In Part 1 of this two-part diary, I’ll be explaining about the effect of alcohol on your glucose level and giving you some guidelines to follow if you decide to indulge in some adult beverages during the upcoming holiday season.  Part 2 (next week) will be some low carb (yep, you heard that right) alcoholic drinks recipes and tips for stocking your diabetic friendly bar.
It’s important for everyone to avoid drinking so much you are unable to protect yourself. For people with diabetes, this includes protecting yourself from hypoglycemia.  Although some alcohols are high in sugar, the biggest risk for diabetics is having your glucose level plummet dangerously while consuming alcohol.
This can be caused by:
·         Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
·         Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels are more likely to cause low blood glucose when alcohol is consumed. Insulin and alcohol work similarly whether you have Type 1 or Type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications.  Your best bet to remain safe is to check your glucose level often while you’re drinking.
·         Food: If you drink on an empty stomach, you are more likely to experience hypoglycemia. Yet, eating while drinking may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.
·         Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia. Avoid drinking while dancing or exercising. Physical activity helps to reduce blood sugar levels, and if the liver is not able to keep up with the production of glucose, the risk of hypoglycemia is even higher.
If you choose to drink, make sure it is in moderation and avoid becoming too intoxicated. Being drunk impairs your judgment, including interfering with your decision-making when it comes to managing your diabetes. Plus, being drunk can look like hypoglycemia, so friends and family members might think you are drunk based on your behavior, when you are actually experiencing hypoglycemia and are in danger.

How to protect yourself from drunk you as much as you can.
·         If you choose to drink, always make sure that you are with someone who is not drinking and knows you are diabetic who can respond quickly in case you experience an emergency low (and provide you with either carbs or glucagon).
·         If you have a continuous glucose monitor (CGM), use it. While you are drinking, it will allow you to see where your glucose is at all times and if it begins to drop quickly. If you don’t have a CGM, test your blood sugar more often, especially if you are not feeling well, you want to know if your sugar is dropping, or if you are getting drunk. You need to know if your sugars are going too low so you can correct them quickly.
·         Never drink on an empty stomach. Instead, have a good meal before or during drinking. But know the carb count of what you are eating and work with your healthcare professional to determine how to take medication for that meal along with the alcohol you are consuming.
·         Have your supplies handy.  Always bring your blood glucose testing kit and enough supplies for you to test frequently. It’s a good idea to have extra test strips, alcohol swabs, lancets, as well as fast-acting forms of glucose, including emergency glucagon in case your blood sugar level doesn’t come up with food or glucose. If you use an insulin pump or a CGM, make sure you check that they are working properly without any low-power indicators before you start to drink. If you need to fill your pump with insulin or change out either your infusion set or CGM sensor, do it before you begin drinking or get drunk.
·         If you take basal insulin in the evening, it’s not an easy answer on what to do if you plan to consume alcohol that evening. Depending on what type of diabetes you have, and other factors, the results of drinking and taking a long-acting insulin before going out, may have differing results. If you have Type 1 and you take your usual amount of long-acting insulin and then you drink alcohol, it may contribute to delayed hypoglycemia when drinking too much alcohol. If you have Type 2 diabetes and are overweight or have significant insulin resistance, taking your usual amount of long-acting insulin may be a good strategy to avoid high blood glucose numbers. No matter what your type of diabetes, frequent blood glucose checking will help you take the right action to avoid high or low blood glucose when choosing to drink alcohol.
Carb content of alcoholic beverages
Here’s how broad classes of alcoholic beverages break down in carbohydrate content:

As you can see, if you stick to light or ultralight beer, dry wine, and spirits, you can keep your carb intake relatively low while safely enjoying an occasional adult beverage.
To learn more about staying safe while drinking you can read, “Drink to That: How to Safely Consume Alcohol with Diabetes.”


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