Drink to That: How to Safely Consume Alcohol with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

We’re already thinking about carbs and calories all the time, and adding alcohol into the mix makes things more complex. ­Experts share their best advice on how to safely drink when living with diabetes.

People who choose to drink alcohol typically do so for a few main reasons: to cope with challenges, to be sociable, or just because they enjoy having a drink. But while alcohol may make some people feel more comfortable, drinking can be especially complicated for people with diabetes. If you’re choosing to drink with friends or loved ones, let’s talk about how you can do so safely with diabetes.

First, alcohol is a drug, and it can be highly addictive. If you don’t drink now, there’s no reason to start. In fact, avoiding alcohol is the healthiest choice for people with or without diabetes. Drinking more than is healthy for the body has been linked to issues in the brain, heart, liver, pancreas, and immune system and is associated with several kinds of cancer, according to the National Institute on Alcohol Abuse and Alcoholism. Drinking is also connected to other health problems, such as unintentional injuries (car accidents, falls, drownings), domestic violence, alcohol use disorders, and fetal alcohol spectrum disorders, per the Centers for Disease Control and Prevention.

So, with all that said, how can you best manage your diabetes if you choose to drink?

What happens in the body when you drink?

Your liver works to create glucose when your blood sugar levels are low, but it also processes any alcohol present in your body, says Sandra Arevalo, a certified diabetes care and education specialist and spokesperson for the Academy of Nutrition and Dietetics. More specifically, “Alcohol gets broken down by your liver. The liver is also in charge of making sugar when your blood sugar levels are low, by converting stored glycogen into glucose, and releasing that glucose into your bloodstream. When you drink, your liver is busy processing the alcohol and has a hard time producing glucose,” she said.

This process “puts people with diabetes at high risk of low blood sugar when they drink,” Arevalo said. “If you are on basal insulin, you may not make enough glucose for the amount of basal insulin you have taken, and you may suffer a hypoglycemic episode.” This applies primarily to people with type 1 diabetes, but people with type 2 diabetes are still at risk for low blood glucose levels when they drink.

What’s in a drink?

That’s a tricky question. What you are drinking and how much of it you choose to drink can make a big difference. Like most things with diabetes, there aren’t simple answers.

According to the CDC, moderate drinking is defined as two drinks or less per day for men, or one drink or less per day for women. The US Dietary Guidelines Advisory Committee recommends one drink or fewer per day for people of any gender. It is illegal for people under 21 to drink alcohol in the United States.

Drinking

Image source: diaTribe

What does the CDC classify as “a drink?” One drink contains 14 grams, or 0.6 ounces, of pure alcohol, which normally equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of hard liquor or spirits such as gin, rum, vodka or whiskey.

What influences your intoxication?

Several factors – including diabetes medications, food, and exercise – can all make things even more complicated, said Carrie S. Swift, a dietician and spokesperson with the Association of Diabetes Care & Education Specialists. “Overall, alcohol intake leads to less predictable blood glucose whether you have type 1 or type 2 diabetes,” she said. But “the impact of alcohol on blood glucose isn’t always the same.”

This can be caused by:

  • Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates, and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
  • Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels – “are more likely to cause low blood glucose when alcohol is consumed,” said Swift. Insulin and alcohol work similarly whether you have type 1 or type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. “Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away,” she said. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications, Swift added.
  • Food: “If you drink on an empty stomach, you are more likely to experience hypoglycemia,” said Swift. Yet, eating while drinking “may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.”
  • Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia.

What and how are you drinking?

If you have diabetes and choose to drink, what should you keep in mind?

