Yes, You Can But, Not Too Much! Alcohol And Type 1 Diabetes

Alcohol is a part of life and a social construct in many societies. A relaxing way to unwind after a long day with a glass of wine can feel excellent. Enjoying the company of friends during a meal with a pint of beer is great. But as a person living with type 1 diabetes can you?

The good news is that as an individual living with type 1 diabetes, you can still enjoy that glass of wine or a shot of whiskey. However, there are some things you need to be aware of before you take yourself out for a Friday night outing to the local pub.

Alcohol, The Liver And Blood Glucose

Approximately 80% of alcohol is metabolised in the liver.¹ This means, when we drink alcohol, the liver works hard filtering and breaking down the alcohol from the bloodstream. This is important to understand the effects of alcohol on blood glucose.

Why the liver? The liver has two important functions relating to blood glucose. First, it produces glucose from proteins or fat (gluconeogenesis – generates new blood glucose). Gluconeogenesis helps to stabilise blood glucose levels during fasting states.¹ The second function is converting a proportion of the excess blood glucose we have ingested (the simplest form of sugar required to give us energy) into glycogen. Glycogen is a more complex form of glucose that can be quickly converted back to glucose in the liver. These processes occur throughout the day and night, keeping our blood glucose levels on track.

The liver breaks down alcohol, releasing biochemicals as “waste” or by-products. These by-products disrupt the liver’s natural process of gluconeogenesis. For example, approximately 6 units of alcohol (~ 48 g or 60 ml of pure alcohol) can reduce gluconeogenesis by about 45%.1 In addition, alcohol also prevents the liver from breaking down glycogen into glucose. Ultimately, each of these processes drops blood glucose levels.¹

Alcohol, Blood Sugar Management And Type 1 Diabetes

So, how does this translate for an individual living with type 1 diabetes?

When we drink alcohol, the blood glucose levels can lower rapidly. What this means for a person living with type 1 diabetes is that they are at a higher risk to develop hypoglycaemia (when blood glucose levels get too low). However, this is not always the case. For example, having a glass of wine or a pint of beer during a meal wouldn’t affect the blood glucose level much, as it is being consumed together with food at a moderated amount.¹ The more alcohol a person consumes, the greater the risk of blood glucose levels dropping.²

People living with type 1 diabetes also need to know that the duration between their last meal and the first drink counts. An article reviewing different studies states that 1 litre (or approximately 2 pints) of beer taken a few hours after a meal increases the risk of hypoglycaemia.¹ As the night wears on and with more alcohol consumed, the chances of developing hypoglycaemia increases.¹ To make things a little more complicated, hypoglycaemia can occur while drinking alcohol and up to 12 hours after.^1,2 In fact, the same article informs that low blood glucose levels were detected the following day even after taking a meal.¹

Other than hypoglycaemia, an individual living with type 1 diabetes may develop hyperglycaemia (high blood glucose) when drinking alcohol.¹ This happens when we have alcohol with mixers and cocktails, which have high sugar content.

Living With Type 1 Diabetes And Drinking Safely

In 2019, The American Diabetes Association guidelines advised people living with type 1 diabetes to drink alcohol in moderation.³ This translates to ≤ 1 drink/day for adult women and ≤ 2 drinks/day for adult men. So, carry your usual hypoglycaemia treatment with you so you can raise your blood glucose levels quickly if you experience hypoglycaemia. By staying up-to-date and being equipped, it will help you to be prepared if you need help during a night out.

Here are some ways to drink safely:²

• Check blood glucose levels before, during and after drinking.
• Have a good meal that includes carbohydrates before going out.
• Carry snacks such as dried fruit, dark chocolate or whole grain crackers with peanut butter with you so you can raise your blood glucose levels quickly if you experience hypoglycaemia.
• Keep yourself hydrated by alternating between alcohol and water.
• Remember that dancing is a form of exercise and can further reduce blood glucose levels.
• Check your blood glucose levels before bed and eat something if your blood glucose is low.
• Try choosing sugar-free mixers to prevent high blood glucose levels (hyperglycaemia).
• Have breakfast after waking up, even if you don’t feel like eating.
• Before a night out, try researching the types of alcohol drinks served and decide what you’d like to have based on the units of alcohol and how it is being served.

Bonus tip:

• Using technology: Consider using the Temporary Basal Rate or Temporary Target features within your insulin pump or continuous glucose monitoring system. This is especially useful if you often find your glucose levels go low after drinking alcohol. Speak to your diabetes healthcare team to find out how using technology may benefit you.

Final thoughts

As you learn how to navigate the road of living with type 1 diabetes you shouldn’t feel like you are missing out on things. Enjoying alcohol if you want to shouldn’t be a problem. Talk to your diabetes healthcare team about how to enjoy an occasional drink. Go ahead and have that glass of wine!

Reference

1. White ND. Alcohol use in young adults with type 1 diabetes mellitus. Am J Lifestyle Med. 2017;11(6):433-435.
2. Diabetes.org.uk. Type 1 diabetes and drinking. https://www.diabetes.org.uk/. 2021 Available at: https://www.diabetes.org.uk/guide-to-diabetes/young-adults/type-1-drinking. (Accessed January 2022).
3. American Diabetes Association. Lifestyle management: Standards of medical care in diabetes. Diab Care. 2019;42(Suppl 1): S46-S60.