In Honor of St. Patrick’s Day: Alcohol and Diabetes
Jessica Torres, MSN, BC-ADM, RN, CDE, CDTC
In my career as a diabetes educator I have heard many mixed messages around alcohol and diabetes. In all honesty, when I bring up alcohol with my patients, many times, it is the first time they have had the subject brought up during a diabetes care appointment. I find this understandable and shocking at the same time. Discussing alcohol consumption with a patient can be a very sensitive subject for many reasons, including: personal convictions about drinking alcohol, fear of the effects of alcohol in combination with diabetes, and also hard to bring up if the patient is underage. Trust me MANY individuals with diabetes, under the age of 21, consume alcohol. I 100% understand what a touchy subject it may be, however, discussing alcohol with patients that have diabetes may save lives! Individuals with diabetes can consume alcohol and as diabetes educators we need to make sure they do so safely with the proper education and preparation.
Physiological Effects of Diabetes and Alcohol
Drinking alcohol can cause a drop in blood glucose because alcohol blocks the production of glucose in the liver. The liver is what contains “emergency stores” of glucose to raise blood sugar if it drops too low. Once the liver's stores of glucose are used up, a person with diabetes who has drank a lot of alcohol cannot make more right away, and that can lead to dangerously low blood glucose or even death. This is why it is critical to explain the physiological effects of alcohol to patients and then to also educate them on how to drink safely with diabetes (“ADA Alcohol”, 2018).
Patient Education on How to Drink Safely with Diabetes
First and foremost, set all judgements aside and start with general alcohol consumption guidelines. Yes, people with diabetes get to use the same guidelines as those without diabetes if they choose to drink, which includes: women no more than 1 drink per day and men no more than 2 drinks per day. One drink is equal to a 12 oz beer, 5 oz glass of wine or 1 ½ oz distilled spirits including: vodka, whiskey, gin, etc. (“ADA Alcohol”, 2018). Next, give patients tips that apply to drinking with diabetes. These tips include:
- Do not drink on an empty stomach or when blood glucose levels are low. Again, this is due to the increased risk of low blood glucose after drinking.
- Follow the rule above and have alcohol with food. This is mainly important for those on insulin and other diabetes pills that can lower blood glucose by making more insulin.
- Don’t skip a meal if the plan is to drink. If a patient uses carbohydrate counting to plan meals, it is important for them to understand how the drinks they choose affect blood glucose and often their insulin dose will need to be decreased if having more than one drink.
- Wear an I.D. that notes that they have diabetes. Remind patients that if in a setting where people are drinking alcohol, hypoglycemia may be mistaken for being drunk. The symptoms of too much alcohol and hypoglycemia can be similar, for example, feeling sleepy, dizzy and confused. The one way to get the help needed is to always wear an I.D. that says "I have diabetes." Advise patients to make sure that their family and friends know to be aware of symptoms of hypoglycemia and what to do.
- Alcohol can cause hypoglycemia shortly after drinking and for up to 24 hours after drinking. If a patient is going to drink alcohol, then they need to be educated to check their blood glucose more frequently. For example: before drinking, while drinking, before bed and throughout the night (so set alarms), and more often for up to 24 hours.
- Be sure blood glucose levels are at a safe level, between 100 and 140 mg/dL, before going to sleep. If blood glucose levels are low, eat something to raise it and be sure to check again before going to sleep, and again over night to be sure it’s not dropping too low.
- Watch out for craft beers, which can have twice the alcohol and calories as a light beer.
- For mixed drinks, choose calorie-free drink mixers like diet soda, club soda, diet tonic water or water.
- As with anyone with or without diabetes, do not drive or plan to drive for several hours after you drink alcohol. Always remind the individual not to drink and drive. This is a public service announcement that everyone can share and reiterate, not just law enforcement (“ADA Alcohol”, 2018).
Patients do not always think to start the conversation about drinking alcohol with diabetes. Never assume that the patient has already been educated on the matter and knows how to drink safely. Bring the conversation up during diabetes care appointments and make sure to discuss the above tips with them. Check out this great video resource from the TCOYD ONE conference in 2017, “Alcohol and Diabetes Do They Mix?”, by Jeremy Pettus, MD. https://www.youtube.com/watch?v=GRvjBrFvnSk
Happy St Patrick’s Day! “May your troubles be less. And your blessings be more, and nothing but happiness come through your door.” –Irish Blessing
References
ADA Alcohol. (2018, March 15). Retrieved from http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html
TCOYD Alcohol and Diabetes Do They Mix? (2018, March 15). Retrieved from https://tcoyd.org/one-2017/