  • Alcoholic drinks can have as much added sugar as some desserts, so think about what kinds of drinks you are having. “It’s best not to choose alcohol mixed with punches or soft drink mixers, such as Pepsi, Sprite, or Coke, daiquiris, margaritas, or sweetened liquors like Kahlua or Bailey’s Irish Cream,” said Swift. Regular beer and sweet wines are also higher in carbohydrates. “These drinks not only add carbohydrate, but excess calories from the added sugars,” she said.
  • If you have a continuous glucose monitor (CGM), use it. While you are drinking, you can see where your glucose is at all times and if it drops quickly. If you don’t have a CGM, “test your blood sugar more often,” said Arevalo. “Mainly if you are not feeling well, you want to know if your sugar is dropping, or if you are getting drunk. Even though both feel equally bad, you will want to know if your sugars are low so you can correct them quickly.”
  • Never drink on an empty stomach. Instead, “Have a good meal before or during drinking,” said Arevalo. But know the carb count of what you are eating and work with your healthcare professional to determine how to take medication for that meal along with the alcohol you are consuming.
  • Exercise and alcohol can make your numbers plummet. “Avoid drinking while dancing or exercising,” said Arevalo. “Physical activity helps to reduce blood sugar levels, and if the liver is not able to keep up with the production of glucose, the risk of hypoglycemia is even higher.”
  • Have your supplies handy, such as a hypoglycemia preparedness kit. Always bring your blood glucose testing kit and enough supplies for you to test frequently. It’s a good idea to have extra test strips, alcohol swabs, lancets, as well as fast-acting forms of glucose, including emergency glucagon in case your blood sugar level doesn’t come up with food or glucose.
  •  If you take basal insulin in the evening, it’s not an easy answer on what to do if you plan to consume alcohol that evening, said Swift. “Depending on what type of diabetes the person has, and other factors, the results of drinking and taking a long-acting insulin before going out, may contribute to a different result,” she said. If you have type 1 and you take your usual amount of long-acting insulin and then you drink alcohol, “It may contribute to delayed hypoglycemia when drinking too much alcohol,” she said. If you have type 2 diabetes and are overweight or have significant insulin resistance, “Taking your usual amount of long-acting insulin may be a good strategy to avoid high blood glucose numbers,” she said. “No matter what your type of diabetes, frequent blood glucose checking will help you take the right action to avoid high or low blood glucose when choosing to drink alcohol.”
  • If you use an insulin pump or a CGM, make sure you check that they are working properly before you leave the house, without any low-power indicators. If you need to fill your pump with insulin or change out either your infusion set or CGM sensor, do it before you begin drinking or get drunk. As Dr. Jeremy Pettus and Dr. Steve Edelman say in this video, “Protect yourself from drunk you as much as you possibly can.”

It’s important for everyone to avoid getting drunk to the point of not being able to protect yourself. For people with diabetes, this includes protecting yourself from hypoglycemia.

Navigating social situations

If you find yourself in situations where people around you are drinking, or your friends like to party, there are ways to fit in without feeling left out:

  • “It’s okay to choose sparkling water with lemon or a diet soda instead of an alcoholic drink in a social setting,” said Swift. “If you do choose to drink alcohol, have a glass of water, or another no-calorie beverage between alcohol-containing drinks.” It’s also okay to hold a drink and not consume it, if that makes you more comfortable.
  • Tell a trusted friend ahead of time where you keep your supplies, such as your blood glucose monitor or CGM reader, how to get glucose tabs or juice if you need it, and, if necessary, how to give emergency glucagon, either by injection or by nasal inhalation, said Arevalo. It’s also good to have a designated non-drinker in your group, who can watch out for everyone’s safety. And be sure the group you are with knows that the signs of a low blood sugar and the signs of being drunk are the same, said Swift: slurred speech, blurry vision, dizziness, confusion, lack of coordination, irritability, and potentially, loss of consciousness.
  • Make sure you’re hanging out with people you want to be with, and consider where drinking fits in to your health goals and your life. “Friends are only friends if they accept you the way you are and help to take care of you,” said Arevalo. “If you feel peer-pressured to drink, let them know that you have to take care of yourself because of your diabetes. Good friends will respond in a positive way, and will understand and help you. If you want to have a good time and don’t want to keep an eye on how much you are drinking, alert your friends about your diabetes. Let them know where you have your supplies, how to use them, and who to call and what to do in case of an emergency.” Remember, never drive if you (or your driver) have been drinking.

