Just because you're diabetic doesn't mean you can't enjoy a drink. Whether you're a teenager at a house party, student at University, or perhaps someone who likes a red with a Netflix series, the influence of alcohol on blood glucose is something we as diabetics should be aware of.
My education: BSc Microbiology, MBiol Biology, University of Leeds
What happens when we drink alcohol?
The liver is a neglected organ when it comes to the discussion of diabetes. The liver plays an important role as the body's glucose (sugar) reservoir and helps maintain your blood glucose all day, every day. Believe it or not, the liver is able to both store and manufacture glucose on demand depending on the needs of your body at the time.
When you're not eating i.e overnight or between meals, it's down to your body to supply the glucose necessary for keeping up your bodily functions. Your liver will dump glucose into your blood by turning glycogen (stored glucose) into glucose. This is the reason that we require basal insulin, whether it be through a pump or from injection once or twice a day. Without this background insulin, the glucose being dumped into our blood from our liver will continue to accumulate as it cannot enter the cells that need it for energy.
So why is this important when it comes to alcohol?
When we drink alcohol, the livers ability to release glucose into our blood is interrupted. This is usually because it's too busy processing the alcohol we're throwing down our necks...
This is significant for those on insulin therapy. Think of it this way - if your liver is unable to release glucose into the blood, the background insulin you have on board is going to have a greater effect on your blood glucose than usual, potentially resulting in hypoglycaemia.
With alcohol in your body, your liver prioritises processing this over dumping glucose into the blood. The end result being too much insulin present in the blood required for the concentration of glucose.
A liver impaired by alcohol can last for many hours after your last drink. The main concern around this is falling into hypoglycaemia during your sleep. Being drunk combined with hypoglycaemia is the perfect storm for a terrible outcome. Not only this, but being drunk can mask the symptoms of a hypo. It is for these reasons that EVERYONE with diabetes needs to be educated on how to drink safely.
Drinking with diabetes
Depending on the type of alcohol and how much you're consuming, you need to give your diabetes a bit more of your attention than normal. I think it's perfectly OK to drink alcohol in excess like any other person so long as you take the necessary steps to avoid a good night being ruined. For example, on the first night of freshers week at Uni I got so drunk I fell down a hill and smashed my insulin pump to pieces. Don't be like me.
It's annoying that diabetes sticks its foot in every aspect of our lives, including the social side. Unfortunately this is the card we've been given. Rather than ignoring your diabetes on a night out, co-operate with its demands to make your life easier.
The simplest way to make your drinking session as safe and worry free as possible is to consume drinks that have little to no carbohydrate content. Mixing alcohol and insulin can be a dangerous game which can have some nasty consequences. To put your mind at ease and to make sure you enjoy your evening out, I would always recommend having spirits and diet mixers. If you're a G&T lover, always stick to slimline tonic.
Working out a bolus dose whilst under the influence is never an ideal situation, which is why I will nearly always stick to spirit & mixer. That being said, I do enjoy cocktails which often require insulin.
When drinking in excess, I will always keep my blood glucose on the 'higher side' (8.0 mmol/mol - 12 mmol/mol) than lower. For me, it brings peace of mind knowing that the likelihood of falling into a hypo whilst drunk is kept low. I will either eat something small before I start drinking or will have food as I drink. Depending on my starting blood glucose, I will keep the carbohydrate content in this snack low so I don't have to bolus. This way, I keep the mix of insulin and alcohol to a minimum.
Bolusing when drunk
It would be more irresponsible not being educated on how to bolus insulin when you’re drunk than not know how to do it at all. It’s true that bolusing sober has its risks (hypoglycaemia), but bolusing whilst drunk even more so. The room for error is astronomical and it is for this reason that I feel it’s important for me to share my honest take about how to dance in the flames without getting too badly burnt.
Opt for low carb
I will always stick to sugar free alcoholic drinks. I don’t get regular mixers and instead stick to diet mixers. It will save you so much hassle and worry because you won’t need to keep track of the carbohydrates/sugar's you’re consuming in your drinks. And most importantly, you won’t need to bolus for these drinks. When you’re ordering at the bar, make it very clear to bar staff that you want diet mixers. I’ve worked behind bars before, so I know how easy it is to forget and give someone the opposite.
If you’re drinking cocktails, I stick to the ones that you can swap the sugary stuff for diet stuff. A prime example is one of my go-to’s; the Long Island Iced tea. Usually they make it with regular coke. To make this drink almost sugar free, ask for the diet coke instead. It can be really hard to know how much carb is in all the cocktails on the menu. If you’re going to have them, be sure to look at the ingredients and make a judgement call. If you see it’s made from orange juice or cranberry, then you know you’re looking at 20 g+ of carbohydrate. When injecting for cocktails on the go, I always bolus for less then I think I should. For example, if you think a cocktail is around 40 g of carb, bolus for 30 g instead and see how you go. If you have the freestyle libre, seeing how drinks impact your blood glucose is made easy. If not, testing every 45 minutes or so is fine for me.
It's perfectly normal to want to eat food whilst you're drinking or after you've finished. In fact, from experience I've found this to be beneficial in preventing a hypo hours later. There are some precautions you should take, however.
Don't overdo the carbs. The more carbohydrate you consume, the more insulin you're going to have to take. I've always found that having carbohydrates during or after drinking is safer than not. The times that I've not eaten carbs has always resulted in me needing sugar or carbs at some point to prevent an impending low.
Check your blood glucose. If you only test your blood glucose in a handful of situations, make this the number one time you do. It's sensible and safe to test your blood glucose several times over the course of the night. Before I started the libre, I would test before I started, once or twice during, and again before I ate food. When drinking, it's really important to know where your blood glucose is. The last thing you'll want to do is not test your blood glucose after a night out and end up bolusing for food when you really didn't need it. This has happened to me on several occasions, and now I've finally learnt my lesson. TEST before you inject when drinking.
Check your blood glucose hours after you've eaten/injected. You could find that you've severely under/overestimated the amount of insulin you needed. It's important to take action before you sleep if this ends up being the case.
The only time I really find myself paying extra attention to by blood glucose when I drink is if i’m doing so for the sole purpose of not remembering the night I.e student nights.
Now that I’ve retired from the student lifestyle, I rarely drink, and if I do it’s only one or two.
A glass or two of wine has never had a significant impact on my blood glucose. Some wines may have sugars in them, but most don’t. Therefore you won’t need to spend too much time worrying about bolusing for these drinks. What you should watch out for, however, is the lowering effect they might have on your glucose hours later. If you’re having a glass or two with a meal, consider bolusing less than is required, I.e if you’re eating pasta worth 6 units of bolus, and you’ve drunk one or two glasses of alcohol, perhaps consider only taking 4.5-5 units instead.
Alcohol in excess is dangerous for anyone; especially for us diabetics. Don't let diabetes ruin more then it should. Drink responsibly and don't neglect your condition.
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You can read a lot more about how I managed drinking in excess as a student in my eBook - Diabetes & University. This eBook covers alcohol fully and is suitable for any adult who likes a drink. If you subscribe below, you'll receive a discount code in your confirmation email granting you 100% off all eBook guides.