Alcohol and diabetes: Spilling the (hard) tea about drinking with T1D

Although people living with type 1 diabetes may have to approach certain situations with an elevated sense of awareness, they are able to do all the same things as those without the disease. For instance, it's OK to mix alcohol and diabetes. With knowledge and pre-planning, a person with type 1 diabetes can absolutely enjoy drinks on a night out (or in).

According to a study published in the American Journal of Lifestyle Medicine (AJLM), alcohol use affects glucose metabolism, which means individuals living with T1D need to be aware of how drinking can affect their diabetes. Since blood glucose can swing high or low when alcohol is introduced, it is important for people with T1D to understand how drinking specifically impacts them.

How alcohol affects the body

Everyone reacts to alcohol differently. Some see a difference in blood glucose with any drink, while others are more sensitive to certain types. Additionally, different types of alcoholic beverages can cause varied reactions. Having a mixed drink may cause you to experience a sharper rise and fall, while beer may cause a steady rise and return to normal. It's important to listen to your body.

The AJLM study noted that 80% of alcohol is processed through the liver. Normally, the liver is focused on regulating blood glucose to help keep levels in balance. But when drinking alcohol, the liver's focus shifts to detoxing the body, which means releasing glucose from converted glycogen stores into the bloodstream is no longer the priority. This can potentially lead you to experience low blood sugar, also known as hypoglycemia. Additionally, if glycogen — the body's source of stored glucose — is depleted prior to drinking, due to a lack of carbohydrates in the diet, fasting or drinking without eating, severe hypoglycemia can occur.

As with everything in life, it's best to consume alcohol in moderation. In addition to severe hypoglycemia, drinking in excess can cause insulin resistance and/or diabetic ketoacidosis (DKA), a life-threatening situation that occurs when the body is forced to burn fat for energy. If left untreated, this can lead to a coma or death. Drinking too much can also cause a lack of good judgment overall, which may put you at risk of being unable to take care of your diabetes.

Tips for consuming alcohol with T1D

It is smart to first monitor your experience with alcohol and diabetes in a secure environment before heading out on the town. If questions arise around how medication(s) may interact with alcohol, it's best to consult a physician.

The more prepared you are for a night out, the less likely it is that T1D will interrupt your well-laid plans. If an interruption does happen, it's important to have the right tools on hand. This can help you address the situation with confidence and get back to having fun without delay.

Next time you want to enjoy a drink or two, keeping these tips in mind can help you have a great time — without worrying about T1D:

• Keep an eye on your glucose levels. Make sure you have your meter kit and continuous glucose monitor (CGM) on hand so you can be aware of any swings. Alcohol can distract from the symptoms of low blood sugar or a rise in blood sugar, so being on top of your numbers is important.

• Know your food situation. Eat before you drink and know how many carbs you're consuming. If you need to make adjustments to your bolus (the insulin dose related to a meal or snack) due to the effects of alcohol, make note of that. And if you eat any late-night snacks while drinking, plan to account for those as well.

• Have supplies on hand. In addition to your meter and CGM, bring snacks and your low blood sugar treatment of choice with you to be prepared to treat hypoglycemia. It's important to note that glucagon emergency kits may not be effective while drinking, as alcohol impairs the process of glucagon prompting the liver to release glucose. Snacking on some carbs (especially before heading to bed after drinking) can help avoid a situation where injected glucagon would be necessary, yet ineffective.

• Carry your medical ID. If a person slurs their words or passes out due to severely low blood sugar, it may appear they've had too much to drink — when they actually need medical attention for hypoglycemia. In the event of an emergency, having your medical ID bracelet, necklace or wallet card on hand can help you get the proper attention faster.

• Tell your friends. Let your companions know how they can help you stay safe while drinking with T1D. This extra layer of preparation will help to put everyone's mind at ease so you can have more fun and less concern about diabetes while you are out.

There are a couple of special considerations that people with type 1 diabetes need to keep in mind when enjoying a night out, but as long as you're aware and prepared, nothing should prevent you from having a good time. Using these tips (and keeping a supply kit handy) can ensure T1D doesn't steal the spotlight.

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