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According to the Centers for Disease Control and Prevention, alcohol has been identified as one of the most common causes of premature mortality in individuals with diabetes. Alcohol not only has the potential to interact with medications, but can also cause low blood sugar, known as hypoglycemia. The symptoms of too much alcohol and hypoglycemia can be very similar, thereby making it difficult to recognize not only by an individual, but also by a medical professional.
Hypoglycemia
The National Diabetes Information Clearinghouse states hypoglycemia occurs when blood glucose falls below normal levels. When blood glucose levels decline, hormones signal the liver to release glucose into the bloodstream. For some individuals with diabetes, however, some of these hormone responses may be impaired. Hypoglycemia can happen suddenly, but can usually be treated easily by consuming a glucose-rich food or drink. If left untreated, hypoglycemia can lead to confusion, clumsiness, fainting, seizures, coma and even death.
Interactions
According to the National Institute on Alcohol Abuse and Alcoholism, several diabetes medications can interact with alcohol. Glucophage (metformin), Micronase (glyburide) and Orinase (tolbutamide) are just a few noted to cause abnormally low blood sugar levels, flushing, nausea, vomiting, headache, rapid heartbeat and sudden changes in blood pressure. Some individuals with diabetes may also take other medications to control other diabetes complications; these can also react negatively with alcohol.
Alcohol Metabolism
When consumed, alcohol moves quickly into the bloodstream. The Mayo Clinic states the liver of an average person takes approximately two hours to metabolize one drink. If alcohol is consumed faster than it can be metabolized, the liver’s main job of regulating blood sugar must be put on hold while removing alcohol from the blood.
Hormones
Hormones help maintain a steady blood concentration of glucose, the main source of energy for all tissues. This is particularly important for the brain, because it does not make or store glucose and depends solely on what is supplied by the blood. Alcohol interferes with two hormones, insulin and glucagon, that regulate blood glucose and hormonal responses to hypoglycemia. Binge drinking can lead to severe hypoglycemia or hyperglycemia, high blood glucose levels. The combination of low, or exhausted, glucose stores and the inhibition of glucose production while alcohol is being metabolized can cause severe hypoglycemia. Hyperglycemia is often seen in alcohol abuse, as this reduces the body’s responsiveness to insulin, leading to glucose intolerance even in healthy individuals. Moderate intake can also increase secretion of insulin and cause temporary hypoglycemia. According to “Diabetes Monitor,” even brief periods of hypoglycemia can cause brain damage.
Precautions
Drink alcohol only when blood glucose is under control. Monitor blood sugar before, during and after drinking alcohol and again before bed. Drink alcohol with food in order to slow the absorption of alcohol into the bloodstream. Men should have no more than two drinks a day, and women, no more than one. Always carry a glucose-rich food or drink in case hypoglycemia occurs. Do not mix alcohol and exercise. Wear a diabetes I.D. Talk to health care professionals; they can provide advice on an individual basis.
Mandy Seay, RD, LD, CDE
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