Diabetes and
Drinking
Evan David Rosen, M.D., Ph.D.
I am not going
to preach to you about the perils of drink. I promise. I myself
have been known to enjoy a cold one on a hot day, and I have
rarely said "no" to a glass of wine offered in good
company. The person with diabetes, however, should know a few
things about the effects of alcohol that may save them some
trouble, and possibly even save their life.
I am not being melodramatic when
I say that moderation in alcohol ingestion may save a diabetic's
life. Ethanol overdosage is the leading cause of death due to
low blood sugar in the United States. Even relatively small
amounts of alcohol can cause hypoglycemia in people treated
with insulin, sulfonylureas (e.g., Glucotrol, Micronase, Diabenese,
Amaryl, and others), or repaglinide (Prandin). In one report
from the 1960's, heavy drinking was found to be the culprit
in the hypoglycemic deaths of two insulin-treated patients;
three others suffered severe neurological damage. Drinking on
an empty stomach increases the odds that things will not turn
out well for patients with diabetes who drink heavily.
It is not clear how ethanol causes
this problem, but it certainly involves reductions in the liver's
ability to release sugar into the bloodstream. It may also be
due in part to an increase in insulin secretion from the pancreas.
Another problem is that the symptoms of mild intoxication are
very similar to the symptoms of hypoglycemia, including lightheadedness
and confusion.
In addition to low blood sugar,
alcohol can cause other problems as well. For example, patients
taking certain older sulfonylureas may find that alcohol causes
their medication to be less effective. This is due to ethanol's
ability to induce liver enzymes responsible for destroying drugs.
People taking metformin (Glucophage) are prone to a serious
condition called lactic acidosis. Alcohol also increases acid
levels in the blood, which should make physicians wary about
prescribing this compound to patients who imbibe heavily.
The good news is that studies
have shown that consumption of two glasses of red wine with
a meal did not seem to affect sugar levels in a group of type
1 and type 2 diabetics. So what are some barroom guidelines
for the person with diabetes?
1. Never drink on an empty stomach
2. No more than 1-2 glasses of wine or 1-2 beers or 1-2 mixed
drinks at a single sitting, no more than once or twice a week.
3. Drink slowly (two beers should last almost 2 hours).
4. Avoid drinks with high sugar content.
5. Have a glucose monitor handy.
If one follows these simple guidelines,
it's unlikely that anything untoward will occur. For many patients,
diabetes can be viewed as the excuse one needs to exercise good
judgment and common sense in matters of eating, exercising,
and smoking cessation. Alcohol consumption is clearly no different.
REFERENCE
White JR, Campbell RK. Dangerous
and common drug interactions in patients with diabetes mellitus.
Endocrinology and Metabolism Clinics of North America 29:789
(2000).
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