If you have diabetes, drinking alcohol will affect your blood glucose level, and this article outlines how with careful planning you can keep your levels as well-controlled as possible and avoid hypos. None of the information is intended to replace medical advice, but should be used in conjunction with information from your local diabetes specialist team.
When you have diabetes, the maximum amount of alcohol recommended on a daily basis is no different from someone who does not have diabetes. However, there are additional considerations, because of the effects that alcohol has on your blood glucose levels. These are:
1. Some alcoholic drinks contain carbohydrate, which will make your blood glucose levels rise initially.
2. Alcohol is processed by your liver. Your liver also produces glucose throughout the day, to provide energy and to give you protection if your blood glucose level falls too low. When your liver is processing alcohol, it has less ability to produce glucose.
3. If you drink more than 2-3 units of alcohol during one session, your liver’s ability to produce glucose becomes more impaired, leaving you vulnerable to hypos (hypoglycaemic episodes or low blood glucose levels). Also, because your body depends on the additional glucose to recover from hypos, the lack of this glucose means that hypos after drinking a lot of alcohol can be difficult to recover from and can even be potentially life-threatening.
4. The greater the quantity of alcohol you drink, the more prolonged effect it will have on your liver, potentially putting you at risk of hypos for up to 24 hours after you have been drinking.
Because of all these effects, it is important to think carefully about how you can manage your insulin pump to keep yourself safe from unexpected or prolonged hypos and avoid your blood glucose level swinging too much.
Planning ahead
Planning in advance will help you to work out how you can best manage your diabetes. The most important aim is to avoid hypoglycaemia, even if that is at the expense of keeping your blood glucose slightly higher than you usually prefer, because your liver is unable to come to your rescue if your blood glucose drops.
Step one: Identify whether the drinks you are having contain carbohydrate. If so, decide whether you want to take any insulin for that carbohydrate.
Step two: Work out what alterations you need to make to your insulin doses to avoid hypoglycaemia.
Step three: What additional precautions do you need to take.
Step one: Carbohydrate (CHO) content of drinks
Beer: 10-15g CHO per pint
Lager: 5-10g CHO per pint
Dry cider: 15g cho per pint
Sweet cider: 25g per pint
Sweet white wine: 5g cho per 125ml glass
Sweet sherry: less than 5g cho per 50ml
Liqueurs: 6-8g cho per 25ml
Alcopops: between 15 and 25g cho per 275ml bottle
There is no carbohydrate in spirits, although if you use non-diet mixer drinks they will contain carbohydrate. Also dry white wines and red wines have a very small amount of carbohydrate in, but not enough to be significant.
If your drinks contain carbohydrate and you decide that you want to take some insulin to avoid an initial rise in your blood glucose level, you can use your usual insulin to carbohydrate ratio but you should only take insulin for the first ONE or TWO drinks. After that, because you will have less glucose produced by your liver, you will not need extra insulin
Step two: Lowering your insulin doses
Lowering your insulin doses during the time that alcohol is being processed by your liver will give you the best chance of avoiding hypos. Firstly, programming a temporarily reduced basal rate will stop too much insulin building up when you don’t need it - potentially a 20-50% reduction for a few hours. If your alcohol intake during one session is more than 5 units, you will need to keep the reduced basal rate programmed for longer, for example setting it for the whole of the night. You can then reassess this in the morning, and if necessary, continue the basal rate reduction for some hours of the next day.
It is difficult to be precise about the exact amount of insulin reduction you will need and how many hours you will need to continue that reduction, so some experimenting will be needed to find out what works best for you. From a safety aspect, programming a lower basal rate than you think you will need to start with is recommended. You are also likely to need smaller boluses of insulin for any carbohydrate you eat during the time that the alcohol is still in your body.
Step three: Other precautions
In addition to the first two steps, you may find that you need to eat some additional carbohydrate before you go to bed if you have been drinking a significant amount of alcohol during the evening. This extra carbohydrate is to prevent hypos during the night, so either a reduced insulin bolus or no bolus at all will be needed.
It is also a good idea to talk to your friends or family that you will be with when you are drinking, to ensure that they know what to do if you have a hypo. This is because for an observer, it can be difficult to tell the difference between you having a hypo and being drunk. If in doubt, your friends or family should make sure you swallow some extra glucose (a glucose drink or glucose tablets) to treat the possible hypo and keep you safe.
Jill Rodgers is Business Director of Successful Diabetes, successful diabetes, and has written the UK’s first-ever insulin pump book ‘Using insulin pumps in diabetes’, published by John Wiley & Sons Ltd in 2008.
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