BUT don’t bolus for the full amount! Because alcohol (minus any sugary syrups in cocktails) generally makes your blood sugar go down.
That’s because alcohol prevents your liver from releasing glucose, so you often will go low, BUT just to complicate things, that usually happens overnight or the next day.
Some tips on how to stop the BG rollercoaster:
- Always eat something before drinking
- Avoid sugary mixed drinks
- Bolus for alcohol, but HALF what you normally would for the carbs
- TEST A LOT (before drinking, while drinking, before bed)
- If not on a pump, ALWAYS take your basal insulin (maybe even before you go out)
- Lower temp basal overnight or reduce your basal Lantus/Levemir dose by 20% or so
- Take smaller boluses the next day
- Set an alarm in the middle of the night (3 AM) to check BG
- Don’t bolus right before bed
- If you don’t have one already, GET A CGM
- Allow yourself to run a little high while drinking to avoid lows: target range 160-200mg/dl
In case you’re wondering (and in case of emergency), glucagon still works while drinking! The effect may be reduced, but it can still break down remaining glycogen in your system.
So the bottom line is: If you need it, use it!
Other safety tips:
- Have a “drinking buddy” who knows about your diabetes
- Wear a medical alert bracelet (seriously, do this)
- Don’t be embarrassed about testing at the bar
- Eat before going to bed if your BG < 180mg/dl
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D-Teens and Alcohol: No Bull from Uncle Wil (special edition Ask D'Mine column)
Drinking with Diabetes (community resource site)
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Thanks so much, Jeremy, Oh Wise One… Happy St. Patrick’s Day, and safe imbibing, D-Friends!