Alcohol and Type 1 Diabetes

Of course, your parents and healthcare providers have probably already told you they wish you wouldn’t drink. For starters, drinking under age 21 is illegal in most states, and for a person with type 1 diabetes (juvenile diabetes), there are serious health risks. But the reality is that many teens and college students do it anyway. If you are one of them, consuming alcohol as safely as possible–by staying awake and aware–is key. Some other tips:

  • Keep your glass half full. That way, when a refill is offered, it’s easy to say, “Thanks, I’m fine for now.”
  • A good rule of thumb is a two-drink limit. And eat something before you go to bed.
  • Getting smashed can lead to serious consequences–including low blood sugar hours later, if you pass out without eating. If you do drink too much, make sure the friends you are with don’t just let you “sleep it off.”
  • Hung over? Throwing up? Not eating? You still need your insulin–it’s the same as when you’re sick.
  • Best idea–drink with friends who know you have type 1 diabetes. If you’re among strangers or new acquaintances, tell someone–or play it safe and don’t imbibe.
  • Don’t drink and drive. Dangerous for anyone, the risk is compounded by type 1 diabetes and the possibility of low blood sugar.

Turning 21: Advice on Drinking

A college student with diabetes recently wrote to the following to the Online Diabetes Support Team.

Question: I am not sure how to put this… I was diagnosed a little over two months ago. I am 20 years old and turning 21 on Thursday. I am getting quite torn about the drinking thing. I am just wondering how much people drink with diabetes…and if there were any “special occassions” where you have drunk more.

Answer:  Hi, my name is Melissa. I turned 23 last week; I’ve had type 1 diabetes (juvenile diabetes) for 11 years, and I’ve worn an insulin pump for eight years now. I am not a doctor, so I don’t mean to give you specific medical advice, but maybe I will be of help anyway. I have had some practice drinking with type 1 diabetes–I hope some of what I’ve learned will be helpful to you…

The fundamental thing to remember about alcohol is that it is a depressant. Alcohol can raise your blood sugar when combined with carbohydrates, but it is likely to lower blood sugar if consumed without carbs. Hours later, while you are asleep or even the next day, alcohol can temporarily reduce the glycogen output from your liver so that your insulin lacks something to bounce off of. If you have insulin in your system without enough glycogen to balance it, you can easily go hypoglycemic. If you don’t feel the symptoms and/or you’re asleep when this happens, it can get ugly. If you exercised before going out for the evening, you could have a double-whammy effect because the eight- to 10-hour post-exercise low could double-up with the alcohol-induced glycogen suppression. You may want to shave a couple of units off of your evening intermediate- or long-acting insulin dose the night before to make it less likely that you will have a low blood sugar while you’re asleep that night. You should run that idea past your diabetes educator before just doing it; he or she might not agree, but it’s what a lot of people do.

My personal rules of thumb when I’m out for a big night are:

1) Have a nice meal with some fat in it before going out. Drinking on an empty stomach is not a good idea. Take the insulin you know you need for your dinner and test your blood sugar a couple of hours after the injection.

2) If I’m drinking beer, I treat every two cans or bottles of weak American lager like they’re one piece of bread and give myself insulin accordingly. With darker, richer beers like ales, I treat one bottle or glass like a piece of bread and take insulin accordingly.

3) If you are drinking low-carb beer or wine, you may still need to take some insulin. I test my blood sugar every two hours when I’m out for the night to make sure I’m not going too low or too high. If my blood sugar goes below 80 mg/dL, I drink half a glass of Coke or orange juice. I test again 20 minutes after drinking it. If my blood sugar is still kind of low, I finish the glass. If it’s fine, I just make sure to test again in a couple of hours.

4) If your blood sugar is over 200 three hours after your last injection of short-acting insulin, it is probably wise to follow the instructions you have been given for correcting a high blood sugar. When you drink on a full stomach, your blood sugar can go up. This is more manageable than having it drop very low very fast, as can happen on an empty stomach, but you have to pay attention and not let it stay high. If your blood sugar goes too high (say, above 250 mg/dL) and stays high for several hours, you can wind up in the ER with diabetic ketoacidosis.

5) I avoid tall, sugary cocktails unless I am having just one or two drinks total and then going home. It can be very hard to estimate the amount of sugar in a mixed drink.

6) I avoid doing shots of booze. I get drunk really fast from them and I don’t want my friends to have to take care of me if we all get smashed. I would not trust a drunk friend to look after me if I got a low blood sugar, either. If friends are doing shots, sometimes that means I have to look out for them, so I try to stay a bit more sober anyway!

The amount that you can drink safely depends a lot on your body weight, but also on you as an individual, what you are drinking, and how fast you are sipping. When you personally start to feel pretty drunk, which could be after one drink or three (or however many), it is probably wise to have a big glass of water for your next one or two. Speaking of water, always get a big glass of water when I order a drink at a bar. It helps me pace myself and keeps me from getting dehydrated quickly. Dehydration is bad: it makes you feel more hung-over the next day, and if you’re diabetic it can contribute to diabetic ketoacidosis.

When I am about to go home, I test to make sure I’ll get there safely. I never leave a bar with a blood sugar lower than 100 mg/dL. When I get home I test again just before falling into bed. I usually need a little while to unwind when I get in the door, so the blood sugar I left the bar with may not be the one I take to bed. If you’re lower than 150 mg/dL, you might want to have a little snack — maybe half a peanut butter sandwich and half a cup of milk, or some graham crackers with peanut butter and half a carton of yogurt. The combination of carbs, fat, and protein in either of those snacks is good for preventing night-time hypoglycemia. If you don’t like peanut butter, cheese is also good. I try to chug a whole 32-oz. bottle of water. Then I go to sleep. If you know someone who can come by your place to knock on the door (or call you) at a certain time in the morning to make sure you’re okay, one or both of those might be worth arranging in advance.

Whenever you wake up in the middle of the night, check your blood sugar and make sure that’s not the reason why. If you wake up with a quite high blood sugar, that could mean that you had a low blood sugar in the middle of the night and did not wake up during it. If that happens, correct as you have been instructed, but watch out for a low blood sugar during the day.

If you have any other questions about type 1 diabetes that I might be able to answer, please feel free to send ’em my way…