Self-care in diabetes has been explained as an “evolutionary process” where patients continuously work to strengthen their knowledge and awareness of the complex nature of this disease to achieve optimum health. While there are a number of factors that can negatively impact adherence to self-care in a person with diabetes, this article will focus on alcohol and diabetes: specifically, on how alcohol consumption limits this adherence and affects the overall health of people with diabetes.
Alcohol and Diabetes: Limited Self-care
Alcohol consumption among patients with diabetes impairs judgment and contributes to a decreased adherence to a balanced diet, medication, and disease monitoring. When people with diabetes engage in drinking, specifically heavy drinking, they are less likely to consistently check blood sugar levels, adhere to diabetes medications, and lead healthy lifestyles through diet and exercise. According to an article published by the NIH, even moderate drinkers demonstrate poor adherence to the management of their diabetes.
The relationship between alcohol and diabetes self-care in individuals with diabetes was evaluated. In a study of 66,000 patients with diabetes, adherence to six important diabetes self-care behaviors were assessed in relation to the frequency of alcohol consumption. Those behaviors included exercising, smoking, blood glucose self-monitoring, taking diabetes medications, following a healthy diet, and annual Hemoglobin A1c(HbA1c). More than half of these patients in the study identified as drinkers of alcohol. Not surprisingly, results showed that additional morbidity rates were highest among those who were heavy drinkers. Remarkably, though, a significant negative association between alcohol use and diabetes self-care was found. It was indicated that greater alcohol use was associated with poorer diabetes adherence to treatment and management.
Poor glycemic control maintenance has been associated with the consumption of alcohol. Participants from a diabetes treatment clinic sample who claimed that alcohol use was the main reason for poor adherence were more likely to have unchanged high HbA1c levels at a 12-month follow up than those who claimed poor adherence was due to a new diagnosis of diabetes, poor diet, stress, or other medical issues. Participants who said their poor adherence was due to a new diagnosis of diabetes, or other medical and physical issues were seen to have reduced levels of HbA1c levels. This indicates that alcohol is more of a chronic issue and has a prolonged and significant impact on self-care in the management of diabetes.
Alcohol and Diabetes: The Liver
The liver is the largest solid organ in the body. Among important metabolic functions, the liver is responsible for converting the nutrients consumed from food intake into substances that the body can use by storing those substances and supplying the needs of cells when required. The liver plays a critical role in the metabolism of carbohydrates where it ensures that blood glucose levels are staying constant. After a meal is consumed, the liver stores the glucose from that food as glycogen and uses that stored glucose in the event that the body may need it. The liver knows when to do this based on signals from hormones like insulin and glucagon. This delicate process, however, is interrupted in the presence of alcohol and can be especially detrimental for individuals with diabetes.
Alcohol’s Impact on Glycemic Control
In addition to storing and releasing glucose, the liver also plays a vital role in the elimination of toxins from the body. When alcohol enters the liver, the liver identifies this substance as a toxin and its response to that alcohol is to rid it immediately by breaking it down into safe byproducts. This inhibits the liver from storing and releasing glucose. The liver becomes so focused on detoxifying the alcohol that glucose is no longer properly regulated until the alcohol is eliminated. For a person with diabetes, this can lead to a number of complications including hypoglycemia. In the presence of alcohol, blood glucose levels (BGLs) would begin to fall in any healthy person, but in a person who has diabetes, this can be dangerous, especially when insulin or a medication that stimulates the production of insulin is already in effect. Insulin injected into a patient with diabetes meant to lower BGLSs will continue working, in addition to the liver doing the same when metabolizing alcohol.
This process typically occurs with hard liquors that contain little carbs and also depends on what BGLs are before, during, and after drinking. According to diabetes.co.uk, hypoglycemia can occur anywhere from a few minutes to 12 hours after the consumption of alcohol. Therefore, it is incredibly important for people with diabetes to frequently check their BGLs when partaking in drinking.
It is important to note that alcohol can easily mask the symptoms of hypoglycemia. Therefore a person who has been drinking may not realize when he or she is dropping into dangerously low levels of blood sugar.
Symptoms of low blood sugar may include:
- An irregular heart rhythm
- Pale skin
As low blood sugar becomes worse, confusion and abnormal behavior may begin to develop. Serious symptoms include blurred vision, seizures, loss of consciousness, and even death.
Patients with diabetes can most certainly enjoy alcohol as long as it is consumed in moderation and when their BGLs are well controlled. Educating patients on the relationship between alcohol and diabetes — how alcohol is processed in the body and its effect on diabetes — is crucial for maintaining adherence to self-care while still enjoying life.
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