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Alcohol and Diabetes

Diabetes mellitus is a chronic disorder in the blood level of insulin, a pancreatic hormone, that helps convert blood glucose into energy. Diabetes occurs when the pancreas doesn’t produce enough insulin, or the insulin it does produce doesn’t work properly. Insulin is a hormone that transfers glucose from the bloodstream into the cells to be used for energy. If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood instead of moving into your cells.

The chances of developing diabetes may depend on a mix of your genes and your lifestyle. It’s a manageable condition. But when it’s not well managed, it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations.

In 2014, it was estimated that 29 million Americanse have diabetes (9.3% of the population) and 21 million of these have been diagnosed. Data reported by researchers from the CDC in the journal Population Health Metrics (November 2010) showed three scenarios for projected prevalence of diabetes in the year 2050 predicting that diabetes in the US population could rise to between 21% and 33% in 2050)

It is estimated 95% of Americans with diabetes have type 2 diabetes, while 5% have type 1 diabetes (CDC). The total economic burden of diabetes in the US, including direct and indirect costs, was estimated to be $245 billion in 2012.

 

There are two main types of diabetes

Type 1 diabetes develops if the body can’t produce enough insulin, because insulin-producing cells in the pancreas have been destroyed. It can happen:

  • because of genetic factors
  • when a virus or infection triggers an autoimmune response (where the body starts attacking itself).

People who have this type of diabetes are usually diagnosed before they’re 40 and there’s currently no way to prevent it. Type 1 or juvenile-onset or insulin-dependent diabetes mellitus is a disorder characterised by a lack of insulin production by the beta cells of pancreatic islets. It’s the least common type of diabetes.

If you suffer from diabetes, you can consume alcohol, but preferably with a meal. The consumption of alcohol without a meal can cause blood sugar level to fall unexpectedly (hypoglycaemia), in particular, if you're on insulin.
If more than a light to moderate amount of alcohol is drunk, alcohol can react with many of the prescribed diabetic medications and worsen the side effects of diabetes such as increased blood pressure.

The American Diabetes Association states that ‘Most people with diabetes can have a moderate amount of alcohol. Research has shown that there can be some health benefits such as reducing risk for heart disease. But, moderation is important. If you have any questions about whether alcohol is safe for you, check with your doctor. People with diabetes should follow the same guidelines as those without diabetes if they choose to drink:

Women should have no more that 1 drink per day.

Men should have no more than 2 drinks a day

On drink is equal to 12 oz beer, 5oz glass of wine or 1.5 oz distilled spirits

American Diabetes Association ‘Some Tips to Sip By (click here)

If you have diabetes, practice caution when drinking. Do not drink on an empty stomach or when your blood glucose is low. If you choose to drink, follow the guidelines above and have it with food. This is especially important for those on insulin and diabetes pills such as sulfonylureas and meglitinides (Prandin), which lower blood glucose by making more insulin

Do not omit food from your regular meal plan and replace it with alcohol. (If you use carbohydrate counting to plan meals, do not count alcohol in your plan as a carbohydrate choice.)

Wear an I.D. that notes you have diabetes.

Sip your drink slowly to savor it and make it last have a zero calorie beverage by your side to keep yourself hydrated like water, diet soda or iced tea.

Try a light beer or wine spritzer made with wine, ice cubes and club soda. Watch out for heavy craft beers, which can have twice the alcohol and calories as a light beer.

For mixed drinks, choose calorie-free drink mixers like diet soda, club soda, diet tonic water or water.

Do not drive or plan to drive for several hours after you drink alcohol.

Alcohol can cause hypoglycemia shortly after drinking and for up to 24 hours after drinking. If you are going to drink alcohol, check your blood glucose before you drink while you drink and for up to 24 hours. You should also check your blood glucose before you go to bed to make sure it is at a safe level – between 100 and 140 mg/dL. If your blood glucose is low, eat something to raise it.

The symptoms of too much alcohol and hypoglycemia can be similar – sleepiness, dizziness and disorientation. You do not want anyone to confuse hypoglycemia for drunkenness, because they might not give you the proper assistance and treatment. The best way to get the help you need if you are hypoglycemic is to always wear an I.D. that says "I have diabetes."

Alcohol may lessen your resolve to stay on track with healthy eating. If you plan to have a glass of wine at dinner or if you are going out for the night, plan ahead so you'll be able to stick to your usual meal plan and won't be tempted to overindulge.

If you choose to drink alcohol, follow the guidelines above and have it with food. Talk with your health care team about whether alcohol is safe for you. If you drink alcohol at least several times a week, make sure your doctor knows this before he/she prescribes a diabetes pill.

