Alcohol and diabetes can be dangerous mix
Published 10:45 am, Thursday, November 3, 2011
By Dr. Stephen Ponder
If you have diabetes and drink alcohol, you've probably heard a lot of conflicting claims about its potential benefits. I'm not taking sides about whether regular consumption of a small amount of alcohol is good or bad. But if you do choose to drink, you need to know how alcohol affects your blood sugar levels.
The alcohol molecule behaves more like a fat than anything else. One gram of protein or carbohydrate contains 4 calories. A gram of fat contains 9 calories. But one gram of alcohol equals 7 calories. Now you know where most of the fat in your beer gut comes from; and it's not just the Pringles! If you count calories, a serving of alcohol is equal to two fat exchanges. Beer and many sweet wines contain carbohydrates in addition to alcohol. These will raise blood sugar levels even in the absence of food.
Diabetes self care is all about making proper choices. By its effect on judgment, alcohol use makes it more likely you will make poorer choices or take more risks with your diabetes care, such as overeating or forgetting to take your medicines properly. Alcohol also tends to increase appetite, making it harder for you to control what you eat.
Alcohol enhances the blood sugar lowering effect of some diabetes medicines, including insulin and oral hypoglycemic agents like glipizide and glyburide. It does this by temporarily paralyzing your main internal defense mechanism against low blood sugar. If a large amount of alcohol is consumed, blood sugar levels may fall to dangerously low levels. Hypoglycemia (low blood sugar) and alcohol intoxication is a very deadly combination.
If you combine the diabetes drug metformin (Glucophage) with heavy or binge alcohol drinking, the risk of a deadly metabolic condition called lactic acidosis is more likely. Small daily amounts of alcohol are tolerable, but discuss your alcohol use with your doctor if you take metformin for diabetes.
If you drink, consider the following tips:
- Try to drink alcohol only when eating a meal.
- Sip your drink slowly and take your time; it gives your body more time to metabolize the alcohol.
- Be aware of sweet drinks that may contain high amounts of added sugars, such as sweet wines, wine coolers, cordials and mixed drinks.
- Light beers and dry wines have the least effect on blood sugar levels.
- Consider mixing your liquor with water or diet soda.
A real serving of alcohol is equal to one 5-ounce glass of wine, 1 1/2-ounce shot of liquor or 12-ounce beer. Portion sizes for alcohol, like soda drinks, have become distorted. For example, one can or bottle of beer can be anywhere from 12 to 48 ounces. Beer mugs in bars come in many different sizes, not just 12 ounces. And if you measure 5 ounces of wine, you might see when you dine out you may be getting more than just a single serving. It varies a lot. Even shot glasses are supersized these days.
While it might not seem too cool or hip, checking your blood sugar when drinking is a smart thing to do. If you are with friends, it's a good idea one of them knows about your diabetes and how to help you if you get a low blood sugar. Preferably it would be a friend who isn't drinking, like a designated driver. Keep sources of fast-acting sugar in your pocket or purse to treat a low sugar if you discover one coming on.
If you are pulled over by law enforcement and have the smell of alcohol on your breath, your sobriety will immediately be tested. If you also have diabetes, you might be suffering from low blood sugar which can mimic many of the same signs of alcohol intoxication. Of course, both problems can be present in the same person. But even if you are not legally intoxicated, a low blood sugar level still would impair you to the point you would be dangerous behind the wheel of a vehicle. State troopers have become more aware of this possibility in recent years.
Drinking alcohol is a personal choice. Using it sensibly is a huge responsibility. If you have diabetes, you should be even more careful. Your doctor should discuss your alcohol use with you at visits. If not, bring it up. There are studies that do suggest benefits of alcohol use, but only in limited amounts. The problem is many of us lose control of our alcohol consumption too quickly and put ourselves and others at risk.