Type 1 diabetes and alcohol

Some types of alcohol—like beer, sweeter wines, sweetened mixed drinks, and hard cider—contain a significant amount of carbohydrates all on their own. Straight liquor usually contains zero carbohydrates, but it’s often mixed with very sweet fruit juices, soda, or additives if it’s flavored. This means you may need more insulin for certain alcoholic drinks over others. Approach every drink carefully and research the carbohydrate content, just as you would if it was food to help you estimate insulin doses. 

Your body sees alcohol (or ethanol) as a toxin, which means your liver wants to process it and remove it from your body as quickly as possible. Your liver will stop its other usual functions—like releasing small amounts of glucose every hour—while it’s focused on processing the alcohol you drank. The more you drink, the more work your liver has to do. This increases your risk of hypoglycemia (low blood sugar) in the hours after you drink because your body’s natural glucose production can suddenly drop. If you haven’t reduced your insulin doses, that extra insulin can lead to hypoglycemia when you’re asleep and potentially intoxicated. Activity, such as dancing, combined with drinking alcohol can further increase your risk of severe hypoglycemia.

Having a small snack or meal in your stomach while your liver is processing that alcohol can help offset the reduction in your liver’s glucose production.  

It’s easy to forget about diabetes management if you’re intoxicated and having fun. Consider setting alarms and reminders to check your blood-glucose levels or take evening medications (like your long-acting insulin dose before bed). You might want reminders to wake up later in the night to check your blood-glucose level and another for the morning. Waking up often or early when you’ve been drinking isn’t exactly fun, but this is for your safety. 

If you’re drinking while dancing, that exercise can easily offset the carbohydrates in your cocktail, beer, or wine. This means you’ll want to be extra thoughtful while dosing insulin for those carbohydrates to prevent hypoglycemia. You may want to program a temporary basal rate for the hours after you’re drinking, too, to prevent hypoglycemia while you’re asleep. It’s harder to feel the symptoms of hypoglycemia when you’re intoxicated, so keep a close eye on your continuous glucose monitor (CGM) or check your blood glucose often with your monitor. 

Emergency glucagon is a treatment for severe hypoglycemia that tells your liver to release a large amount of stored glucose. If you’ve consumed a large amount of alcohol, emergency glucagon treatments may not be as effective because your liver is focused on removing alcohol from your body. It won’t respond to the glucagon as fully as it would if there were no alcohol in your system. 

Your friends might think you’re fine when you crash on the couch after a night of drinking, but you might be at risk of severe hypoglycemia. Teaching your friends to never let you “sleep it off” without having checked on your blood-glucose levels and insulin doses is a really important part of enjoying a night out. If they find you vomiting repeatedly or experiencing severe hypoglycemia (unresponsive), teach them to call 911—it could save your life. 

Consuming too much alcohol too quickly can ruin anyone’s night, but it’s extra dangerous with T1D. Slow yourself down by alternating with water. This will also keep you hydrated, which will help prevent headaches the next morning. 

Let your diabetes team help you learn how to dose insulin for alcohol. It takes a lot of trial and error, but the goal is to stay safe while you’re learning.