Most people with diabetes can safely consume alcohol in moderation. The National Institute of Diabetes and Digestive and Kidney Diseases defines moderate consumption as a maximum of one drink/day for women and two drinks/day for men. Past that, excessive alcohol use and diabetes can be a dangerous combination.
Before we can understand how alcohol affects someone with diabetes, we need to understand how diabetes disrupts metabolic processes. When you consume carbohydrates, they are broken down into several components, including the sugar glucose. Glucose is the most efficient energy source for cellular metabolism, and it is carried by the bloodstream to every cell in the body.
Cells cannot directly pick up glucose. They need something that can help them transport glucose out of the blood. The hormone insulin facilitates the transfer of glucose from the blood into cells. Without insulin, cells have no way to access the fuel they need, resulting in a catastrophic failure of metabolism.
Diabetes is characterized by a lack of insulin. If someone with diabetes does not carefully monitor their blood sugar (the level of glucose in their blood) and administer appropriate amounts of insulin, glucose accumulates in their bloodstream (“hyperglycemia”) while cells starve for fuel.
Alcohol and Blood Sugar
Drinking alcohol causes blood sugar to drop because alcohol-derived glucose triggers insulin production in people without diabetes. Someone with diabetes will have insulin in their blood because they previously administered it. In both cases, insulin quickly moves glucose out of the blood.
- In the absence of alcohol, the liver helps regulate blood glucose levels. After a meal, blood glucose is high, and the liver stores some of it for future use. When blood glucose drops, the liver releases glucose to ensure that cells have enough fuel.
- If alcohol is present, the liver halts all other metabolic activity to focus on metabolizing it at a rate of about one drink per hour. Consequently, even if all of the glucose in your blood has been used for cellular metabolism, your liver will not release more until all of the alcohol in your blood has been metabolized.
If you had three drinks, your liver will spend about three hours metabolizing those three drinks and ignoring all other metabolic functions. During this time, insulin and glucose are depleted as they continue to fuel cellular metabolism.
Once all of the alcohol has been detoxified, the liver can release glucose, which triggers insulin production, and cellular metabolism is fueled once again. However, if you have type 1 diabetes, you cannot produce insulin no matter how much glucose your liver releases, and cellular metabolism remains stalled. If insulin is not administered quickly, this can become a very dangerous situation.
Type 1 vs. Type 2 Diabetes
- Type 1 diabetes is characterized by an inability to produce insulin. If insulin is not administered regularly, type 1 diabetes is fatal. Type 1 diabetes is usually diagnosed during childhood, and it makes up 5-10% of diabetes cases.
- Type 2 diabetes is characterized by a reduced capacity to produce insulin as well as cells that are “resistant” to insulin. It is generally considered to be a lifestyle disorder that is caused by a poor diet and lack of exercise. Type 2 diabetes is usually diagnosed during adulthood, and it accounts for 90-95% of diabetes cases.
Complications Between Alcohol and Diabetes
Low blood sugar (“hypoglycemia”) and alcohol intoxication have similar symptoms:
- Lack of coordination
Consequently, someone with diabetes who has had a few drinks may attribute symptoms of hypoglycemia to being intoxicated. This is called “hypoglycemic unawareness” and can be very dangerous. If someone with type 1 diabetes has several drinks and then goes home and falls asleep, they may not recognize that they desperately need glucose. If not treated, they could die.
People with type 2 diabetes often have poor diets and do not exercise regularly. Alcohol is high in sugars that directly promote weight gain, and is also linked to cravings for greasy food and midnight snacks. Next-day hangovers promote overeating and decrease the likelihood that someone will exercise. These all lead to alcohol-induced hyperglycemia, which is a major contributor to the progression of type 2 diabetes.
Further, drugs that reduce insulin resistance (metformin and troglitazone, for example) can interact with alcohol, resulting in impaired liver function and increasing the risk of liver disease.
Educating Your Teen About Diabetic Risks of Alcohol Consumption
Children who are diagnosed early on with type 1 diabetes often grow up being acutely aware of their disorder. However, kids who are diagnosed with diabetes in late adolescence may have a tougher time accepting the risks associated with alcohol use. Steps you can take to ensure their safety include:
- Find a young adult with diabetes who can be a mentor to your teen;
- Seeking out an experienced pediatric endocrinologist who can educate them about the risks of alcohol use.
Delayed Onset of Hypoglycemia
Delayed onset of hypoglycemia (DOH) usually occurs 6-12 hours after a high-intensity exercise session. There are two factors that contribute to DOH:
- Exercise increases insulin sensitivity, so cells remove glucose from the bloodstream more quickly;
- Exercise depletes stores of glucose in the liver and muscle tissue.
If someone with diabetes follows a workout session with a night on the town, their risk for potentially dangerous hypoglycemic unawareness is substantially increased.
Similarity of Symptoms Between Intoxication and Low Blood Sugar
Symptoms of hypoglycemia and symptoms of alcohol intoxication overlap substantially. Dizziness, lightheadedness, and loss of coordination are cardinal symptoms of hypoglycemia as well as alcohol intoxication.
People with hypoglycemia may appear to be drunk, but this can be a very serious medical emergency that has nothing to do with alcohol. If your teenager is a diabetic and is acting drunk, they may be experiencing dangerously low blood sugar. The first thing to do is to check their blood sugar. If it is below 70 mg/dl, give them a piece of candy or fruit juice and recheck in 15 minutes. If they do not improve quickly, seek medical help.
Drinking Alcohol with Diabetes Checklist
- Wear a medical ID
- Understand what’s in a drink and track intake (there’s an Android and iOS app for that!)
- Eat food with alcohol and before going to bed
- Continuously monitor blood sugar during and after consumption
- Pack a diabetes kit (testing kit, glucose tabs, snacks, etc.)
- Discuss low blood sugar symptoms to look for with a friend so they may monitor the situation
Key Points: Drinking Alcohol with Diabetes
- For many diabetics, moderate alcohol consumption is not dangerous.
- Moderate alcohol consumption is defined here as a maximum of one alcoholic drink/day for women and two drinks/day for men.
- Type 1 and type 2 diabetes have different sensitivities to alcohol.
- Type 1 diabetics who consume alcohol are at risk for hypoglycemic unawareness, a dangerous and potentially fatal consequence of alcohol use.
- Type 2 diabetics often take medications that can have negative interactions with alcohol.
- Hypoglycemia and alcohol intoxication have similar symptoms; if your teen is acting drunk, the first thing you should do is to check their blood glucose level.
Teenagers with diabetes have unique challenges and responsibilities that can be very frustrating to them. If you are concerned that your teen is feeling overwhelmed and you don’t know how to help, contact Next Generation Village today. Our experts can help you learn how to work together to manage diabetes in a healthy, productive way.