_ Key West and the Keylime Martini_
One of the hardest diabetes-related subjects to navigate is drinking alcohol. The long time medical mantra has been “just don’t do it,” but for those who live with type 1 diabetes, the bottom line is that you will probably blow off that medical advice. And if you blow off the advice to avoid alcohol, then what is your strategy for drinking and dosing insulin?
A couple of weeks ago, I had an email from a concerned parent, who had heard about a t1 college student who was found unconscious after binge drinking. Her blood sugar had dipped too low and the alcohol had made it impossible for her to respond to the low. Therein lies the real problem with the medical advice that says “don’t drink.”
So in an attempt to fill in the gap, I have reached out to my favorite d-resource of Integrated Diabetes and asked Jennifer Smith for CDE advice and guidance on the subject.
Let’s start from the beginning:
How the liver works
The average liver weighs about three pounds and handles over 500 functions, but its main job is to filter the blood, detoxify chemicals and metabolize drugs.
The liver acts as the body’s glucose reservoir and releases sugar into the blood stream when signaled by the hormones, insulin and glucagon. During the night, the body has to make it’s own sugar, so it turns glycogen into glucose to supply the body with adequate amounts of sugar to maintain normal functions.
The liver is also responsible for those pesky ketones, which happens when the body’s glycogen storage is running low. Sugar is necessary to run vital processes, such as the brain, red blood cells and kidney function. To supplement the low glycogen level, the body will breakdown fats into ketones, as an alternate fuel. Ketones are burned as fuel by muscles and other body organs, while the glucose is saved for the organs that need it.
Alcohol, the liver, and diabetes
The liver is in charge of processing alcohol and detoxifying the blood, so the liver serves as the body’s liquor control board. In other words, when you have too much to drink, it is the liver that is telling you it can’t handle the load and it shoots the alcohol back into the bloodstream, where it continues to stay until the liver can pick up the task of processing it out of the body. Typically, alcohol blocks the hormones in your kidneys and with each drink your body becomes more dehydrated, then as your body begins breaking down alcohol, it pumps out lactic acid that impedes the balance between sugar and electrolytes. The searing headache—often associated with a hangover—is likely due to dehydration.
When diabetes is involved and alcohol is consumed, the liver can’t convert all the protein from your meal into glucose. According to Dr. Bernstein, “If you are insulin-dependent and your calculation of how much insulin you’ll require to cover your meal is based on, say, two hot dogs, and those hot dogs can not be completely converted to glucose, the insulin you’ve injected will take your blood sugar too low. You’ll have hyperglycemia, or low blood sugar.”
Distilled alcohol (hard liquor or spirits) has no direct effect on the blood sugar, and small amounts (1.5 oz) are usually no problem.
Wine – choose a dry variety and a four ounce pour, which has about one gram of carbs. Sweet Dessert wines at two ounces have one gram of carbs. Champagne has about four carbs per glass.
Beer poses a more complex scenario as it has carbs. A 12 oz. regular beer has 13 grams of carb, but a light beer has five, and non-alcoholic beer has 13 grams of carb. Mixers for margaritas and appletinis have approximately 25 grams of carb/three fluid oz.
- Moderate amounts of alcohol have a rapid effect on the liver, by preventing the conversion of protein to glucose and our carb/insulin ratio goes out the window!
For sure my guilty pleasure is dinner with a glass of wine with friends, and sometimes I have a martini. Learning the strategy to manage my diabetes while drinking has taken years, mostly because I did not have the education to help myself. Part 2 of this post looks at more information to build strategies around managing your diabetes while drinking, because we don't expect you to go completely alcohol-free (unless otherwise noted by your doctor)!