Drinking and Diabetes Part 2: Three Strategies for Managing Both

Patient Expert

Previously, we looked at how the liver functions with alcohol, most specifically how it functions when you have diabetes. In this part we are looking at how the body is affected by alcohol and the insulin you take.

Having an icy drink in the Hotel de Glace in Quebec, Canada.

When it comes to diabetes and drinking, it’s muddy water to know what to expect.  Each body is different and each diet is different, so how your blood sugar will respond is unique to you. It is imperative that you test, test, test, or watch your cgm like a hawk to learn how your body handles alcohol. Additionally, have an open conversation with your diabetes care team to construct the best details for managing your diabetes when drinking.

With that said, Jennifer Smith from Integrated Diabetes had some pearls of wisdom to consider.

Alcohol and your body:

  • Alcohol goes from your stomach straight into your blood. The alcohol in your bloodstream is highest 30 to 90 minutes after drinking.
  • Your liver slowly breaks down alcohol. If you weigh 150 lbs., it takes about two hours to break down one drink. Two drinks takes twice as long, or four hours.
  • Some signs of too much alcohol, such as slurred speech and confusion, are similar to low blood glucose signs and symptoms. Very important, since hypoglycemic symptoms can look the same. Preventing a hypo is of paramount importance!
  • _Never grab a drink if your blood sugar is low! _

Breakout the calculator and get ready to add and subtract at the same time!

Managing diabetes and alcohol can become like a word problem to solve. For example, beer will raise your blood glucose level in the short term, but several hours later it will cause your liver to stop secreting glucose, and therefore drops the blood sugar. Integrated Diabetes suggested lowering your basal rate once you have stopped drinking. To decide how much to lower basal rate, talk with your care team to decide what’s an appropriate level for you.

Never drink on an empty stomach!

The other aspect to drinking is food.  The best option is to eat a meal with or right before you start drinking. I can remember a few college parties where food was non-existent—if this is the case, eat right before you go. It's also not a bad idea to have a snack, like apple and peanut butter after an evening of drinking. The fat, protein and carbs will help manage the potential low blood sugar after you are asleep.

Also, high fat meals and snacks throw curve balls into drinking.  Fatty food causes the blood sugar to rise more slowly, often over a period of 6-10 hours. In “Think Like a Pancreas," Gary Scheiner writes, “The exact mechanism by which fat causes a delayed rise in blood sugar is not entirely understood, but it is believed to be a combination of 1) partial conversion of fatty acids into glucose, 2) insulin resistance caused by elevated fatty acids in the bloodstream; and 3) a slowdown in the digestion of some carbohydrates consumed with along with fat.” If you’re like me, a nice cheese and glass of wine, at 6pm, aren’t reflected in my blood sugar until about 3am and then the rise in bg is substantial, so I usually bolus a small amount before I go to sleep, and hope that I don’t hear the beep of the GCM at 3am.

Jennifer Smith commented, "Fat actually causes insulin resistance after consuming it, so a high fat meal (examples of high fat meal: mac and cheese, burger and fries, Alfredo sauce, Philly Cheese steak sandwich) most likely needs a temporary INCREASE in basal insulin. It might be helpful to have a bit of a higher fat meal when consuming alcohol, as the fat can reduce the action of insulin in a time when alcohol is likley to bring your blood glucose down. If drinking with a high fat meal, you wouldn't need to increase basal insulin. Essentally, this is a way to reduce the risk of low blood sugar overnight - although not the best tactic for weight management long term!"

D-buddy up!

Strategy is everything to success.  If leaving for a party is going to be several hours after dinner, grab a friend and go for a light meal or snack. Be honest about the reason, because it shows that you are in control of your care, and friends are always willing to help and support each other, whatever the issue. Always carry medical alert, or some form of emergency information in your wallet that identifies that you have type1 diabetes. (Never say never.)

For more on alcohol and diabetes – both type1 and type2 - check out these posts:

Alcohol and Diabetes Don’t Mix

What effect does Alcohol/beer have on diabetics

Diabetes, Teens and Alcohol: Part 1

Diabetes, Teens and Alcohol: Part 2

David Mendosa: Why I Drink