Type 1 diabetes alcohol

When I was first diagnosed with type 1 diabetes, I was told that I should completely avoid alcohol because of the detrimental health effects. At 24-years-old, this was a very daunting task as many social functions revolve around alcohol whether it’s happy hour, birthday parties, or even religious ceremonies. We all know that drinking alcohol to excess is not good for anybody’s health, however, I believe that people with type 1 diabetes should still be able to enjoy alcohol in moderation. Moreover, they may be using it anyway, so clinicians need to be prepared to have an open dialogue about it. Many of us are diagnosed during our adolescence and into our early 20s and we are confronted with multiple decisions regarding alcohol. Thus, we need a more realistic approach to our relationship with alcohol. Helping patients develop a safe plan in regard to its use is important, as is also making sure there are no additional health concerns, which could exclude alcohol use altogether.

The relationship between alcohol and hypoglycemia

Of primary importance is ensuring that those with diabetes understand the physiological response alcohol can have on their bodies. Mainly, it can increase the risk of hypoglycemia. Many are aware of the long-term effects of alcohol on the liver, however it is the short-term effects that get us into trouble. The liver is a vital organ for the daily regulation of our blood sugar through two main processes, which include glycogenesis/glycogenolysis and gluconeogenesis. When we consume excess carbohydrates our liver can store sugar in the form of glycogen (glycogenesis) and then break it down for use (glycogenolysis) when needed such as during a brief fast or exercise. When our glycogen stores are depleted our liver can then actually produce glucose and release it into our bloodstream (gluconeogenesis). All of this happens several times a day even when we sleep. These processes are however hindered by the consumption of alcohol, even a modest amount can lead to hypoglycemia sometimes several hours after our last beer! Therefore, patients should be advised that if they do have a night out with drinks, it is necessary for them to continue to monitor their blood sugar levels especially before sleep.

Many people with diabetes often wonder why their blood sugar is high, sometimes even in the 200s-300s, after drinking. And the answer to this question is that it depends on the type of alcohol. Beer is carbohydrates! And, several mixologists concoct delicious cocktails that often have syrups, juices, or sodas in the them, all of which can cause a person’s blood sugar to skyrocket. It’s important to advise patients to be aware of the ingredients in their drinks. Even a virgin (no alcohol) cocktail can pose a problem because of sugar content. The University of California San Francisco has produced an excellent outline of the calories and carbohydrate content in drinks such as beer, wine, and cocktails. For those who love craft beers, unfortunately it can be difficult to gauge the carbohydrate content as most do not come with a nutrition label, especially when poured from the tap. In my experience, heavier beers such as Indian Pale Ales (IPA), stouts, pale ales, and wheat beers will have higher carbohydrate content usually between 12g-20g. In general, most of these beers may require 1 unit of insulin if using the 15g to 1 unit ratio.

So far, it’s clear that alcohol can cause lability in an individual’s blood sugar level. However, one small study followed 14 people with diabetes while drinking and discovered glucose variation, but not necessarily increased risk of hypoglycemia. Nonetheless, from experience I still find alcohol to even decrease my blood sugar the following day, so it’s important for clinicians to note that each person will have different reactions. The delicate dance of drinking and managing diabetes is by no means easy and should be approached judiciously.

I will end with a few key pieces of advice that can help patients with blood sugar management while enjoying a night out.

  • Always eat while drinking alcohol. Not only will eating slow the absorption of alcohol and is advised for anybody, but it will also help to prevent hypoglycemia for those with diabetes. Sometimes it is prudent to have a snack before bed to prevent the delayed effects of alcohol, which we know can interfere with gluconeogenesis. I may even require less insulin the following morning for breakfast!
  • Use the buddy system. Patients should be advised to have a friend, spouse, or family member with them who know what to do if they are having trouble with alcohol and managing their diabetes, specifically an episode of hypoglycemia. Even when I am not out with my wife she still knows where I am going and whom I am with. This would be the ingredients for a healthy relationship even without diabetes!
  • Know what you are drinking. I mentioned this earlier because it is truly essential to keeping blood sugar within a normal range. For example, I completely avoid margaritas because no matter what it will still spike my blood sugar. This unfortunately may come with trial and error and figuring out which types of alcohol your body handles best.
  • Test often and be prepared. Alcohol causes frequent fluctuations in blood sugar levels so it is important to stay informed. I will test several times a night when drinking or if a patient wears a CGM he/she will be even more prepared. This will allow people to reach for that spare granola bar or glucose tablet in their pockets proactively.

I always enjoy writing about my own experiences because I hope they help provide insight for clinicians to counsel and have an open dialogue with their patients who wish to enjoy alcohol and its associated social functions.

Contents

A Guide To Drinking Alcohol While Travelling With Type 1 Diabetes

First things first, a little about me and my relationship with alcohol

I was diagnosed with type 1 diabetes when I was 16 and I had tried alcohol just before then. I’d never been “drunk” as such, but I did know what a cocktail tasted like. I could have easily made the decision not to drink at all or not learn how to master the art of drinking with type 1 diabetes, but, I knew I wanted to enjoy a glass of wine or champagne or a pina colada on a beach whilst travelling…so…I made sure I knew how to find the balance.

This isn’t a guide on “binge-drinking” with diabetes….rather, I don’t think being extremely drunk with type 1 diabetes is a good idea at all, especially since the symptoms of a bad hypo are similar to those being drunk, rather this is a guide to knowing what to do to safely enjoy drinking with type 1 diabetes whilst travelling.

Carbohydrate counting alcohol

When I’m travelling, there is always the opportunity to enjoy a drink, or enjoy new types of alcohol. However, a simple carb count usually isn’t the way to deal with alcohol.Different types of alcohol have different carbohydrate counts in them which make counting your carbs a little more difficult. Regardless of the carbs…alcohol will drag your blood sugar down. So, even if it rises it initially, there will be a delayed pull of your blood which can risk you going into hypo for a full 24 hours after you have stopped drinking.

We discovered cachaca in Brazil and it’s amazingggg

Lets have a look at some of the different carbohydrates in alcohol and some of my advice on how to handle them.

Wine/Prosecco/champagne

I enjoy a glass every now and again- although it’s not cheap when travelling!

Whether it’s a wine on a Friday evening after a long week of work or a celebratory glass of fizz, these drinks do contain carbohydrates.

As a general rule, the bigger bodied the wine, the higher the carb count. The lighter bodied the wine, the lower the carb count. You can get very low carb wines- which may be useful, but in general, it’s typically around 4-5 g of carbs per serving. Prosecco and champagne are pretty low in carb, so these are a better choice.

If you are drinking one glass of wine or fizz- then chances are it won’t have much effect on your blood sugars. So just test as normal and keep an eye, but you should be fine.

If you drink around 2-3 glasses of wine (250ml glass), then this is essentially a bottle, and you will usually find that it begins to raise your blood sugar. My advice is to avoid bolusing for the wine and if you rise, you will come back down. If you are eating with your wine, then still bolus for your food.

Spirits

Spirits come in the form of vodka, gin, rum, whiskey, etc. These drinks contain little to NO carbs.