Drink only when and if blood glucose is under control. Test blood glucose (if prescribed) to help you decide if you should drink.

Takeaways

• If you choose to drink alcohol, follow the guidelines above and have it with food. Talk with your health care team about whether alcohol is safe for you.

• If you drink alcohol at least several times a week, make sure your doctor knows this before he/she prescribes a diabetes pill.

• Drink only when and if blood glucose is under control. Test blood glucose (if prescribed) to help you decide if you should drink.

See more at: www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html#sthash.PXcRXT2F.dpuf

’Which drinks?

Dry varieties of wine and cider are recommended. These include still and sparkling styles and dry sherry, but not a sweet or medium dry/sweet sherry or sweet dessert wines. Beers and spirits (avoid sweet mixers) are fine but high sugar liqueurs and fortified wines should also be avoided.

Type 2 (late onset) diabetes develops when the body can still make some insulin, but not enough, or when the body becomes resistant to insulin. It can happen:
  • when people are overweight and inactive.
  • People who are an ‘apple-shape’ (with lots of fat around the abdomen) have a greater risk of developing type 2 diabetes
  • because of genetic factors.

Type 2 or adult-onset diabetes mellitus, which accounts for more than 85% of all incidences of diabetes mellitus, is a disorder characterised by resistance to the effects of circulating insulin. This disorder leads to a substantial increase in risk of cardiovascular disease, which is the major cause of mortality, accounting for up to 80% of all deaths in individuals with type 2 diabetes mellitus; the age-adjusted relative risk of death due to cardiovascular disease is approximately three-fold higher than in the general population.

Apart from obesity and physical inactivity there are few well-established modifiable risk factors for type 2 diabetes mellitus. Recent evidence suggests, however, moderate alcohol consumption may be a potentially protective factor against contracting type 2 diabetes mellitus. A J-shaped relationship has been observed between level of alcohol consumption and risk of developing late onset diabetes in both men and women whereby if you drink moderately you have a decreased risk, but is you drink heavily your risk increases.

What the experts say...…

A recent meta-analysis by Pietraszek et al (2010) concluded: "light to moderate alcohol consumption seems to reduce the risk of type 2 diabetes by 30%, while heavy drinkers have the same or higher risk than total abstainers." Crandall et al (2009) have also shown that pre-diabetics who consume alcohol are at lower risk of developing diabetes. The analysis was from the Diabetes Prevention Program, involving patients from 27 centres throughout the US.

Another recent paper by Joosten et al 2010 showed that moderate drinking considerably lowered the risk of developing type 2 diabetes even among subjects who are otherwise following a healthy lifestyle (not obese, non-smokers, physically active, eating a healthy diet). The authors suggest that moderate drinking should be considered as a complement, and not as an alternative, to other healthy lifestyle habits that lower the risk of chronic diseases such as diabetes and coronary heart disease.

Cardiovascular disease remains as the leading cause of death among diabetics. Thus, it may also be important to comment on the very convincing and consistent data over many decades indicating a much lower risk of cardiovascular disease among diabetics who drink alcohol in comparison with abstainers.
However, binge drinking increased the number of diabetes cases. Excessive consumption can impair glycaemic control, and increase the risk of diabetic neuropathy and retinopathy.

People with diabetes don’t usually have to give up alcohol

Keep track of what you’re drinking. Use one of the online tools to help you keep track of the calories and units in your drinks:

NIAAA drink calculator

educ alcool BAC calculator

Doctors usually advise diabetics that they can safely drink alcohol in moderation. So, if you have diabetes and drink, it’s particularly important to stay within the government guidelines. It’s also important to eat a healthy diet and take exercise to help control blood sugar levels.

Tips

Eat well. A healthy meal before you start drinking, and snacks between drinks can help to slow down the absorption of alcohol. It’s particularly important if you’re diabetic. Alcohol lowers blood sugar levels, so eat plenty of food, preferably carbohydrates, to make sure blood sugar levels stay steady.

More information on diabetes (click here).

For more information about diabetes:

www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html

American Association of Diabetes Educators (AADE) www.diabeteseducator.org

American Diabetes Association www.diabetes.org

National Diabetes Education Program (a joint program of NIDDK and CDC) www.yourdiabetesinfo.org

Centers for Disease Control and Prevention (CDC) www.cdc.gov/diabetes/

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes.niddk.nih.gov/

Please visit the gateway to sensible drinking and health, alcoholinmoderation.com for specific studies and summary papers.

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