Diabetic beer olympics: advice on alcohol use?

I love drinking :slight_smile:

And I really don’t know what to do with diabetes when I’m drinking. What I’ve done in college and post-college drinking is just not bolus for any drinks, have lots of drinks, go up to 400ish, then overnight I would come down (from my basal going but no glucose release from my poor liver (I’m guessing)) to wake up low. I reaaaaalllly want to figure out a better plan for dealing with diabetes when drinking :sweat_smile:

So heads up lots of questions coming up, and I may have missed the correct threads here on FUD when I was searching around, so apologies in advance!!!

  • Do you bolus for alcohol? How much? I’m guessing it depends on what you’re drinking …
  • So do you do different types of boluses/carb counting for different kinds of alcohol?
  • What’s the timing on prebolusing/bolusing for alcohol?
  • What do you do for lows that may result from drinking? Temp basals once you get in bed?
  • Do you use different “protocols”/diabetes management when you’re having just a couple drinks vs a big drinking night? I think I’ve noticed that just a few drinks won’t fry my liver from releasing glucose later on
  • Do you adjust how you bolus for food when you’ve been drinking? I’m guessing this may only apply if you’ve drank a lot?

THANKS so much in advance for any advice!!! I know it’s not all cut and dry but I feel pretty clueless and not properly equipped

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Also not condoning binge drinking but also acknowledging it happens!

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I have a more thorough answer I can give but until I can get over to my computer (I’m on my phone now) I’ll give the main tip I have

I made a basal profile for drinking and I switch to it right when I start drinking, or before I leave the house if I’m going out. What ended up working pretty well for me was a 15% basal reduction from 12am-10am. This works well for me because I don’t have to try to set up a temp basal while drunk, the only issue is I do have to remember to switch back to my normal basal profile the next day. I consider forgetting to do a temp basal when drinking and going low to be a bigger concern than forgetting to switch to my regular profile and going high the next night :grin:

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Other things to try include eating a snack/meal uncovered before going to bed. Here is pretty non scientific link, but offers some other ideas and explanations.

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Another thought, on average it takes the liver about an hour to process one drink, so if you have 3 drinks with dinner, the alcohol would be processed before bed. If you have 7 drinks, it is going to take more time, plus once you get over a threshold amount the liver isn’t as efficient at processing alcohol. Now if you are drinking more often, you can habituate your liver to work even better at processing alcohol, but I think this takes some consistent work. Also, everyone is different, so the averages may not work out well for you. As the states continue to reduce the BAC for impaired driving you get some unintended consequences. I had a co-worker that had two drinks with dinner (she is a pretty petite woman) and she was popped for a DUI, so be careful out there.

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I’m not great for advice for great bg control during drinking…but I certainly did notice the absence of dawn phenomenon after drinking wine the night before. And my breakfast bolus needed to be lowered by 35%ish? By lunch I was back to normal.

Great topic!

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Love this idea. You set this basal when you have in mind that you’ll probably have more than a few drinks right? Or this applies for when you think you’ll have just one or two drinks as well?

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Yes, I don’t do the basal profile for 2 drinks or less. More than that and I tend to see lows overnight so I use it

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Thanks for the link! From it:

Oh, and when you’ve been drinking, your body will respond more sluggishly to the treatment of those lows. The rebound will be a lot slower than you’re used to. So don’t panic, just be prepared for a 2-3 times longer “recovery” than you’d experience with sober lows.

Do you know the reason for that??

Interesting. And good to know at least for a ball park.

Now I’m not like getting smashed every weekend but I do have a few drinks a couple nights a week and the big drinking nights come along like once or twice a month - not planning on getting my liver into a habit of processing alcohol !!

Also, I’m a huge advocate of just not touching your car keys once you start drinking, no matter how much you’ve had.

Only for carb containing beverages (Beer, port, sherry, liquers, etc.)
No bolus for a gin and diet tonic, scotch, or any hard alcohol with or without mixer.

I generally carb count and bolus for the carbs.

  • What’s the timing on prebolusing/bolusing for alcohol?
    Probably 10-15 minutes for a beer, but I am not really strict.

  • What do you do for lows that may result from drinking? Temp basals once you get in bed?
    Glucose or food or a lower temp basal.

I find that the lows I get from drinking are usually from walking home and not so much the drink itself. I do usually see an elimination of dawn phenomenon if I have enough booze, so I do a temp the following morning - usually 80%-ish.