My “easy” drink of choice is always vodka with diet Pepsi as it doesn’t require any insulin from me. There is no sugar in this drink at all, so it’s never going to make my blood sugar rise, but it will make it drop. I find it easier knowing it’s going to go one way, rather than go high then maybe go low etc.

When I am drinking vodka and diet mixer, I make sure my blood sugar is on perhaps an 8 or 9 and typically I’ll drop to around a 4-5, by which I will make sure I eat something.

If you are dancing in a club, then switch your diet mixers to full-fat mixers and it will help counteract the drop that the spirit will bring and help to keep you level. Remember dancing is exercise, so you will need to be extra cautious.

It’s taken a lot of practice to know how to drink this type of alcohol without going into hypo- and sometimes I get it wrong! But, alcohol will affect everyone differently and you will typically find something that suits your blood sugars better.

Beer/Cider/Lager etc

These all contain carbohydrates, and often are quite high. Especially if you are drinking fruit ciders. Whilst they are delicious, they are filled with sugar and will typically send your sugars quite high. I enjoy a cider on a hot summers day, but these drinks do not make me go low, so I take the full carbohydrate amount and cover it with insulin.

Guinness- 10 grams

Budweiser- 12 grams

Use apps like “My Fitness Pal” to get carbohydrate counts on drinks you don’t know.

Because of the high carbohydrate count in these drinks, I don’t recommend completely avoiding insulin, because you will just end up feeling sluggish, tired, thirsty (and everything else a high blood sugar makes you feel). I would suggest giving “half” the amount of the required insulin for the carbs to begin with and record how that affects your blood sugar.

It’s always important to record how each drink has affected your blood sugars. This way you can develop a pattern and you can learn what to do, what not to do, and how much your “body” can “handle” without falling into a hypo OR going super high.

Here are some other tips for drinking with type 1 diabetes

Brazil <3

  • Don’t start drinking “spirits” with a blood sugar that’s lower than 6. You could fall into hypo quite quickly.
  • Remember no more than 14 units is recommended for anyone a week!
  • Never drink on an empty stomach (you absorb the alcohol quicker)
  • Wear a CGM or Freestyle Libre if you can- It will help you catch things quicker and work out patterns
  • Set an alarm to check your blood sugar in the middle of the night so around 3 am (or 5 am if you just got back at 3!) Allow yourself to run a little higher whilst drinking to avoid major lows. Especially if you are “clubbing”. Aim for 140-200mg/dl (7.8-11.5)
  • Lower your temp basal overnight or reduce your basal Lantus/Levemir dose by 20% or so
  • Test frequently
  • Bolus for alcohol when it’s got carbs but only HALF the amount
  • Carry a glucagon pen if you are out and about whilst drinking. It will still work, the effectiveness will just be limited, but it’s still worth using in an emergency. Make sure someone you are with knows how to use this pen.
  • Wear diabetic ID if you’re out with your friends drinking or out alone
  • Make the people you are with aware you are type 1 diabetic, and that the symptoms of being low are similar to that of being drunk
  • If your blood sugar is below 180 mg/dl (10.0) then have a carb snack!
  • Have an emergency contact number with you
  • Keep some glucose on you, such as a small packet of sweets or dextrose, and if you’ve got some friends with you, ask them to carry some too.

I’m now almost 25 and I did Uni for 4 years, so I know the drinking culture and I’ve had my practice within it. I’ve never had any serious issues with my diabetes whilst drinking (thank god) and as long as I monitor and be sensible, I hope I never will.

When traveling, there are lots of opportunities to party, but Bradley and I party a lot less as we’ve got older (Uni takes it out of you! 😛 ), whereas we are more inclined to enjoy a bottle of wine at home than in a bar doing shots. That’s not to say we don’t party sometimes. (I won’t say no to full moon parties), but I am certainly more refined in what I drink and how I drink nowadays.

Finding the balance with alcohol is literally a game of practice. There is no simple method. But, if you want to lessen the calculations, then spirits and sugar-free mixers or low carb alcohols such as Prosecco are a great place to start!

Never feel peer pressured into drinking if you don’t want to. Drinking isn’t something you have to do, rather it’s something you should be given the choice to do and diabetes shouldn’t take that choice away from you.

So be sensible, drink safely and follow these tips! Alcohol tends to be cheaper in Asia, South America etc (almost anywhere that isn’t the UK), but make sure you’re drinking real alcohol and not pure poison (ethanol). Only drink branded drinks and don’t accept drinks from people you don’t know.

Comment below if you’ve got any other tips for drinking with type 1 diabetes.

For more guidance, tips, ticks and resources for travelling the world with type 1 diabetes. Check out the E-book!

Alcohol
and diabetes

Drinkaware is an independent charity working to reduce alcohol misuse and harm in the UK. We’re here to help people make better choices about drinking.

Diabetes is a common, life-long condition that occurs when the pancreas doesn’t produce enough insulin, or the insulin it does produce doesn’t work properly. Insulin is a hormone that transfers glucose from the bloodstream into the cells to be used for energy. If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood instead of moving into your cells.

The chances of developing diabetes may depend on a mix of your genes and your lifestyle. Drinking to excess, for example, can contribute to the conditions that cause diabetes.

Diabetes is a manageable condition. But when it’s not well managed, it is associated with serious health complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations2.

Type 1 and Type 2 Diabetes: what’s the difference?

There are two main types of diabetes3. Type 1 diabetes develops if the body can’t produce enough insulin, because insulin-producing cells in the pancreas have been destroyed. It can happen:

  • Because of genetic factors
  • When a virus or infection triggers an autoimmune response (where the body starts attacking itself).

People who have this type of diabetes are usually diagnosed before they’re 40 and there’s currently no way to prevent it. It’s the least common type of diabetes – only 10% of all cases are type 14.

Type 2 diabetes. Develops when the body can still make some insulin, but not enough, or when the body becomes resistant to insulin. It can happen:

  • When people are overweight and inactive. People who are an ‘apple-shape’ (with lots of fat around the abdomen) have a greater risk of developing type 2 diabetes
  • Because of genetic factors.

People who have this type of diabetes are usually diagnosed when they’re over 40, and it’s more common in men. However, more overweight children and young people in the UK are being diagnosed with the condition. It is also particularly common among people of African-Caribbean, Asian and Hispanic origin. 90% of all adults with diabetes have type 2 diabetes5.

Symptoms of diabetes

Being extremely tired, blurred vision and feeling more thirsty than usual are all symptoms associated with diabetes6. Some additional signs of undiagnosed diabetes can include:

  • Going to the toilet to urinate more often than usual, especially at night
  • Unexplained weight loss
  • Genital itching or regular episodes of thrush
  • Slow healing of cuts and wounds

With type 1 diabetes, signs and symptoms are usually obvious and develop very quickly over a few weeks. Once the diabetes is treated and under control, symptoms will go away quickly.

In type 2 diabetes, signs and symptoms may not be so obvious. The condition develops slowly over several years, and it might only be picked up in a routine medical check-up. As with type 1 diabetes, symptoms are quickly relieved once diabetes is treated and under control.

