Alcohol: drink safely and smartly

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Diabetes is a disease synonymous with behaviours and activities that you can’t do. Most people still walk into my office wanting a diabetic diet sheet, a list of foods that they can and can’t eat. Thankfully, we’ve moved on from there.

It’s also a disease that places so many restrictions on your health and makes you keenly aware of all the bad habits that people enjoy and the differences between people with diabetes who can’t do something and those without diabetes who can do whatever they like. This is also not completely true.

It is true that most people with diabetes tend to drink about half as much as other adults. Why? Perhaps they have been advised that alcohol and diabetes don’t mix. Perhaps some have health conditions that are incompatible with alcohol. Or maybe they’re just concerned about all those kilojoules and carbs.

But is the occasional glass of wine or beer really so bad? Is it possible to enjoy a few drinks with friends even if you have diabetes? The key message is you need to drink safely and smartly.

What can you drink? 

These are the bare facts. For women, one unit of alcohol a day is considered moderate and for men, up to two units.

A unit of alcohol is 200ml wine, a 340ml beer or 40ml spirits. And you can’t bank your daily allowance and save it for the rugby game on Saturday afternoon. (Although if last year’s Rugby World Cup was anything to go by, you may need to!)

A few cautionary tales 

All alcohol, regardless of whether it’s a lite beer or an expensive whiskey, is made from carbohydrates. Hops and barley are fermented to make beer, wine comes from grapes and spirits are also made from grain or malt; all carbohydrates.

The simple reason that diabetes and alcohol aren’t good friends is that all these drinks will rise your blood glucose levels.

Many of the mixers used in creating drinks are also sugar-containing beverages. These will also raise blood glucose levels. It’s possible to have sugar-free sodas but then glucose levels may drop.

It’s perhaps a lesser known fact that alcohol and glucose compete for metabolism in the liver. What this means is that the liver will preferentially metabolise alcohol over maintaining your blood glucose levels. This is, in part, a survival mechanism to prevent you from becoming over-intoxicated.

It’s also particularly pronounced when your stomach is empty. The result of this being the risk of hypoglycaemia (low blood glucose) after you have been drinking. That is why many clinicians will suggest a high fat meal or snack (peanuts, milk, cheese sandwich) before drinking. Obviously, this food will cause a rise in your blood glucose reading but at least it may help prevent a serious and complicated low glucose level.

The liver is also fairly slow at metabolising alcohol and generally each unit of alcohol will take one to two hours to be fully eradicated from your body. This timing will also depend on your body weight and the frequency that you’re used to drinking.

Reaction of medication and alcohol

Taking insulin or oral anti-diabetic medication combined with the glucose-lowering effects of alcohol can have a combined effect of significant hypoglycaemia.

In addition, the use of a glucagon pen to treat the low glucose level may also not be effective. This is because glucagon works quickly but only for a short time whereas alcohol may cause the glucose levels to drop for up to two hours. Often repeated doses of glucagon are required to counteract an alcohol-induced hypoglycaemic event. Certainly, a better option is to ensure adequate kilojoule intake through liquids and other foods.

Another problem is that many of the symptoms of hypoglycaemia (slurred speech, drowsiness, confusion, or difficulty walking) are also symptoms of being drunk and it can be difficult to tell the two apart.

The added concern of hypoglycaemic unawareness (a condition in which you don’t recognise you’re going low), makes drinking especially difficult.

Alcohol after exercise

What about those people who play a round of golf and then head off to the 19^thtee or those who play tennis and then enjoy a glass or two of wine afterwards?

Again, the added effect of aerobic exercise dropping the glucose levels and alcohol-induced hypoglycaemia can be very dangerous. Depending on the type and duration of exercise, this combined double-hit may only manifest a few hours after exercising so you do need to be very careful.

Dehydration and alcohol

Drinking is often associated with a balmy summer’s day by the pool or engaging in water sports at the dam. Another potentially disastrous combination is alcohol and dehydration. This is because your body fluid volume becomes depleted due to dehydration and the effects of the alcohol are all the more pronounced.

A good rule of thumb is to follow each unit of alcohol with a glass of water to ensure you stay well hydrated. If you’re out in the sun or doing physical activity, you can add another glass of water on. 

Faster glucose level reaction

And finally, drinks are liquid. That seems like a simple enough fact. But liquids are absorbed more quickly by the body than solid foods so whatever effect the alcohol is going to have on your glucose levels, it’s likely to happen quicker than what you can treat it with a few peanuts or cheese sandwich. In fact, you can probably expect your glucose levels to peak about 30 to 90 minutes after drinking. 

How to drink safely 

If you’re going to have a drink, here are a few things for you to consider.

• Firstly, speak to your doctor or diabetes educator and ask him/her to advise you on your specific needs and risks. Discuss your concerns with your healthcare team and ensure that you have the correct information relating to your specific condition.
• Always take your glucose testing equipment with you when you are drinking and be sure to test regularly (every hour if necessary) as glucose levels can fluctuate rapidly when you are drinking.

Discuss with your doctor when and how to intervene and you’ll also start to be more aware of what effects the alcohol is having.

• Limit your drinking to the recommended daily limit and to drinks where you know the effects on your body. Drink sizes and carbohydrate portions vary per drink so finding your preferred drink and knowing its effect on your body is probably very wise advice.
• It’s also a good idea to ensure that the people that you’re drinking with know that you have diabetes and that you have all your essential supplies with you. Make emergency details and arrangements known to those that you’re with (a list of your medications, your regular doctor, where your glucometer is, who should they contact). All this information can be recorded and placed in a safe place in your wallet or on a medical alert device so that it’s easily accessible each time.
• It may also be a good idea to have a formal discussion with your family about the conditions of safe drinking. Issues such as only drinking when your glucose levels are stable, only with trusted friends and having a distinct emergency plan may be very helpful to discuss in the sober light of day. Alcohol clouds judgement and making decisions when you already have a few units of alcohol can be very challenging.

The takeaway

Drinking is individualised and there’s no universal rule for how to do it safely when you live with diabetes. The best advice is to talk to your healthcare team and your family and make decisions based upon what is best for your health.

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