Finally, if you’re going to drink, be smart about it. Always start with a blood glucose level that’s at a healthy, in-range level, sip—don’t chug—your alcohol, and avoid drinking to excess. Your body, your brain, and your diabetes will all be easier to manage once you’re done drinking, either for the evening, the event, or for good.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

Diabetes and Hangovers: What You Need to Know

Anyone who lives with diabetes knows that a hangover can wreak havoc not only on productivity and sense of well-being but also on your blood sugars, leaving them unpredictable for hours and even days. When you’ve had too much to drink and you’re feeling hungover, what can you do?

This article will touch upon the best course of action to take to help your diabetes management when you are hungover, the best food and beverages to help treat a hangover, and how you can prevent a hangover in the future.

What Exactly Is a Hangover?

A hangover, quite simply, is the culmination of unpleasant symptoms that develop several hours after drinking too much alcohol. Common signs of a hangover include:

  • Headache
  • Nausea, vomiting, or stomach pain
  • Light and sound sensitivity
  • Fatigue
  • Thirst
  • Dizziness
  • Poor sleep quality
  • Decreased ability to concentrate

More severe symptoms of a hangover include:

  • Shallow breathing
  • Low body temperature
  • Excessive vomiting (not able to hold down water)
  • Confusion
  • Seizures
  • Blue-tinged skin
  • Loss of consciousness

If someone you know is experiencing severe symptoms of a hangover, seek emergency medical treatment immediately, or call 911.

So You’re Hungover; What Should You Do?

A hangover’s nemesis is time and hydration. Most hangovers disappear within 24 hours, although some can last for days. It can be excruciating, but sometimes you simply must wait it out.

While you’re waiting, the next best thing you can do is hydrate with water (about 15.5 cups, or 3.7 liters, of fluids a day for men and about 11.5 cups, or 2.7 liters, of fluids a day for women), and make sure to get plenty of electrolytes from sources such as coconut water and sports drinks (although make sure to count carbohydrates and dose insulin appropriately, if needed).

The caffeine in coffee can also energize you and can be beneficial for headaches and sleepiness after a night of drinking. Staying adequately hydrated will also make blood sugar management easier.

It is also extremely important to keep a close watch on your blood sugars and watch for any signs or symptoms of developing diabetic ketoacidosis (DKA), which can be life-threatening. Check your blood sugar every few hours or wear a continuous glucose monitor (CGM) to make sure you’re staying in range, as recommended by your doctor.

If you notice your blood sugar remaining stubbornly high (at or above 250 mg/dL) for several hours or more and you have moderate to high ketones, contact your doctor right away and seek medical attention to prevent developing DKA. You may need IV fluids administered at a hospital to hydrate and an intravenous insulin drip, which can bring blood sugars down more aggressively than subcutaneous injections at home.

Some people experience low blood sugars after a night of drinking because the liver is busy processing the alcohol content from drinks consumed, leaving one to fend for themselves because glycogen (glucose) will not be released if one’s blood sugar starts to drop. The more one drinks, the greater the likelihood of low blood sugar, which can be dangerous.

glucose tabs

Tip: Carry glucose tabs when you’re drinking with friends. | Photo credit: iStock

People with diabetes should always carry glucose tabs or gel with them in case of an emergency low and should check their blood sugar regularly both during and after drinking. It’s also important to remember that some diabetes medications may not work as well if too much alcohol is consumed, especially type 2 diabetes medications.

If your blood sugars are staying within range and you don’t feel too nauseous, make sure to eat a good meal, which helps combat hangovers and stabilizes blood sugar. Aim for a balance of carbohydrates, fat, and protein. Some recommended foods include:

  • Bananas
  • Oranges
  • Eggs
  • Avocados
  • Rice
  • Oatmeal
  • Toast
  • Crackers
  • Clear broth soup

Getting plenty of sleep also helps remedy a hangover; alcohol notoriously disturbs sleep patterns, so if you didn’t get a good night’s rest after drinking, taking a nap the next day can help you bounce back quicker.