Drinking alcohol can contribute to the conditions that cause diabetes

There are three main ways drinking alcohol to excess can be a factor in causing diabetes:

1.Heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes7.
2.Diabetes is a common side effect of chronic pancreatitis, which is overwhelmingly caused by heavy drinking.
3.Alcoholic drinks often contain a lot of calories – For instance, one pint of lager can be equivalent to a slice of pizza. So drinking can also increase your chance of becoming overweight which raises your risk of developing type 2 diabetes8.

Get some practical tips on cutting down.

Teetotallers and heavy drinkers have an equal risks of developing diabetes

According to a review of 15 previous studies (in 2005) into the link between Type 2 diabetes and alcohol, drinking 3 units/day reduces the risk of Type 2 diabetes by 40% for women and 13% for men. People who drink 6 units/day (for women), or 8 units/day (for men), are at greater risk of Type 2 diabetes than teetotallers9.

Take our Alcohol Self Assessment test to find out if you’re drinking too much.

The effects of diabetes

When someone has diabetes, more of the glucose in their body stays in their blood – it isn’t being used as fuel for energy. The body tries to reduce blood glucose levels by flushing the excess glucose out of the body into their urine.

Patients on insulin treatment for diabetes can develop abnormally low blood sugar levels. This is known as hypoglycaemia. Symptoms of hypoglycaemia include:

  • Slurring words
  • A headache
  • Confusion
  • Double vision
  • Abnormal behaviour

Hypoglycaemia’s symptoms can be particularly dangerous when you’re drinking because people can mistakenly think that you’re drunk and may not realise you need urgent medical help. Drinking heavily can also increase the chances of developing hypoglycaemia because it prevents the liver from making glucose when you drink on an empty stomach11. For example, the risk of hypoglycaemia would increase the morning after you’ve slept following heavy drinking.

If you have nerve damage as a result of diabetes, drinking alcohol can make it worse and increase the pain, tingling, numbness and other symptoms12.

I have diabetes, is it still safe to drink alcohol?

Doctors advise everyone, including diabetics, that they if they chose to drink, to keep health risks to a low level it’s important to stay within the UK Chief Medical Officers’ (CMO) low risk drinking guidelines and not regularly drink more than 14 units a week. After all, it’s not just diabetes that you need to consider, the more you drink the greater your risk of developing a number of other short and long-term health issues such as seven types of cancer, mental health, heart and liver problems.

It’s also important, if you want to avoid developing diabetes, or already have it and want to manage it well, that you look after your general health by eating a healthy diet and taking regular exercise, to help control blood sugar levels.

How much alcohol is too much?

Busting the myths about diabetes

  • You cannot catch diabetes. But you can control some of the risk factors that lead to the development of type 2 diabetes.
  • Eating sweets and sugar does not cause diabetes. But eating a lot of sugary and fatty foods can lead to being overweight which in turn can result in the necessary conditions for becoming diabetic.
  • Stress does not cause diabetes. Although it may make the symptoms worse in people who already have the condition.
  • An accident or an illness will not cause diabetes. But it may reveal diabetes if it is already there.

How can I reduce the risks to my health from alcohol?

  1. Stay within the low risk drinking guidelines: following the UK CMOs’ advice and not regularly drinking more than 14 units a week is the best way to keep health risks from alcohol to a low level. If you do choose to drink it’s important not to save up those units to drink all in one go and spread your drinking evenly over at least three days. A great way to cut down the overall amount you drink is to take more Drink Free Days throughout the week.
  2. Keep track of what you’re drinking. Use our free and simple mobile app to track not only your units but the calories you’re drinking, and how much you’re sepending on alcohol.
  3. Know your strength. Alcoholic drinks labels will have the abbreviation “ABV” which stands for Alcohol By Volume, or sometimes just the word “vol”. It shows the percentage of your drink that’s pure alcohol. This can vary a lot. For example, some ales are 3.5%, some stronger lagers can be as much as 6% ABV. This means that just one pint of strong lager can be more than three units of alcohol, so you need to keep your eye on what you’re drinking.

See how much alcohol is really in your drinks with our Unit Calculator.

Further information

If you have concerns about your health, are worried you might be diabetic or want advice relating to a diabetes diagnosis then you should always speak to your GP directly.

For more information about diabetes, visit the Diabetes UK website. They work for people with diabetes, funding research, campaigning and helping people live with the condition.

Concerned about yours or someone else’s drinking?

We run a confidential online instant messaging service where you can chat to a trained advisor if you are worried about your own or someone else’s drinking.

Alternatively, Drinkline runs a free, confidential helpline. Call 0300 123 1110.

Chat with an advisor

Was this information useful?

If you would like to give us feedback about the information on this webpage, or any others on this website, please do so by emailing your comments to [email protected]

Last reviewed: 14 March 2016

Next review due: 14 March 2019

Type 1 diabetes and alcohol consumption

Type 1 diabetes is a challenging and complex disorder to manage, and this becomes more difficult when young people are beginning to experience the pleasures and effects of alcohol consumption. For a young person with type 1 diabetes, alcohol consumption can have harmful effects on their current and future wellbeing. The article focuses on the effects of alcohol in type 1 diabetes and the difficulties a young person faces in maintaining glycaemic control when drinking alcohol. The effects of living in an alcohol permissive culture and the knowledge and risks of alcohol consumption, as well as issues associated with depression and denial are discussed. In addition, we aim to raise awareness of best practice guidelines for healthcare professionals to reduce short and long-term complications associated with alcohol-induced hypoglycaemia.

Nursing Standard. 29, 50, 41-47. doi: 10.7748/ns.29.50.41.e9812

Correspondence

[email protected]

Peer review

All articles are subject to external double-blind peer review and checked for plagiarism using automated software.

Received: 29 November 2014

Accepted: 23 January 2015

The influence of liberal alcohol consumption on glucose metabolism in patients with type 1 diabetes: a pilot study

Abstract

Background: Little is known about the consequences of excessive alcohol ingestion in patients with type 1 diabetes.

Aim: To examine the metabolic effects of acute ingestion of liberal amounts of alcohol in patients with type 1 diabetes.

Design: A pilot study using a randomized, placebo controlled, double blind design in Hospital Clinical Research Unit.

Methods: The study included 10 patients with type 1 diabetes (seven male, age 43.9 ± 9.0 years, duration of diabetes 17.3 ± 13.8 years, HbA1c 8.0 ± 1.5%) who had a standard 600-calorie lunch on two separate occasions, together with either white wine (men eight units, women six units), or an equivalent volume of alcohol-free wine. Bloods were collected before lunch and hourly for 4 h for glucose, intermediary metabolites, counter-regulatory hormones and inflammatory markers.

Results: There were no significant differences between alcohol and alcohol-free days in levels of glucose, triglycerides, free fatty acids, glycerol, cortisol and growth hormone. In contrast, lactate levels rose in response to the meal but with alcohol the overall response was augmented (P = 0.014). β-Hydroxybutyrate levels were suppressed post prandially on the alcohol-free day but were significantly elevated with alcohol (P < 0.001).