  • Do you use different “protocols”/diabetes management when you’re having just a couple drinks vs a big drinking night? I think I’ve noticed that just a few drinks won’t fry my liver from releasing glucose later on

I tend to limit my consumption to 2-ish drinks in a sitting because I am old and have kids :slight_smile:

My advice is pace yourself so that you can still control your diabetes :wink:

  • Do you adjust how you bolus for food when you’ve been drinking? I’m guessing this may only apply if you’ve drank a lot?

Not really.

The link @Chris sent was pretty good at explaining things - and remember glucagon on will not work on a drunk liver so you need to be prepared how to get the carbs in when you are drunk…

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That is some fun testing right there.

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:astonished::astonished::astonished: I didn’t know that diet tonic existed

That’s the goal ! Recently trying to manage diabetes while drinking has been a huge guessing game which is why I turned to you guys… Just trying to figure out some tactics on how to have fun but be safe doing so

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It is a thing… :slight_smile:

image

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Others mentioned it earlier, but processing of alcohol is job 1 for the liver, stepping in front of gluconeogenesis (making glucose out of protein), and response to glucagon, both of which can cause problems.

A year or so ago, I drank about 6 neat Bourbons and BG was fine at bed, but about 52 at 3 am, due to inhibiting gluconeogenesis. In hindsight, I should have cut my basal to account for this.

Your treatment will vary based on diet, carbs in the drinks, number of drinks, etc. I’d experiment in comfortable circumstances (at home, no driving, friends in the know around you, etc) and get a feel for how to adjust your insulin. Might be easier with no carb drinks too, to limit variables to just alcohol at this time, until you understand how it affects your treatment protocol.

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The mom in me has one thought (Don’t binge drink! It’s just bad for everyone!)

But the practical side of my brain realizes that’s not necessarily realistic or helpful.

You’ve gotten a bunch of awesome tips and suggestions here, I’d be really curious to see how any of these work out for you. My guess is you’ll be able to figure out a good strategy for a few beers or a glass or two of wine fairly quickly.

It might take a while to figure out a plan for drinking more than a few drinks – if you are drinking to excess once a month, I’d guess i would take 6 months before you’d crack that one. Good luck and be safe of course. Personally, i can no longer drink more than two drinks in a sitting. The next day is awful and it’s just exponentially more awful to be hungover when you also have three kids needing you at 5 in the morning.

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Great topic @LarissaW. Hopefully a 20 year old with D stumbles across this while googling about D and drinking!

My recommendation based on personal experience would be to find the drinks that work best with your D management. For me, this means drinks I don’t need to dose for. Make those your go-to drinks for when you’re having more than 2 in a night.

Most other advice I have to offer is based on using a long-acting insulin. I can’t do temp basals, so my strategies will likely be different than yours.

Dry red wines are, by far, the easiest drinks for me. They tend to have almost no impact on my bg levels. However, I do notice a small spike about 4-5 hours after drinking if I’ve had 4-5 over the course of a night (4+ hours).

Beer is, br far, the hardest drink for me (most sours are easier though). 2-3 wheat beers in a sitting will send my bg soaring. I don’t respond to insulin like I should- I need way more. Using way more insulin is dangerous past 2 beers though. For all these reasons, I try to only have 2 beers/night. If I want to drink more past that, then I switch to wine or liquor.

Many sour beers (not the sweet fruity ones) seem to have less sugar. At a sour beer tasting class, I was told it’s bevause the bacteria (added to the beer to make the beer sour) eats through most of the sugar. I really like the session sour made by dogfishead, SeaQuench. Delicious! And 4-5% alcohol, so you can have a few before you start to feel it. I don’t have to dose for this beer. Though, as with wine, I get a small spike around 4-5 hours later if I have several.

Liquor doesn’t have carbs, but the mixers do. I don’t like sweet drinks most of the time, so it’s no hardship for me to seek out the drinks with lower carbs. These will make it easier for me to manage bg levels too. If you’re going to have multiple no carb cocktails, eating is an absolute must. Wine and beer have carbs that can can offset the liver glucose reduction (unless you’re drinking way too many). Liquor does not. I’m much more likely to drop low if I have 4-5 no/low carb cocktails than if I have 4-5 glasses of wine. I usually limit myself to 3 cocktails for any time frame. I love wine, so switching to wine if I need another drink is not a hardship for me.

Drinking with friends always makes it safer. :slight_smile: If I’m drinking with new people, I stick to drinks I know and have no more than 4 in a 4 hour period.

I’ve only had a handful of hangovers in my life. I generally don’t get them for whatever reason, so that doesn’t influence my drinking choices. The only people in my extended family that drink (that I know of) are the same way, so I guess there’s some kind of genetic thing going on there.

