Alcohol and diabetes. Never a more timely topic than this week. Please enjoy today's guest post responsibly ;)
A Guest Post by Hope Warshaw, nutrition expert and CDE
St Paddy's Day 2010 is just days away. Thinking of gulps of green beer or Guinness Stout, or sips of Irish whiskey or Bailey's? Alcohol, in its many forms, is at-the-ready for pouring to mark holidays, family events, religious holidays and myriad annual festivities. St Patrick's Day is just one day among many.
Do you wonder: Can I drink alcohol? If so, how can I sip it safely and responsibly? Let's cut to the chase and talk straight.
Diabetes and alcohol? Yes, they can mix? If (oh yea, aren't there always ifs), you don't have/have had a problem abusing alcohol or medical reasons or problems (related to or beyond diabetes) to avoid alcohol. All clear? Then you're welcome to belly up to the bar for a moderate amount of alcohol. How is moderation defined by the experts? One drink a day for women and two for men (One drink is defined as: 12 oz beer, 5 oz wine, 1.5 oz distilled spirits).
Let's dive deeper...moderate amounts of alcohol, when sipped along with some food, has little impact on your blood glucose. However, hyperglycemia (high blood glucose) can result due to the added calories from mixers which may be added to drinks - regular soft drinks, tonic water, fruit juice, syrups, etc. — and calories from foods you eat, along with the sips of alcohol.
On the flip side, alcohol can cause hypoglycemia (low). Whether alcohol does so has nearly everything to do with whether you take blood-glucose lowering medication(s) and which ones you take. Here's the quick physiology lesson: alcohol can increase the glucose-lowering effect of insulin as well as several oral medications (ones that stimulate the pancreas to put out more insulin). Hypoglycemia can happen because alcohol slows down the liver's ability to breakdown glycogen (stored glucose) and supply glucose (from stored energy) to keep blood glucose on an even keel.
Hypoglycemia can occur soon after you drink alcohol if you've not had much food to eat to raise your blood glucose and/or the blood-glucose lowering medication you've taken is at peak action (e.g.: an hour or so into the action curve of rapid acting insulin) and you've downed more than a few drinks.
An often missed detail is that alcohol can cause hypoglycemia a number of hours post drinking. This is due to the impact noted above on the liver and because of the greater chance to begin with (without alcohol on board) of hypoglycemia during the night due to hormonal changes.
Think back: have you had a low or two from over celebrating at previous St. Patrick's Day or other times of alcohol overindulgence? Has it been immediate or several hours after you've finally fallen into a sweet slumber? Your answer is likely several hours later.
If you have type 2 and don't take blood glucose lowering medications that typically cause hypoglycemia, you're unlikely to experience it. Your concerns with sipping green beer or other liquid concoctions should be the excess calories and risk of hyperglycemia.
• Don't drink if your BG is low or headed low. Eat something to raise it before you start to drink.
• Carry BG testing supplies. Check your BG more often. The results will help you prevent lows and get ahead of impending lows. In addition, BG checks can help you gather data about the effect of alcohol on your body for future reference.
• Be prepared to treat a low by having hypoglycemia treatments handy. Don't count on these aids being in close proximity when you need them. Easy to tote foods are hard candy, Lifesavers, boxes of raisins or juice. Sources of pure glucose may work even quicker, such as tablets, liquid, or gel.
• Check your BG before you drive after you've had alcohol. Make sure your BG is in a safe range and you are competent to drive. If your BG is headed south (low), eat carbs to raise it.
• Don't hit the pillow for the night without checking your BG. Eat if you are low and/or think you haven't eaten enough in the last few hours.
• Wear medical ID. A bracelet or necklace is best. Realize the symptoms of intoxication and hypoglycemia can be similar.
• Educate people you are with about your usual signs and symptoms of lows. Let them know how to help you should a low that you can't handle alone arise.
With these tips in tow and, of course a bit of Irish luck, sip one or few this St Patrick's Day and at many more of life's celebrations, but please do it safely.
- Hope Warshaw, MMSc, RD, CDE
Hope is author of numerous ADA-published books on diabetes and nutrition, including Diabetes Meal Planning Made Easy.