Conclusions: A rise in ketones following alcohol ingestion occurred despite subjects being in a strictly controlled environment with no interruption in insulin administration. Such individuals might be at risk of significant ketosis in less-controlled circumstances where insulin administration might be more erratic. Patient education material should contain information to highlight these potential problems.

Introduction

Although the health hazards of excessive alcohol consumption are well documented, there is epidemiological evidence that moderate alcohol consumption has demonstrable health benefits.1–3 For example, within the diabetic population, several studies have suggested a lowering of risk of premature vascular disease associated with modest alcohol consumption.4–7 Thus there are clinical reasons to encourage regular use of alcohol in patients with diabetes. Suggested limits for ‘safe’ levels of alcohol use are generally accepted to be 1–2 U of alcohol per day for women, 2–3 U/day for men (1 unit = 8–10 g of ethanol).8

Recent studies9,10 have also suggested that the pattern of alcohol intake may be important in that regular consumption of small quantities is safer than ‘binge drinking’. There is no internationally agreed definition of binge drinking, but in the UK, drinking surveys normally define binge drinkers as men consuming at least eight, and women six standard units of alcohol per week.11

One concern from the combination of type 1 diabetes and excessive alcohol is the risk of alcoholic ketoacidosis (AKA)12 seen in those individuals who drink excessively, while eating very little. AKA is often unsuspected as patients most often present some time after a drinking session so may not appear intoxicated nor have elevated blood alcohol levels. In the more common diabetic ketoacidosis, insulin deficiency results in excess mobilization of fatty acids from adipose tissue with the production of aceto-acetic acid and β-hydroxybutyric acid, resulting in a high anion gap acidosis.13 In alcoholic ketoacidosis, glucose levels may be only marginally elevated or even low and development of ketoacidosis results from a complex interaction of alcohol metabolism, decreased caloric intake, volume depletion and enhanced release of counter-regulatory hormones (e.g. cortisol, glucagon), the net result being a relative insulin deficiency and hyperglucagonaemia.12

Although similar hormonal changes underlie both conditions, in patients with AKA, the altered redox state, as a consequence of NADH+ formation during the metabolism of alcohol, favours the production of β-hydroxybutyrate and the β-hydroxybutyrate/acetoacetate ratio tends to be higher compared to DKA.14 However, β-hydroxybutyrate remains the main ketone produced15 and the ratio is an unreliable discriminator as similar values can result in DKA due to the presence of sepsis, vascular collapse or concomitant lactic acidosis.16

The potential for development of ketonaemia both in diabetes and with alcohol intake raises the possibility that the combination of excessive alcohol consumption together with lax diabetic control may conspire together to produce ketoacidosis. Yet, to our knowledge, no studies have examined the metabolic effects of significant alcohol ingestion in patients with type 1 diabetes.

The aim of this pilot study, therefore, was to examine the effect of acute ingestion of liberal amounts of alcohol, in a controlled environment, on glucose levels and intermediate metabolites in patients with type 1 diabetes.

Patients and methods

Twelve patients with type 1 diabetes (eight men) were recruited to the study. All the subjects were using multiple daily injections of analogue insulin (pre-meal Insulin Aspart or Insulin Lispro with basal Insulin Glargine) to control their diabetes and all reported modest use of alcohol (<14 U for females and <21 U for males each week). None were taking other drugs known to interfere with alcohol or glucose metabolism. All subjects gave written consent to participate in the study, which was approved by the Somerset Research Ethics Committee, Taunton.

Prior to the study day, subjects abstained from alcohol for 3 days. On the morning of the study, subjects had their usual insulin and breakfast prior to attending the Clinical Research Room in the Bournemouth Diabetes and Endocrine Centre. On arrival, an intravenous cannula with a three-way tap was inserted and a slow infusion of 0.9% saline commenced to maintain patency of the cannula. Venous blood glucose was monitored regularly throughout the morning and where necessary, small correction doses (2–4 U) of analogue insulin were given to attain pre-lunch blood glucose levels of 8–10 mmol/l.

Lunch was identical on both occasions and comprised a standard 600-calorie meal (83 g carbohydrate, 24 g fat, 19 g protein, 7.6 g fibre). Using a randomized double blind design (opaque, closed-envelope system with a randomized computer generated pattern), each subject also drank either white wine (men 8 units women 6 units) or an equivalent volume of alcohol-free wine, over a 90-min period (with the alternative consumed on a second visit 2 weeks later).

Venous blood samples were taken 45 min before (Baseline 1) and immediately prior to lunch (Baseline 2) and subsequently, at hourly intervals over 4 h for glucose, insulin, alcohol, triglycerides, β-hydroxybutyrate, free fatty acids, glycerol, lactate, cortisol, growth hormone and inflammatory markers—High Sensitivity CRP (hsCRP), Interleukin-6 (IL-6) and Tumour Necrosis Factor-α (TNF-α). Samples were either analysed immediately (glucose, alcohol, triglyerides, lactate, cortisol, growth hormone) or stored at −70°C prior to analysis. Heart rate and blood pressure were recorded hourly and participants were asked to complete a 100 mm Visual Analogue Score (VAS) to measure their perception of glucose levels and degree of alcohol intoxication. Extremes of the scales were ‘Sober’ and ‘Drunk’ for alcohol and ‘Low’ and ‘High’ for self-perception of glucose levels.

Following completion of blood sampling, a meal was provided and participants were accompanied home by a friend or relative who stayed with them during the evening and overnight. Each subject also received telephone follow-up the same evening, warning of the possible effects of hypoglycaemia that evening or the following morning.

Glucose, triglyerides and lactate were measured on an AU640 clinical chemistry analyser (Olympus UK Ltd, Watford); cortisol was measured by a solid-phase, competitive chemiluminescent immunoassay and growth hormone by a solid-phase, two-site chemiluminescent immunometric assay on a DPC 2500 automated immunoassay analyser (Siemens Diagnostics, Llanberis, Wales); alcohol was measured using a Phillips PU4500 gas chromatography system with flame ionization detection (Pye Unichem, Cambridge, UK); β-hydroxybutyrate and glycerol by kinetic enzymatic methods (Randox Laboratories Ltd, Crumlin, Northern Ireland); Non-Esterified Fatty Acids (NEFA) were measured by an enzymatic colorimetric method (Wako, NEFA-C, Alpha Laboratories, Eastleigh, UK); hsCRP was measured by a solid phase, chemiluminescent immunometric assay and IL-6 by a solid phase, enzyme labelled, chemiluminescent sequential immunometric assay, both on the Immulite 2500; TNF-α was measured using an ultrasensitive ELISA (Biosource, Invitrogen Ltd, Paisley, UK).

For the purposes of this pilot study, acetoacetate was not measured as practical issues in analysis preclude the ready availability of a commercial assay and17 and because of instability of acetoacetate on storage.18 Insulin was not measured due to the low cross reactivity of insulin analogues with available immunoassays19 while lack of radioimmunoassay facilities precluded the measurement of glucagon.