Anyway, I’m not sure I answered all your questions, but I’m happy to fill in any gaps. These are just my experiences over the last 9 years. Experiment with small amounts, find drinks that work best, and then you can try adding more. It’s better to run a little high than run low- especially while experimenting. Eating/drinking lower carb has worked better for me when binge drinking. It’s hard to curb aggressive dosing (which I naturally do when sober) when you’ve drank too much, and aggressive dosing is very, very dangerous when you’re drunk.

Also, have fun :slight_smile: I love trying new drinks. I just switch to wine after having tried the new drinks so I’m in well-known territory after that. Drinking isn’t just about getting drunk! Trying new drinks and enjoying the buzz while socializing are some of my favorite things in life.

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@LarissaW, great subject.

Lots of people have already given you good info. In particular, the link that @Chris gave you, while a bit simple-minded as he wrote, has some good fundamentals.

As an engineer, I need to understand how things work in order to internalize them. In case you are like me, here is the problem set.

The source of the problem

I think the most important thing to consider (the fundamental issue) is that drinking inhibits your liver from delivering glucose regularly as it normally does. The liver has several functions. One of them to filter your blood from toxins and other nefarious substances. Your liver views alcohol as a poison (it would be, of course, to your body, if your liver did not deal with it), and immediately switches its priority to filtering it out of your bloodstream. The problem is that, when it does that, it largely stops the rest of what it does, which is to turn the glycogen it stores into glucose and regularly release some of that glucose into your blood. The outcome is that, as long as you have a good amount of alcohol into your blood, you will not get much glucose from your liver.

The consequences are three-fold:

  • since you don’t get a normal glucose release, you are likely to get hypo, sometimes for a long time (many reliable sources mention 24 hours). Depending upon how your body reacts, the effect may not be continuous, but spring upon later in the period of effect.

  • taking carbs will not produce a normal correction effect: it may be much slower than usual (unless they are pure dextrose/glucose, and even then), since the liver will not help much in delivering it to your bloodstream

  • glucagon will not have much of an effect for the same reason, since it signals the liver to dump its glycogen—but the liver is already busy

In addition, the effect of alcohol in the evening is much worse if you went through significant exercise during the day—both can cause hypoglycemia on their own. Combined they can constitute a great danger. The delayed lows caused by exercise may be made much worse by the alcohol-processing of your liver.

The consequences can be extreme in some cases such as binge drinking: if you have enough alcohol to largely block your liver from releasing glucose for a long time, your best home choice will be to use pure dextrose/glucose as a source of carbs (almost any other carb requires liver mediation). In some cases you may just need a glucose IV at the emergency room

A common early death scenario for young adults is to go drink with buddies, ingest a large amount of alcohol, go to sleep it off, not wake up to normal signs of hypos because of the usual effect of alcohol, get into a deep hypo and die. The worst of it is that, even if you wake up and take sugar, if you are too deep into a hypo already, the ingestion of carbs may not raise you in time, since its effect may be greatly slowed by the lack of support from your liver. There is a point where only a glucose IV may do the job. This, of course, is the nightmare scenario.

Possible means of dealing with it

  • since alcohol will likely produce lows, eating some slow acting carbs prior to/during drinking helps mitigate the effect. In fact, some medical sites recommend that you always eat when drinking (example below).

  • For the same reason, adjusting your basal down (if you are pumping) can also be helpful. @glitzabetes mentioned her thoughts on that. MDI users may also be able to lower the relevant 1/2 day dose if they use 2 injections/day (particularly with levemir, whose action tends to wane faster).

  • if you don’t have a CGM be ready to test frequently

  • It is critical to let your drinking friends know about the symptoms of hypoglycemia, so that they understand what may happen to you, and can help you if needed. Be sure to let them know that, in many ways, they are similar to the symptoms of drunkenness.

  • because your sense of judgment gets affected by your alcohol intake, if your group has a designated driver, it is a good idea to use him/her to monitor your condition, in particular if you have given that person some training on diabetes treatment.

  • if you drink more than is reasonable for you, in some ways sleep is not your friend. I am not sure what to suggest there, except that having some friends check on you regularly (check your CGM, really) while you sleep after an evening of wild drinking might save your life.

As much as I don’t want to sound like an overbearing parent, I would be reckless if I didn’t mention that excessive drinking can easily be deadly to PWDs :frowning: Scandinavian countries have the best statistics in existence on diabetes death rates, because of the way they administer their type of socialized medicine. My understanding (it was a while since I read these numbers) is that alcohol deaths and depression are the top sources of death for young diabetic adults. The numbers were frightening.

Different effects from different drinks

Separate from the problem of hypoglycemia generated by ingestion of alcohol is the issue of managing the ingestion of carbs while you drink.

