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 Diabetes

February 2010
Alcohol for Diabetics
Dr R N Mehrotra
 
Alcohol is everywhere – at family gatherings, at cookouts, after the cricket game, at parties…. "What would you like to have?" someone asks. If you have diabetes, what should you say?

It all depends. Start by asking yourself three basic questions:
  1. Is my diabetes under control?
  2. Does my doctor agree that I am free from health problems that alcohol can make worse - for example, diabetic nerve damage or high blood pressure?
  3. Do I know how alcohol can affect me and my diabetes?
If you said "yes" to all three, it's okay to have an occasional drink. What does occasional mean? The American Diabetes Association suggests that you have no more than two drinks a day if you are a man and no more than one drink a day if you are a woman, though an increasing number of experts suggest that you have only three or four drinks a week. This recommendation is the same for people without diabetes.

Your Body and Alcohol
Alcohol moves very quickly into the blood without being broken down (metabolised) in your stomach. Within five minutes of having a drink, there's enough alcohol in your blood to be measured. 30 to 90 minutes after having a drink, the alcohol in your bloodstream is at its highest level.

Your liver does most of the job of breaking down the alcohol once it is in your body. But it needs time. If you weigh 68 Kgs, it will take about two hours to metabolise a beer or mixed drink. If you drink alcohol faster than your liver can break it down, the excess alcohol moves through your bloodstream to other parts of your body. Brain cells are easy targets. When someone talks about getting a buzz from alcohol, this is what they are feeling.

Risk of Low Blood Sugar
If you have diabetes and take insulin shots or oral diabetes pills, you risk low blood sugar when you drink alcohol. To protect yourself, never drink on an empty stomach. Plan to have your drink with a meal or after eating a snack.

How does alcohol add to your chances of having low blood sugar? It has to do with your liver. Normally, when your blood sugar level starts to drop, your liver steps in. It goes to work changing stored carbohydrate into glucose. Then it sends the glucose out into the blood, which helps you avoid or slow down a low blood sugar reaction. However, when alcohol enters your system, this changes. Alcohol is a toxin. Your body reacts to alcohol like a poison. The liver wants to clear it from the blood quickly. In fact, the liver won't put out glucose again until it has taken care of the alcohol! If your blood glucose level is falling, you can quickly wind up with very low blood sugar.

This is why drinking as little as 2 ounces of alcohol (that's about 57 ml; around two drinks) on an empty stomach can lead to very low blood sugar. When you mix alcohol and exercise, you increase the risk of going low. This can happen because exercise helps lower your blood sugar levels. Let's say you've just played a couple of hard sets of tennis. You have a beer after the match. But in the hours after the game, your body is still working. It is replacing the energy your muscles used up. To do this, it clears glucose from the blood and adds it to the muscles' store. This is why exercise can cause your blood sugar level to go down.

If you take insulin or diabetes pills, they too are working to clear glucose from your blood. Unless you eat or your liver adds glucose to your blood, you could be heading for a low blood sugar level. If you drink a beer, the alcohol will stop your liver from sending out any glucose. Your chances of going low are even higher. Check with your doctor to see if it is alright to combine alcohol with your diabetes medications. Low blood sugar when drinking, is less of a risk for those with type 2 diabetes, who control their diabetes with meal planning and exercise alone.

Alcohol affects your body's ability to get over a low blood sugar level. If you have low blood sugar, you may need to treat it more than once, as time goes by. If you've been drinking, check your blood sugar before you go to sleep. Eat a snack before you retire to avoid a low blood sugar reaction while you sleep.

Your Diabetic Wife
  1. Diabetes mellitus is like your wife, It will be with you throughout your life;It's yours to adjust and compromise, With all the resources that form your premise.
  2. Diabetes and militancy cannot be terminated, It can be controlled but not eliminated; It affects every part of your body's action, And shows its might with destruction.
  3. Diabetes is a dangerous companion, It engulfs you without compassion; Dips you it in deep sea to fret, With aggression, without regret.
  4. Control your diabetes with ideal weight, Drugs are secondary but they can't wait; Exercise and diet together, Can almost protect you forever.
  5. Keep you lipids level in the safe zone, And your HbA1c within seven alone; As if in heaven, learn to enjoy life, Without changing you lifestyle or your 'wife'.
Dr. K Babu Rao is Rtd Sr. Medical Superintendent, Railways, and Consulting Surgeon & Physician, Visakhapatnam

A Warning
Glucagon shots don't help severe low blood glucose caused by drinking. Glucagon shots treat very severe low blood glucose reactions caused by too much insulin. Glucagon works by getting your liver to release more glucose into your blood. But alcohol stops this process. You need to be able to treat your reaction with a carbohydrate, such as oral glucose tablets or gels. So you need to avoid letting a low blood glucose level become severe. If you pass out, you will need glucose injected into your bloodstream by a healthcare professional. Heavy drinking over time can hurt your liver. It won't be able to make glucose as well. When this happens, your diabetes is harder to control.

Wise Drink Choices
Some drinks are better choices for people with diabetes. Select drinks that are lower in alcohol and sugar. If you use mixers in your drinks, choose ones that are sugar free, such as diet soft drinks, diet tonic, club soda, or water. This will help keep your blood sugar levels in your target range.

Light beer and dry wines are good choices. They have less alcohol and carbohydrates and fewer calories. To make drinks last longer, try a "spritzer": Mix wine with sparkling water, club soda, or diet soda. Try a "virgin" Bloody Mary made without alcohol.

Alcohol is a Poor Choice
People with diabetes should preferably not drink alcohol. Alcohol can make some diabetic problems worse. If you have nerve damage from diabetes in your arms or legs, drinking can make it worse. Alcohol is toxic to nerves. Drinking can increase the pain, burning, tingling, numbness, and other symptoms found with nerve damage. Some studies show that even regular light drinking (less than two drinks per week) can bring on nerve damage.

Heavy drinking (three or more drinks per day) may make diabetic eye disease worse. If you have high blood pressure, you can lower it if you stop drinking alcohol. Many people with diabetes have high levels of the fat called triglycerides in their blood. If you do, you should not drink alcohol. Alcohol affects how the liver clears fat from the blood. Alcohol also spurs the liver on to make more triglycerides. Even light drinking can raise triglyceride levels.
Dr. R N Mehrotra is Sr. Consultant - Endocrinology & Diabetes, Apollo Health City, Hyderabad

    
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