Statistical analysis

Data were analysed using Microsoft Excel. Difference scores between alcohol and non-alcohol arms of the study were assumed to be normally distributed and analysed using the paired t-test with a two-tailed 5% significance level. Four patients in the non-alcohol arm and three in the alcohol arm required supplemental insulin between −90 and −40 min, to adjust their blood glucose in accordance with protocol. To reduce the chance of types 1 and 2 statistical errors, the primary analysis has been based on an ‘area under the curve’ (AUC) analysis between t = 0 and t = 240, calculated using the trapezoidal rule, and using the mean of baselines 1 and 2 to represent t = 0.

Results

Two subjects attended on only one occasion and subsequently withdrew consent. Results, therefore, are for the 10 subjects (seven male, age 43.9 ± 9.0 years, duration of diabetes 17.3 ± 13.8 years, HbA1c 8.0 ± 1.5%) who completed both arms of the study. Participants (7 of 10) received alcohol on the first visit.

Their reported usual alcohol consumption was 13 ± 5 U/week. Four patients in the non-alcohol arm and three in the alcohol arm required supplemental insulin (between 90 and 40 min before the meal) to adjust their blood glucose in accordance with protocol. For all measurements, the mean of the two baseline levels was taken for time zero levels with the exception of ketone measurements for those patients requiring supplemental insulin because of the influence of insulin on blood ketones.

Table 1 shows changes in glucose, triglycerides, free fatty acids, glycerol, cortisol and growth hormone, measured at hourly intervals after the meal on both study days, together with the alcohol levels when alcohol was taken (there was no detectable alcohol in any subject on the alcohol-free days). There was no significant difference between the two study days for the AUC analysis for any of these measurements.

Table 1

Baseline observations and responses to a standard meal on alcohol (A) and alcohol free (NA) study days.

All observations are mean ± SD

Table 1

Baseline observations and responses to a standard meal on alcohol (A) and alcohol free (NA) study days.

All observations are mean ± SD

On the alcohol-free day, levels of β-hydroxybutyrate were suppressed post prandially whereas when alcohol was ingested levels rose and remained elevated 4 h after the meal. There was a significant difference between levels at all time points from 60 to 240 min (Figure 1, all P < 0.001, AUC P < 0.001).

Figure 1.

Mean ± SE of β-hydroxybutyrate levels on alcohol (full squares, unbroken line) and alcohol-free (open squares, broken line) study days. There were highly significant differences at each time point from 60 to 240 min (all P < 0.01, AUC P < 0.001).

Figure 1.

Mean ± SE of β-hydroxybutyrate levels on alcohol (full squares, unbroken line) and alcohol-free (open squares, broken line) study days. There were highly significant differences at each time point from 60 to 240 min (all P < 0.01, AUC P < 0.001).

Lactate rose in response to the meal but with alcohol the overall response was augmented (AUC P = 0.014) with peaks at 120–240 min (Figure 2). In contrast, there were no differences in any of the inflammatory markers either in AUC or at individual time points on respective study days (Table 2).

Table 2

Comparison of mean (SD) levels of inflammatory markers after drinking alcoholic (A) and non-alcoholic (NA) wine.

Table 2

Comparison of mean (SD) levels of inflammatory markers after drinking alcoholic (A) and non-alcoholic (NA) wine.

Figure 2.

Mean ± SE lactate levels on alcohol (full squares, unbroken line) and alcohol-free (open squares, broken line) study days. There were significant differences at each time point from 120 to 240 min (P = 0.03 at 120 min, P < 0.01 at 180 and 240 min, AUC = 0.014).

Figure 2.

Mean ± SE lactate levels on alcohol (full squares, unbroken line) and alcohol-free (open squares, broken line) study days. There were significant differences at each time point from 120 to 240 min (P = 0.03 at 120 min, P < 0.01 at 180 and 240 min, AUC = 0.014).

Subjects showed no differences in the perception of prevailing glucose levels after wine compared to the non-alcoholic wine (AUC P = 0.98, Figure 3a) but correctly reported feelings of intoxication after wine (AUC P < 0.001, Figure 3b).

Figure 3.

(a) Change from baseline in Visual Analogue Scores for perception of blood glucose level (unbroken lines) on alcohol days (full triangles) and non-alcohol days (open triangles) compared with actual blood glucose level (broken lines, triangles as before). (b) Change from baseline in Visual Analogue Scores for perception of blood alcohol level (unbroken lines) on alcohol days (full triangles) and non-alcohol days (open triangles) compared with actual blood alcohol level (unbroken lines, black triangles—alcohol day only represented as no change in alcohol level on non-alcohol days).

Figure 3.

(a) Change from baseline in Visual Analogue Scores for perception of blood glucose level (unbroken lines) on alcohol days (full triangles) and non-alcohol days (open triangles) compared with actual blood glucose level (broken lines, triangles as before). (b) Change from baseline in Visual Analogue Scores for perception of blood alcohol level (unbroken lines) on alcohol days (full triangles) and non-alcohol days (open triangles) compared with actual blood alcohol level (unbroken lines, black triangles—alcohol day only represented as no change in alcohol level on non-alcohol days).

Conclusions

There is no evidence that individuals with type 1 diabetes have a different approach to alcohol compared to the background population. A recent systematic review reported that consumption of a moderate amount of alcohol may be associated with a small decrease in plasma glucose concentrations but there are no studies examining diabetes self-care behaviours including medication adherence, glucose monitoring diet or exercise.20 Therefore, it is not surprising that insulin-treated patients often receive conflicting advice about how to deal with alcohol in relation to their diabetes. In this study, liberal lunchtime ingestion of alcohol was associated with failure to suppress post-prandial levels of β-hydroxybutyrate and elevated levels of lactate, with no differences in triglycerides NEFA or glycerol. The latter would be consistent with good diabetes control and adequate insulin levels preventing lipolysis and indicate that the increased β-hydroxybutyrate and lactate level were attributable to alcohol metabolism. No acute changes in levels of counter-regulatory hormones were noted.

Alcohol can also have further important implications for patients treated with insulin. Ingestion of even small amounts may impair the ability of the individual to detect the onset of hypoglycaemia at a stage when they are still able to take appropriate action, i.e. eat some carbohydrate.21 Also, hypoglycaemia per se may be mistaken for intoxication by third parties with legal as well as health consequences. Alcohol has also been shown to directly impair the usual hormonal counter-regulatory responses to low blood glucose levels22 and even small amounts can augment the cognitive deficits associated with hypoglycaemia in individuals with type 1 diabetes.23 In a laboratory-based study, Turner and colleagues reported that ingestion of alcohol with an evening meal increased the risk of hypoglycaemia the next morning in patients with type 1 diabetes.24 Here, subjects correctly identified feelings of intoxication but did not ‘feel’ more hypoglycaemic after alcohol.

