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.