Some people take over-the-counter pain relievers, such as aspirin or ibuprofen, to manage symptoms. If you’re unsure what to take or are worried about the side effects of any over-the-counter medication, talk with your doctor about what will work best for you.

Finally, even though you may not feel well, getting outside for a quick, 20-minute walk can help revitalize you, get some fresh air into your lungs, and help you feel better faster. While vigorous exercise is not recommended while hungover, some light exercise can boost not only your mental health but will charge the cardiovascular system and speed up recovery.

How to Prevent a Hangover

The surest way to prevent a hangover is by abstaining from alcohol or only drinking in moderation. Some other tactics to help prevent hangovers include:

  • Drink alcohol only with food and never on an empty stomach
  • Drink slowly
  • Make sure you stay hydrated with water while drinking (a good rule of thumb is drinking one glass of water for every alcoholic beverage)
  • Keep a close watch on your blood sugar (sugary alcoholic beverages can make your blood sugars spike, while the alcohol itself can make you crash. Be wary of both consequences and check your blood sugar often).
  • Avoid sugary mixed drinks and sweet wines, which are not only bad for blood sugars but may also make hangovers much worse. Instead, mix liquor with water, seltzer water, or diet drinks.
  • Know your limits, and stick to them
  • Stick with friends or family who will watch (and potentially limit) your alcohol intake
  • Avoid alcohol that contains higher amounts of congeners: congeners give many types of alcoholic beverages their flavor. They are found in larger amounts primarily in dark liquors (like brandy and bourbon) and contribute to worse hangovers. Instead, choose lighter beverages such as vodka, white wine, or gin
  • Eat something (like a banana) and drink water before going to bed after a night of drinking

Hangovers are an unpleasant side-effect of drinking alcohol, and having a hangover with diabetes makes them all the more complicated. But with these strategies, you can help prevent hangovers in the future, while still imbibing from time to time.

If you think you have a problem with drinking or develop signs of alcohol addiction, get help immediately.

Source: diabetesdaily.com

Caramel Apple Cider Mimosa

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

By Sarah Severance

This is a fun twist on a traditional mimosa, but keep in mind it does have about 22 grams of carb and 10 grams of sugar per serving. To keep the carbs and sugar lower, you can make sugar free spiced apple cider and chill it before adding it to the champagne.

* Always drink responsibly.

Caramel Apple Cider Mimosa

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Caramel Apple Cider Mimosa

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A fun variation on the classic mimosa, this crisp and refreshing brunch companion may be your new favorite. Pop some bubbly and find something to celebrate!
Servings 2 servings
Calories 127kcal

Ingredients

  • 2 tbsp. sugar or sugar substitute
  • 2 tbsp. cinnamon
  • 2 tsp. caramel sauce
  • 1 bottle champagne
  • 4 oz. spiced cider (half a cup)

Instructions

  • Mix sugar and cinnamon together.
  • Rim each champagne flute in caramel sauce and then dip in the sugar/cinnamon mixture.
  • Fill each glass with desired amount of champagne (we did 1/2 flute).
  • Add a splash of spiced cider (we did 2 oz) per glass.

Notes

Always drink responsibly. 

Nutrition

Calories: 127kcal | Carbohydrates: 21.5g | Fat: 5g | Fiber: 4g | Sugar: 10g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Caramel Apple Cider Mimosa Recipe

Source: diabetesdaily.com

Sugar-Free and Dairy-Free White Russian

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.This twist on the classic White Russian is made without Kahlua, which reduces the sugar in the cocktail. It can also be made to taste with almond milk instead of coconut milk if one is preferred over the other. Sugar-Free and Dairy […]
Source: diabetesdaily.com

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