Whether the type of alcohol intake, wine, beer or spirits and the potential differences between red and white wine, or whether only the total amount of alcohol independent of the medium is of importance for any health benefit of alcohol, has been the subject of many studies, without a definitive conclusion.25 Systemic markers of inflammation have been associated with a higher prevalence of cardiovascular disease and moderate alcohol consumption appears to have beneficial effects on inflammation26 notably with red wine or sparkling white Cava.27,28 Here, we found no effect of acute ingestion of white wine on markers of inflammation in subjects with type 1 diabetes. It may be noteworthy that our subjects were already regular users of alcohol and therefore any effect of alcohol on inflammation may already have been present. Alternatively the effect of the type 1 diabetic state per se on inflammatory responses remains unclear.

In summary, liberal lunchtime ingestion of alcohol was associated with failure to suppress post-prandial levels of β-hydroxybutyrate and elevated levels of lactate without changes in levels of counter-regulatory hormones, free fatty acids, glycerol and triglyceride levels. Patient education material should contain information to highlight the potential problems associated with ‘binge’ drinking which may be of more significance individuals with diabetes in addition to the established concerns for the general population.

Funding

Wessex Medical Trust.

Conflict of interest: None declared.

1. Doll R , Peto R , Hall E , Wheatley K , Gray R . Mortality in relation to consumption of alcohol: 13 years observations on male British doctors, BMJ, 1994, vol. 309 (pg. 911-8) 2. Fuchs CS , Stampfer MJ , Colditz GA , Giovannucci EL , Manson JE , Kawachi I , et al. Alcohol consumption and mortality among women, New Engl J Med, 1995, vol. 332 (pg. 1245-50) 3. Yuan JM , Ross RK , Gao YT , Henderson BE , Yu MC . Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China, BMJ, 1997, vol. 314 (pg. 18-23) 4. Manson JE , Colditz GA , Stampfer MJ , Willett WC , Krolewski AS , Rosner B , et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women, Arch Intern Med, 1991, vol. 151 (pg. 1141-7) 5. Valmadrid CT , Klein R , Moss SE , Klein BE , Cruickshanks KJ . Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus, JAMA, 1999, vol. 282 (pg. 239-46) 6. Tanasescu M , Hu FB , Willett WC , Stampfer MJ , Rimm EB . Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus, J Amer Coll Cardiol, 2001, vol. 38 (pg. 1836-42) 7. Ajani UA , Gaziano JM , Lotufo PA , Liu S , Hennekens CH , Buring JE , et al. Alcohol consumption and risk of coronary heart disease by diabetes status, Circulation, 2000, vol. 102 (pg. 500-5) 8. UK Department of Health Safe. Sensible. Social. The next steps in the national alcohol strategy UK Department of Health, Gateway reference 8079,2007. 9. Gaziano JM , Buring JE , Breslow JL , Goldharber SZ , Rosner R , VanDenburgh M , et al. Moderate alcohol intake, increase levels of high density lipoprotein and its subfractions, and decreased risk of myocardial infarction, New Engl J Med, 1993, vol. 329 (pg. 1829-34) 10. Trevisan M , Dorn J , Falkner K , Russell M , Ram M , Muti P , et al. Drinking pattern and risk of non-fatal myocardial infarction: a population-based case-control study, Addiction, 2004, vol. 99 (pg. 313-22) 11. Institute of Alcohol Studies Binge Drinking – Nature, prevalence and causes. IAS factsheet. Accessed 10 October 2008). 12. Adams SL . Alcoholic ketoacidosis, Emerg Med Clin North Amer, 1990, vol. 8 (pg. 749-60) 13. Wyckoff J , Abrahamson AJ . Kahn CR , Weir GC , King GL , Jackobson AL , Moses AC , Smith RJ . Diabetic ketoacidosis and hyperosmolar state, Joslin’s Diabetes Mellitus14th edn Philadelphia, Lippincott, Williams & Wilkins, 2005. 14. Umpierrez GE , Di Girolamo M , Tuvlin JA , Isaacs SD , Bhoola SM , Juha P , et al. Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis, J Crit Care, 2000, vol. 15 pg. 52 15. Laffel L . Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes, Diabetes Metab Res Rev, 1999, vol. 15 (pg. 412-26) 16. Marliss EB , Ohman JLJr, Aoki TT , Kozak GP . Altered redox state obscuring ketoacidosis in diabetic patients with lactic acidosis, N Engl J Med, 1970, vol. 283 (pg. 978-80) 17. Galan A , Hernandez JM , Jimenez O . Measurement of blood acetoacetate and β-hydroxybutyrate in an automatic analyzer, J Autom Methods Manage Chem, 2001, vol. 23 (pg. 69-76) 18. Fritsche I , Bührdel P , Melcher R , Böhme HJ . Stility of ketone bodies in serum is dependent on storage time and storage temperature, Clin Lab, 2001, vol. 47 (pg. 399-403) 19. Owen WE , Roberts WL . Cross reactivity of three recombinant insulin analogues with five commercial insulin immunoassays, Clin Chem, 2004, vol. 50 (pg. 257-9) 20. Howard AA , Arnsten JH , Gourevitch MN . Effect of alcohol consumption on diabetes mellitus: a systematic review, Ann Intern Med, 2004, vol. 140 (pg. 211-9) 21. Kerr D , Macdonald IA , Heller SR , Tattersall RB . Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 (insulin-dependent) diabetes, Diabetologia, 1990, vol. 33 (pg. 216-21) 22. Rasmussen BM , Orskov L , Schmitz O , Hermansen K . Alcohol and glucose counter-regulation during acute insulin-induced hypoglycaemia in type 2 diabetic subjects, Metabolism, 2001, vol. 50 (pg. 451-7) 23. Cheyne EH , Sherwin RS , Lunt MJ , Cavan DA , Thomas PW , Kerr D . Influence of alcohol on cognitive performance during mild hypoglycaemia; implications for Type 1 diabetes, Diabet Med, 2004, vol. 21 (pg. 230-7) 24. Turner BC , Jenkins E , Kerr D , Sherwin RS , Cavan DA . The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes, Diabetes Care, 2001, vol. 24 (pg. 1888-93) 25. Sasaki S , Kesteloot H . Wine and non-wine alcohol: differential effect on all-cause and cause-specific mortality, Nutr Metab Cardiovasc, 1994, vol. 4 (pg. 177-82) 26. Imhof A , Woodward M , Doering A , Helbecque N , Loewel H , Amouyel P , et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in Western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille), Eur Heart J, 2004, vol. 25 (pg. 2092-100) 27. Opie LH , Lecour S . The red wine hypothesis: from concepts to protective signalling molecules, Eur Heart J, 2007, vol. 28 (pg. 1683-93) 28. Vazquez-Agell M , Sacanella E , Tobias E , Monagas M , Antunez E , Zamora-Ros R , et al. Inflammatory markers of atherosclerosis are decreased after moderate consumption of cava (sparkling wine) in men with low cardiovascular risk, J Nutr, 2007, vol. 137 (pg. 2279-84) © The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]

Drinking 101: Type 1 Diabetes in College Edition

Before leaving for college, I had one last visit with my endocrinologist from back home. His parting words of advice to me were, “Now, if you remember anything about taking care of yourself in college, remember this: Hard alcohol will drop your blood sugar, drinks like beer will make it go up, and then you will drop.” I had never experienced alcohol before then; it was foreign and a little bit scary. This was mostly because my parents had always strongly advised against it. I don’t blame them for trying to condition me to stay away from it; if you aren’t careful, things can take a turn for the worst. Still, it is something that most all of us fellow type 1’s will try at one point in our lives. College just happens to be a time where most of the activities that happen revolve around alcohol. The thing to remember is that we can do anything and everything we want and diabetes will never stop us. Just keep in mind that in situations like this, taking extra precautions and experimenting within reason are very small prices to pay.

