@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 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:
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.
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 ?