  • Different drinks have different carb contents, that need to be carefully considered when dosing for them. Light beer has a small number of carbs (about 6g/12 oz), as does wine (abt 4g/5 oz)—in some ways it might be helpful because some of those carbs may counter some of the hypo effect of the alcohol in the same drink. But different beers and wines can have widely different carb content. In particular, desert (sweet) wines have many carbs, as do some specific types of beer. Some examples for beer for 12 oz: typical ale 13g, Bud 12g, Heineken 11g, Sam Adams Bostom Lager 18g. Some examples for wine for 5 oz: some dry whites 4g, sweet sherry 13g, typical desert wine 14g, Pedro Ximenez Leyenda sherry 55g. You really have to check everyone!

  • different drinks, as we all know, also have different amounts of alcohol. Wines can have a very wide range, for instance.

  • Common hard liquor such as vodka, gin or whisky, typically does not have any carbs. But many liqueurs and other alcohols do (thanks to @Beacher for this list!): sweet vermouth (4 g/oz), Dubonnet (4 g/oz), bitters such as Campari (7 g/oz) or Aperol (11 g/oz), Triple Sec (11 g/oz), Cointreau (8 g/oz), Kahlua (15g/oz), Amaretto (17g/oz)…

  • most reliable sources on drinking and diabetes recommend avoiding home-made punch, because you often have no way to know how many carbs are in there. Cocktails can vary widely, from bar to bar, in how many carbs they have.

  • even when you know the number of carbs, it can be quite difficult to dose, both for the carbs in your drinks, and for the food that may accompany it, because of the uncertainty that comes with your liver’s change in its processing of glycogen.

  • Finally, I was surprised two years ago when I read, in the context of drinking and diabetes, that DKA can happen with normal blood glucose. All the more reason to be careful.

I like this reference chart from UCSF—it shows the differences between sources of alcohol:

https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/diabetes-alcohol/

Mainstream professional medical recommendations

Joslin Diabetes Center: https://www.joslin.org/info/Diabetes_and_Alcohol.html

" People with diabetes can include alcohol in their diet in a responsible way," states Elizabeth Staum, M.S., R.D., of the Joslin Diabetes Center. Joslin recommends that women with type 1 or type 2 diabetes consume at most one drink per day, and men a maximum of two drinks per day.
An important note: consumption of alcoholic beverages must be done with food. Why? “Alcohol actually puts patients at higher risk for low blood glucose, so it is safest to consume alcohol either with a meal that includes carbs, like starches for example, or with a carb-containing snack like crackers,” Staum says.

WebMD: https://www.webmd.com/diabetes/guide/drinking-alcohol

People with diabetes who drink should follow these alcohol consumption guidelines:

  • Do not drink more than two drinks of alcohol in a one-day period if you are a man, or one drink if you are a woman. (Example: one alcoholic drink = 5-ounce glass of wine, 1 1/2-ounce “shot” of liquor or 12-ounce beer).
  • Drink alcohol only with food.
  • Drink slowly.
  • Avoid “sugary” mixed drinks, sweet wines, or cordials.
  • Mix liquor with water, club soda, or diet soft drinks.
  • Always wear a medical alert piece of jewelry that says you have diabetes.

My personal thoughts

Imho, it is quite alright for PWDs to drink in reasonable amounts as long as they understand how to deal with it. I don’t think that, for PWDs, getting truly drunk can be made safe, unless you have a diabetes-educated non-drinking buddy that can monitor your condition during the night that follows.

This post makes me realize we don’t have an alcohol wiki. Would anyone like to work with me to put one together? @LarrisaW, maybe :slight_smile: ?

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@Katers87, I just crossposted with you: I love your post!

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Helpful stuff @michel! Based on my experience (perhaps I’m alone in this?), most beers have a lot of carbs in them. At their carbiest, they have much, much more than all wines I’ve had (other than dessert wines which I almost never drink, and I only have small amounts when I do). I suppose I don’t look up the carb content. This is simply based off the way my body reacted. I’m surprised that you said they only have a small amount and that you mention the variation in wine but not beer?

I find the variation between wines to be less significant than the variation between beers too. I suppose I don’t seek out sweet wines, so perhaps that’s why. It’s not uncommon for me to just order the house red and for things to go pretty well though. It’s one of the reasons red wine is my go to drink. The variation is less than I see among all cocktails or beers.

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@Katers87, I totally agree that some beers have more carbs. Most light beers have about 6 carbs per 12 ounces, I believe, from what is typically reported, but some regular beers have much more. An average glass of red or white wine has about 4 carbs per 5 ounces.

I did mention the variation for both–maybe you missed it? Here it is:

But your point is well taken—I will modify my original post to quote numbers.

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