I decided that I would try a little bit at a time with different drinks, to see what effect they would have on me. The thing to keep in mind about alcohol is that it is pretty unpredictable. It can vary in outcomes based on many different factors. The most concerning part about drinking for people with type 1 diabetes are the overnight lows. Though I’ve had my fair share of miscalculations and faults, I always try to err on the side of caution. There is a list of tricks that I have up my sleeve to help me be prepared. So, in order to make sure that you are as safe as possible, it’s important to keep a few things in mind.

Here are some things that have worked for me as a person who is on insulin shots (multiple daily injections):

  1. Different liquors have different sugar content, and every individual person will have different reactions to it. Stick to one or two shots of alcohol that don’t have carbs or added sugar. In regards to mixed drinks, I have found it is it is best to stay away from sugary drinks like mojitos, since there are a lot more factors involved. Opting for diet soda instead of regular when mixing alcohol has been the safest way to go.
  2. That being said, if you drink hard alcohol (like vodka) at night, make sure to set a few alarms sporadically throughout the time you will be sleeping. You are likely to go low, so it is best if you catch it early.
  3. It is important that the people around you are educated on diabetes and drinking. Make sure you stay with a sober friend/roommate who knows how to take care of you; however, since that is not always a possibility, setting a few alarms throughout the night is the next best thing. Setting alarms after a night of drinking any type of alcohol is a good idea, especially if you have more than a few drinks. For instance, if I am to only have a couple beers/drinks, I will most likely not set an alarm, particularly if I have eaten correctly and watched my BG closely throughout the night. These measures seem tedious, but if you are ever in a predicament where you are not able to take care of yourself, they can save your life!
  4. It is always a good idea to eat something before you drink. I found it helpful to eat dinner and then a snack thirty minutes prior to drinking (usually a banana and some peanut butter to stabilize me). I tend to correct for food/BGs a little bit differently if I am planning on drinking. This works for me, but it might be different for you. The best thing to do is to experiment on a small scale, first.
  5. If you have a CGM (continuous glucose monitor), wear it! They come in handy, particularly when you are drinking! You can get an idea of where your BG is going at all times. It might be a good idea to have a trusted sober friend keep an eye on it while you are out, too.
  6. Also, remember to wear your Medic-Alert bracelet whenever you go out, because you never know when a time might come when you are unable to advocate for yourself if your friends aren’t nearby.

Remember that college is supposed to be fun, and you should never feel stressed out in situations like these. It’s easy to feel like a burden or embarrassed because of the extra things you have to do to compensate for having diabetes, but the people around you should be more than willing to help you out. Making sure that you are safe is never too much to ask. Cheers!

Drinking with type 1 diabetes

Can I drink alcohol when I have type 1 diabetes?

You don’t need to stop drinking, but it is best to avoid drinking excessive amounts of alcohol, as it could cause you to have a hypo. That’s because when you drink alcohol, the liver has to stop work to break down the toxins and remove it. While your liver is doing this it can’t do all the other jobs it normally would, such as releasing stored glucose if your levels start to fall. This effect can last for many hours after you have been drinking and may continue overnight and into the next day.

How should I manage drinking with type 1 diabetes?

It is recommended that you don’t drink too much in one session and have some carbohydrate to eat before or while you drink. You should also test your blood glucose level before you go to bed and eat a snack if your level is normal to low.

On occasion, you may find that your blood glucose level rises too high after drinks that contain carbohydrate, such as spirits mixed with regular soft drink or large amounts of beer. Where possible, choose a diet drink as a mixer.

Similar Articles

-Jill Petrie/GluJill

We hear it a lot on Glu and when we’re out at events – drinking alcohol is yet another challenge of life with type 1 diabetes (for those 21 and older, of course).

We recently spoke with Jane Dickinson, a CDE and a Program Coordinate and Adjunct Associate Professor at Teachers College at Columbia University. She told us what makes drinking with diabetes extra challenging.

“The biggest challenge with alcohol and diabetes is hypoglycemia (low blood glucose) later on. This can happen because the liver is busy detoxing, or breaking down, the alcohol and can’t help out by releasing stored glucose as needed.”

It’s worth noting that low blood sugars can occur many hours AFTER you drink – which can lead to lows overnight or even into the next day.

Thirsty for More?

Learn about drinking with diabetes from our latest installment of Did You Know. You’ll see results from a few recent Glu Questions of the Day, a personal perspective from a college student who experimented with alcohol and insulin, and more tips from Jane Dickinson. If you are of the legal drinking age and want tips to help you avoid low blood sugars, download Project Alcohol now!

Want more from Did You Know? Check out Project Pizza and stay tuned for our upcoming Project Sleep!

Want more type 1 diabetes-related news stories, and the chance to help type 1 diabetes research? Take a moment to join T1D Exchange Glu now by clicking here.

Alcohol and type 1 diabetes booklet

Information for young people with type 1 diabetes.

The following information on alcohol should be used as a guide. Alcohol affects people differently and some of this information may not apply to all people with type 1 diabetes.

This booklet is available in two formats.

You can download and print out the PDF version.

Or you can read it as a website page below.

Alcohol is the most commonly used recreational drug in Australia, available legally to anyone over the age of 18. It is actually classified as a ‘depressant’ drug which simply means that it slows down your body’s response rates, which can lead to poor decision making and slower reflexes. Drinking alcohol can cause immediate problems with speaking and movement which can lead to harmful accidents or injuries, or unwanted physical or sexual violence.

When you become a teenager your body goes through a lot of changes. Just as your body keeps developing and maturing, so does your brain. There are a lot of reasons not to drink alcohol when you are young but one of the most important ones is that it can affect your brain because it can actually stop your brain from developing normally. Alcohol affects the brains of young people differently from the way it affects adults, and can cause health problems, memory problems, addiction or depression.

If you have diabetes you are still able to drink alcohol, but there is a higher risk of your diabetes becoming unstable when alcohol is added to the mix. It is important for you to know about these risks so you can prevent them and avoid dangerous situations.

What is a standard drink? A standard drink is one that contains 10 grams of alcohol.

One standard drink is equal to:

  • 285ml regular beer
  • 425ml low alcohol beer (less than 3% alcohol)
  • Pre-mixed drink
  • 100ml wine
  • 60ml fortified wine (port, sherry)
  • 30ml spirits

It is important to be familiar with how much is in a standard drink of each type of alcohol as it is easy to misjudge the amount consumed. By Australian law, the label on every alcoholic drink has to show how many standard drinks it contains.

