Insulin Dose Adjustments Necessary to Prevent Hypoglycemia for Type 1s Who Drink

Insulin Dose Adjustments Necessary to Prevent Hypoglycemia for Type 1s Who Drink in the Evening

Modest intake of alcohol with an evening meal may increase the risk of next-day hypoglycemia in patients with type 1 diabetes’ "There is no evidence to suggest that individuals with type 1 diabetes adopt a different approach to their use of alcohol than the rest of the population," Dr. Tristan Richardson and colleagues from Royal Bournemouth Hospital, UK, write. "Nevertheless, in patients treated with insulin, alcohol has been implicated in up to one-fifth of hospital attendances with hypoglycemia."

To investigate the effect of evening alcohol use on the risk of hypoglycemia in type 1 diabetic patients over a 24-hr period, the researchers studied 16 patients (mean age, 39 years) who had had diabetes for an average of 15 years and who consumed alcohol on a regular basis. All the subjects "had normal awareness of hypoglycemia" and stable glycemic control (HbA1c, 8.1%).

The participants wore the continuous glucose monitoring system (CGMS) on two occasions separated by 2 weeks. On one occasion or the other they were given either placebo (orange juice) or vodka (0.85 g/kg) and orange juice with a standardized meals.

The subjects received the same dose of insulin with the meal and before bed. On day 2, the patients abstained from alcohol and the team recorded meals, insulin doses, exercise, sleep, and hypoglycemic events.

Subjects experienced a mean of 1.3 hypoglycemic episodes per day during the 24 hours after the alcoholic drink, compared to 0.6 after the placebo (p = 0.02). No episodes of severe hypoglycemia were reported.

"Overall, the average interstitial glucose level was 1.2 mmol/L lower with alcohol compared with placebo (7.4 mmol/L versus 8.6 mmol/L; p = 0.02)," Dr. Richardson and colleagues explain. "This translated into an increased risk of interstitial hypoglycemia throughout the 24-h period, with a persistent risk of hypoglycemia continuing into the next day," the team concludes.

They suggest that the information may enable people with diabetes "to be proactive and adjust insulin appropriately, with the aim to reduce the overall risk of hypoglycemia associated with alcohol."
Diabetes Care 2005;28:1801-1802

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