Diabetes and Alcohol

Diabetes and Alcohol

DIABETES AND ALCOHOL

by Peter J. Nebergall,
PhD

In his "When Diabetes Complicates Your Life"

(Chronimed, 1993), Joseph Juliano, MD, writes of a diabetic

man, in good health, who went to a dinner party, and drank.

Active, dancing, and talking with friends, he had four

drinks of Scotch and soda over four hours. As he had eaten

several snacks and sandwiches at the party, he skipped his

usual before-bed snack.

Consumption of alcohol can lower blood glucose level.

Between 4 and 5 a.m., Dr. Juliano reports, the drinker went

into an insulin reaction. Normally, he would have awakened,

but the alcohol had dulled his senses. With a blood glucose

of 23mg/dl, he went into convulsions, and was only brought

around by an emergency glucose infusion. It was a very near

thing.

"I was that man," reports Dr. Juliano.

What happens when you drink alcohol? Three things:

1. Alcoholic drinks have measurable food value; so

many carbohydrates per drink. These carbs have to be "paid

for." To preserve the integrity of your meal plan, an

increase in carbs from beer would require a decrease in

carbs from other sources-- and you might need those foods

more than that glass of brew.

2. Alcohol can affect perception. Most folks, most

of the time, won't feel more than a pleasant buzz, but if

you really "go on a bender," you may not be in the best

shape to self-monitor your blood glucose or draw up insulin.

Take care.

3. Glycogen, stored in the liver, is normally

available for release into the blood as needed, to

compensate for a "low." For most folks, this

"glycogenolysis" occurs spontaneously. An injection of

glucagon (an emergency medication all diabetics should keep

on hand) sparks the same process.

Consumption of alcohol interferes with the liver's

release of glycogen. A significant amount of blood alcohol

can completely stop glycogenolysis, leaving you "without a

parachute" if you get low. This can mean an ambulance ride.

Alcohol's effect on blood sugars is complex and

unpredictable. A drinker may experience a rapid rise (from

the carbohydrate), followed by a steep drop. But where he

or she might normally perceive the oncoming hypo, and take

action, alcohol "dulls the signals," and can lead to the

induced equivalent of hypoglycemia unawareness. As Dr.

Juliano reports, this can lead to real problems.

The type II (NIDDM) diabetic, using one of the

sulfonylureas such as glyburide, glipizide, tolbutamide,

tolazamide, or chlorpropamide to help control blood glucose,

can experience another problem with the consumption of

alcohol. In some individuals the sulfonylureas react with

the alcohol, producing a brightly flushed complexion.

So should you drink? People consume alcoholic

beverages for many different reasons, and those reasons

usually determine their drinking patterns. Other than "if

you are going to drink, keep it moderate, and take with

food", there can be no easy blanket answer. Alcoholic

beverages impose a new risk on the diabetic, who already has

a lot to juggle. It is up to each individual to make an

informed judgement about how much of that risk is

appropriate, so talk to your doctor about how to drink

safely. Ancient Greek physician Hippocrates' teachings of

moderation; of a healthy lifestyle, are never more

appropriate than right here and now.