It’s important to remember that some drinks served at restaurants, bars, clubs, and particularly at parties, can have more alcohol than a standard drink. As an example, an average serving of wine at a restaurant is 150ml making it 1.5 standard drinks. In addition, cocktails can contain many shots of different spirits, so even though they may look like one standard drink, they can actually contain a whole lot more.

How much is too much?

Research shows that people with diabetes can drink alcohol like everyone else, but it is advisable that they stick to the recommended 2 standard drinks limit per day which relates to all Australians. Most people with diabetes can safely drink alcohol in moderation, but it is always best to check with your doctor if you have any questions.

For young people under 18 years of age, not drinking alcohol is the safest option.

Excessive drinking or ‘binge drinking’ can be dangerous for your health. Short term effects can include hangovers, headaches, nausea, vomiting, memory loss and injuries. There is also the risk of alcohol poisoning which can cause death. Other effects include changed behaviour such as aggression or depression. Long term effects can include alcohol dependence which can lead to liver or brain damage over time.

You can lower your health risks and avoid dangerous situations by following these guidelines:

  • Adult men and women should drink no more than 2 standard drinks a day.
  • Drink no more than 4 standard drinks on a single occasion.
  • Have at least 2–3 alcohol free days each week.

How does alcohol affect a person without diabetes?

Because everyone is different, alcohol can have different effects on people depending on a number of things including:

  • gender
  • weight
  • amount of body fat
  • what they have eaten beforehand
  • physical activity
  • how they are feeling at the time.

More information on the effects of alcohol can be found in the Australian Government’s National Health and Medical Research Council’s (NHMRC) guidelines.

How does alcohol affect a person with type 1 diabetes?

People with type 1 diabetes face more risks when drinking alcohol than people without diabetes. Alcohol can affect your blood glucose levels (BGLs), which may cause hypoglycaemia (a ‘hypo’).

When you drink alcohol, your liver thinks it is a toxin that needs to be processed. Until the alcohol is completely processed, your liver will not release a sufficient amount of glucose into your blood which means your BGLs are lower, and may lead to a hypo. Sometimes your BGLs are first raised by the sugar content in some alcoholic drinks (which are mixed with soft drink) and then lowered once your liver starts processing the alcohol. The risk of a hypo occurring is possible both during the time you are drinking, as well as for many hours after drinking.

Symptoms of a hypo can include shaking, sweating, dizziness, headaches, crying, grumpiness, hunger and numbness around the lips and fingers. So it is very important to treat a hypo if you feel any or all of these symptoms. You should check your blood glucose level. If it is below 4mmol/L you should have:

  • Glucose tablets equivalent to 15 grams carbohydrate OR
  • 6–7 jellybeans OR
  • 1/2 can of regular soft drink (not ‘diet’) OR
  • 3 teaspoons sugar or honey OR
  • 1/2 glass of fruit juice.

For more information on how to treat a hypo, see the Managing hypoglycaemia fact sheet.

Alcohol and hypos

If you drink alcohol, you and your friends may not recognise the symptoms of a hypo because it may be assumed that you are drunk. This is dangerous because you may not get the right help fast enough.

Young people with type 1 diabetes need to plan ahead if they are drinking. Tips to reduce your risk of alcohol-related hypos:

  • Never drink on an empty stomach. Always ensure you have some carbohydrate in a meal or snack prior to commencing drinking.
  • Check your blood glucose just before going to bed to minimise the chances of hypoglycaemia while sleeping.
  • Eat a snack before going to bed. Remember that the body continues to process alcohol even after drinking stops.
  • Never drink alone. Identify a friend, who knows you have diabetes, to watch out for you if you decide to drink. Make sure they know how to recognise when you are having a hypo and that they know how to help you to treat it.

If you drink alcohol, you and your friends may not recognise the symptoms of a hypo because it may be assumed that you are drunk.

What types of alcohol can I drink?

Different types of alcohol may have different effects on your body. While alcohol can lower your BGLs it is important to remember that many types of beverages also contain carbohydrates which can raise your BGLs.

There is no hard and fast rule as to how much insulin to take for each drink you consume. It’s best to pace yourself and learn how your body responds to different types of alcohol.

  • Learn the carbohydrate content of what you are drinking. Websites and apps such as Calorie King can tell you what is in your drink. The more information you have, the easier it will be to manage your BGLs.
  • Pre-mixed drinks often have higher sugar content and can initially raise BGLs, followed by a fall once the alcohol effect on the liver has kicked in.
  • Check your BGLs often to see how different types of alcoholic drinks affect your body.

Peer pressure

Wanting to fit in and make friends can make you act in certain ways. Sometimes your friends might pressure you to do something you don’t really want to do, making you feel uncomfortable or left out unless you join in.

If you are offered alcohol that you don’t wish to drink, stand your ground. You have the right to say no. Resisting pressure can be hard at times but you can do it. You should only do something if you want to, know how to do it safely and feel comfortable in doing so.

If you’re finding it hard to work up the courage to say no to something, you should know that sticking up for what you believe in feels really good. People don’t have to agree on everything, and if you can explain to people in a calm way why something is not for you, more often than not, you’ll gain their respect.

When to say no

It may be wise to drink less or avoid alcohol all together if you:

  • are overweight
  • have poor blood glucose control
  • have high blood pressure
  • have high triglycerides (fat) levels
  • have eye disease caused by diabetes
  • have nerve damage in the arms or legs.

Drinking alcohol can make all of these conditions a lot worse.

Think when you drink: planning an evening out

  • Make sure to eat a carbohydrate containing meal before heading out. Avoid drinking on an empty stomach.
  • Carry extra carbohydrate snacks in case you have a hypo. This may include long acting carbohydrates (a muesli bar or 2–3 pieces of dried fruit) as well as quick acting carbohydrates (6–7 jellybeans or 1/2 can of soft drink).
  • Wear diabetes identification such as a medical alert bracelet.
  • Monitor your BGLs. Take along your blood glucose measurement kit and check levels frequently while you are out.
  • Pace yourself. Consider alternating one alcoholic drink with a glass of water. Binge drinking is never a good idea as your liver will not be able to keep up with the large quantities of alcohol being consumed. This could result in vomiting and clouding of your judgement so you won’t be able to manage your diabetes properly.
  • Never stop taking your insulin. Doing so could result in very high BGLs which can lead to diabetic ketoacidosis (DKA) which may be life-threatening.

Before you go to bed

  • Check your blood glucose levels and drink water to avoid waking up dehydrated the following day.
  • Set your alarm to wake you up a few hours later to check your levels. And/or ask a roommate, family member or partner to check up on you while you’re sleeping.
  • Have hypo treatment within reach during the night.

Further resources

Alcohol fact sheet

National Health and Medical Research Council’s 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol

Australian Drug Information Network

Type 1 Diabetes Network: Alcohol in the Type 1 diabetes starter kit for newly diagnosed adults

Headspace: National Youth Mental Health Foundation

Diabetes UK: Alcohol

  1. National Health and Medical Research Council: 2009 Australian guidelines to reduce health risks from drinking alcohol: nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcoholqa.pdf

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