Diabetes and Drinking - Part I: If You Choose to Drink
_A note from Dr. Cogen: _
_When thinking about the long list of issues today's teens must face, alcohol use is near the top. The pressure from friends to drink can be overwhelming. Ginger and I would like to provide medically correct information about alcohol and how it affects you and your diabetes management. Clearly, in an ideal environment, we want you to choose to engage in only healthy behaviors. But if you are currently struggling with this decision or have already made the decision to drink, we would be doing a great disservice to you (and your families) by choosing to ignore this topic, especially since this behavior is potentially dangerous. _
I know you've heard this a million times before, but remember to keep the following things in mind as you read this blog:
- The legal drinking age in the United States is 21 years
- If your caught breaking this law, consequences include: fines, jail time, community service and driver's license suspension.
- Alcohol use puts you and others at risk for getting hurt.
Ginger: Realistically, I know you may choose to drink alcohol as an underage person with diabetes because-guess what-I've done it too.
Right up front, I'm going to tell you one of the best decisions I ever made for both my physical and mental health was to stop drinking alcohol.
And I know you've probably already heard the "scare them so they don't ever drink" speech from your doctor. (Dr. C: This isn't always the best approach, but we try to be as direct and honest as possible) I've heard it too, and it didn't work on me either. The decision to stop drinking was completely my own.
But this is the thing, coming from a college student with diabetes (not a doctor) who chose to drink occasionally on the weekends with friends-it is dangerous, and you have to be careful. If you choose to drink (Dr. C:keeping in mind the above disclaimer), why not choose to do it wisely because the risks are serious.
ALCOHOL AND YOUR BLOOD SUGAR (Ginger and Dr. C)
Alcohol-all kinds, beer, hard liquor, wine-effect your blood sugar in two primary ways:
- There is sugar in all kinds of alcohol. Some have more than others (and all of this can be found on nutrition information web sites), but even if you're drinking a hard liquor with a diet soda, you are still consuming a significant amount of sugar in the hard liquor. You need insulin to cover those carbs, right? Makes sense....
- However, the actual alcohol part of these drinks has a delayed effect on your blood sugar: it can lower it! This is because the liver is trying to get rid of this toxic chemical (yes, all bodies see alcohol as poison) and is doing everything it can to clear it out of your system. (Dr. C:Because the same metabolic pathway in the liver is used to break down stored glucose to provide energy, it is unable to do so while "detoxifying" the alcohol. Therefore, it also has stopped your body from producing any glucose. This becomes an even greater problem if you do not eat when you drink.)
Ginger: So...does that mean you can simply not take any insulin with your drinks and you'll be fine?
NO! It isn't that simple!
In fact, there's really no perfect solution to this-the whole thing is a big guessing game and is totally different from person to person. And after about two years of drinking (one underage, one legal) I can't say I ever actually figured out how to maintain perfect blood sugars while doing it. And I can tell you, once or twice I definitely risked having a really bad high or low because I had so much to drink I wasn't able to keep an eye on my diabetes. Here comes the dangerous part.
WHAT ARE THE RISKS? (Ginger)
- If you drink too much, to the point where you're drunk to any degree, you are not going to keep a close eye on your blood sugars. This becomes even more complicated when you think about the impact of your drink on your blood sugar. If you're drunk, can you really think logically about how much insulin you should take based on the carbs in the drink and the alcohol that will lower it later on? Are you going to remember to take your insulin at all? Or test yoru blood sugar an hour later to see how you're doing?
- Let's say you forget to take your insulin-which is very possible considering you've been drinking or maybe at a party surrounded by friends. You may be eating pizza or other junk food along with it (which adds another complication to how much insulin you need to take). So now, you've forgotten to take your insulin or you've taken a miscalculated amount; who is watching your blood sugar? Your friends? Is that their responsibility? Is it fair to expect them to save you when you start seizing due to low blood sugar resulting from drinking?
- Dr. C:What if you have not given yourself enough time to sober up and decide to drive home? Not a good idea. Why? First, you may have impaired judgment due to being drunk or from low blood sugar. You are at high risk of a traffic accident or driving erratically. Second, if stopped by the police, they may assume you are driving under the influence. However, the same symptoms associated with alcohol excess may be the same as having low blood sugar. And, if they don't know you have diabetes (another reason why you need wear some form of ID), they will not know to give you carbs to treat your low. This places you at risk for a severe low or hypoglycemic seizure and a visit to the police station.
- And of course, don't think the effects of alcohol really stop affecting your body the next day. You may have a hang-over. You might classically crave junk food to soothe a nauseous stomach. You might not want to get out of bed until three in the afternoon. It all sounds like a recipe for really high blood sugars, if you ask me!
- Other risks of drinking regularly:
- Weight gain: there are lots of empty calories in alcohol!
- Liver damage: your liver works really hard to flush it out of your system as quickly as it can because it sees alcohol as toxic
- Very out of control blood sugars: it is hard to maintain healthy blood sugars if you're drinking regularly because you are, quite simply, harming your body, stressing your body, adding a lot of unneeded sugars and poisons that your body has to work really hard to get rid of (and it definitely can't always do this, which will lead you and even people without diabetes forced to go to the hospital to have their stomachs pumped-free of the alcohol).
IF YOU ARE GOING TO DRINK (keeping in mind all that you have just learned)** Ginger:** It's pretty clear that drinking, whether you have diabetes or not-isn't safe. But if you're going to drink, let's think clearly about how to be as safe as possible.
Ginger and Dr. C:
- EAT FOOD WHILE YOU DRINK: drinking on an empty stomach speeds up the amount of time it takes for the alcohol to get into your system, the amount of time it takes for it to affect your blood sugar (first raising it, then lowering it by using that common metabolic pathway in the liver), and the overall impact it can have on your body's sensitivity to it.
- CHECK YOUR BLOOD SUGAR OFTEN: of course, this goes out the window as soon as you're too drunk to remember to check your blood sugar...but the variables are endless when it comes to drinking and diabetes, so the more often you check, the better you are.
- TAKE YOUR INSULIN: like above, you could easily forget this as soon as you're too drunk, which leads us to the next thing.
- DON'T GET DRUNK: Try to limit yourself to an amount of alcohol that doesn't leave you overly intoxicated. The key here is moderation. If you want to drink a few beers and hang out with your friends, you can do that more safely while still checking your blood sugar and taking your insulin.
- MAKE SURE YOUR FRIENDS KNOW to never let you just "sleep it off." Even though it's not their responsibility, ask them to remind you to check your blood sugar and to try to wake you up if they see that you've passed out. Of course, this also goes out the window if your friends are also intoxicated.
- MAKE SURE YOU ARE WEARING SOME FORM OF IDENTIFICATION so that if you do get stopped by authorities or are found by friends, they know you have diabetes and can call for help!
- DON'T DRINK AND DRIVE (with or without diabetes) and always have a designated sober driver.
- ALWAYS HAVE A FORM OF RAPID ACTING CARBOHYDRATE ON YOUR PERSON to treat lows.
- KNOW WHEN TO CALL FOR HELP: it's your body we are talking about.
Stay tuned for part II: Choosing NOT to drink-all the great benefits and how to deal with friends who continue to pressure to have a beer!