Alcohol & Type 1 Diabetes
After ten months without alcohol, I fell off the wagon over Christmas. It reminded me of why I stopped drinking in the first place. When everyone had gone home after a successful dinner I drank the rest of an open bottle of wine while feasting on the leftover potato dauphinoise and chocolate-coated walnuts. I then injected a random amount of insulin and went to bed. When I woke up my blood sugar was at 16.7 mmol/l (300 mg/dl), which is the highest it’s been in a year.
Normally, the problem is the reverse when I wake up sweating with blood sugars in the 2’s (32-47 mg/dl). I’ve had my worst hypos after drinking alcohol, which is why I dropped the drink. When you have alcohol the liver stops putting out glucose, hence the high risk for hypos if you take basal insulin. With shorter-acting basals, like Levemir or Lantus, you can lower the dose when drinking, but this is not an option with ultra-long-acting insulin like Tresiba.
While you’re awake and drinking alcohol, things are not too difficult to manage. You just need to test often and top yourself up with fast-acting carbs if your blood sugar starts dropping. Dry wine is probably the best drink for diabetes, as there are enough carbs (5g per glass) to keep levels stable. Beer, unless low carb, spikes blood sugar and straight spirits tend to drive them down too low. The problem comes if you go to bed drunk as blood sugar levels drop, and you can sleep through a hypo that would normally wake you up. Your liver is also too busy with detoxification to throw you the lifeline glucose you need. The day after drinking you have to be careful with insulin as you’re still at an increased risk for hypos.
For me, the final deal-breaker was the miserable hangovers you get on the ketogenic diet. We don’t know what causes them but there’s a theory that people who are adapted to fat-burning have lower glycogen stores. Carbs bind water, so this might also have something to do with it. If the theory is right, eating more carbs while drinking should improve things. The caveat to this is that you might spike your blood sugar, which is uncomfortable if you have tight control.
In my case, I decided I’m better off not drinking alcohol anymore. Unless, of course, it’s Christmas.