Got questions about life with diabetes? So do we! That’s why we offer our weekly diabetes advice column, Ask D’Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. This week, takes on a nuanced question about how diabetes and alcoholism may share the same genetic link, and whether both can be passed down through the generations. Read on…

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

 

Cathy, type 3 from Nebraska, writes: I have observed a high coincidence between alcoholism and diabetes. I am not talking about the occasional social drink that I understand that most diabetics can have. I am talking about full-blown, falling down drunk every night, alcoholism. I have met several folks with both diseases in recovery circles. It is rumored in my family that my grandfather had both conditions and the combination killed him. He was in the hospital for his diabetes and some drinking buddies brought booze to him in the hospital. He died. I remember being a little girl and waving to him on the sidewalk outside the hospital. I was too young to be allowed to visit in person. That was the last time I saw him. I think I was about 4 years old. Some of us have both the diabetes gene and the addiction gene. Is there a connection? 

Wil@Ask D’Mine answers: That’s such a sad story—waving to your grandfather from the sidewalk—but it’s an interesting question. And a bedevilingly complex one.

For many years experts have recognized that alcoholism runs in families. In fact, it’s well known that children of alcoholics are four times more likely to become alcoholic than folks whose parent’s didn’t hit the bottle.

But is it like father, like son (or like mother, like daughter), or bad genes?

The truth is probably a mixture of both. While extensive work has been undertaken to identify the “alcoholism gene,” and there does appear to be one, how much influence it plays is open to heated debate. After all, an alcoholism gene by itself won’t trigger alcoholism. That requires alcohol. So alcoholism, known as Alcohol Use Disorder, or AUD, in medical circles, remains a complex quagmire of social and genetic factors. The social factors, which alcohol experts (you know what I mean) like to call “environmental issues” can include stress, family history and support—or lack thereof, abuse history, work relationships, peer support groups, economic status, religion, and more.

But all of that aside, are the genes for alcoholism—if not connected—at least more common in folks with diabetes? That doesn’t seem to be well-studied. At least not directly, so we’ll need to look at this another way to try to get an answer for you. 

Now, I’ve noticed that my type 1 crowd are a pretty heavy drinking bunch, myself included. Although that said, I’m not sure that most of us are “full-blown, falling down drunk every night” drinkers. Still, why do I think we’re quick to grab the bottle? Simple: When your blood sugar is doing the funky chicken dance despite your best efforts 24-7-365 to control it, why the hell not have a flippin’ drink? It’s a culturally acceptable way of blowing off steam.

Still, are we genetically predisposed to turn to the bottle, as opposed to being genetically predisposed to turn to aroma therapy candles? That I can’t say, but I did find another type of research that serves as a spotlight on the issue, in the absence of genetic research. And it’s chilling.

Back in the day, type 1 diabetics died of diabetes. But now that medical technology has improved our lifespans, we have a new reaper. Yeah. You guessed it. Alcohol has risen to become a significant killer of people who’ve had type 1 diabetes for a while. How significant? A relatively recent study showed that alcohol kills a full 39% of T1s during their first 20 years of having diabetes.

If you compare that to the alcohol death rate for the country at large, which is “only” about 10% of deaths, you can see that we T1s have a drinking problem. But is it in our genes? There’s no way of knowing that. 

Now, what about type 2s? Some studies show that abusing alcohol can lead to diabetes. And it’s well known that if you have diabetes already, alcohol can give you a lot more trouble. But this is all squirrel cage, chicken-or-egg science showing relationships, not causes. None of the studies I found are digging deeper into the genome. Why not? Well, just to show you how complex this all is, take a look at a famous Finnish study of twins, which lasted for decades. Among other things, the researchers looked at alcohol consumption’s relationship to type 2 diabetes, and what they found was intriguing, to say the least. PWDs who drank moderately actually had a reduced risk of diabetes; while binge drinkers had an increased risk of diabetes. 

As Paracelsus said, “Sola dosis facit veneum.” Roughly translated: “The dose makes the poison.”

So… wouldn’t you expect purely negative outcomes if AUD genes were part and parcel of type 2 diabetes? Going beyond that, if AUD genes were really part and parcel of type 2, I wouldn’t expect there to be a large group of moderate consumers of alcohol in the sample at all. I’d expect all of them to be full-blown, falling down drunk every night consumers.

My feeling is that, given the death rates from alcohol in T1s, perhaps the AUD genes may be more strongly associated with T1 than average. The reason I say “perhaps” is that it’s equally possible that instead, we simply have a gene that makes us more susceptible to the potentially fatal side effects of alcohol. Or that, given the complexity of diabetes control with exogenous insulin, we are more prone to bad outcomes after drinking. On the other hand, given the data we see on type 2s, I’m not thinking that T2s are any more likely than anyone else to have alcoholic genes. So, my best guess is that there’s no connection between T2 genes and alcoholic genes, while there might be one for T1s.

But here’s something else to consider: Diabetes in any flavor is a huge stressor; and in our country booze is the number one self-prescribed stress reliever. Genes aside, given a chronic stressor that requires chronic stress relief, I suspect that diabetes—without any other genetic help—can lead to alcoholism. In short: I suspect alcohol abuse is heavier with all D-folks, but not necessarily caused by our genes. 

Now as to your grandfather’s demise, I’m not sure that I agree with the family rumor. At least, not in the sense that his drinking buddies bringing him booze in the hospital resulted in killing him outright. While the combo of diabetes and booze probably did kill him, it didn’t happen in a single visit. I suspect that he was well on the way to the next world before the boys showed up with the booze.

I’m willing to cut his friends some slack here. They did what they thought was right, out of an odd sense of love and kindness. They simply did what they’d want their buddies to do for them if they were in the hospital. Isn’t that what we all do?

And if your grandfather was as bad an alcoholic as you indicate, he was probably glad of the visit, and savored his last drink.

 

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. Bottom Line: You still need the guidance and care of a licensed medical professional.