With the holiday season upon us, you may find yourself being offered more wine, beer, and mixed drinks than usual. If you have diabetes, there’s a bit more to consider than whether you prefer red or white wine. It’s important to understand how alcohol affects the body and what that means for your diabetes care.
When alcohol is processed in the body, the liver stops sending out glucose into the blood stream as it normally does, and, therefore, the blood sugar can drop. In people without diabetes, the pancreas will then decrease the amount of insulin it’s sending out to the blood stream to compensate and prevent low blood sugars. However, when your pancreas is an insulin pump or pen, it’s not getting any communication from the liver to back off on the insulin while it processes the alcohol. Also, if the person with diabetes has consumed a lot of alcohol and are not thinking clearly, they could end up in a very dangerous situation.
Consuming alcohol with T1D can increase the risk for both hypoglycemia and hospitalization with diabetic ketoacidosis (DKA).1 Given these risks, there are a few important things we stive to know:
- When do people typically start engaging in risk behaviors such as alcohol consumption?
- What is the likelihood for adolescents or young adults with type 1 diabetes to engage in drinking or binge drinking?
- When should you talk to your adolescent or young adult about alcohol use?
- What resources are available for parents, teens, people with diabetes, loved ones or healthcare providers to help?
Typically, substance use, including alcohol, tobacco or drugs begins in adolescence or young adulthood.1 In the general U.S. population, 60% of high school students had consumed alcohol, 30% had smoked a cigarette, and 36% had tried marijuana.1 Every person is different, but, in general, this is a normal part of development when adolescents start to become more independent and have increased autonomy which can result in more risk-taking behavior.
Research from North Carolina showed that young adults with T1D who were participating in the SEARCH for Diabetes in Youth Study were drinking just as much as their peers and binge drinking more than their peers.2 A similar study out of Canada showed that out of 164 adolescents with T1D, there was no difference in having tried illicit substances but that adolescents with T1D were less likely to continue illicit substance abuse compared to the general population.3
Because alcohol and substance use are sensitive topics, many adolescents and young adults feel uncomfortable telling their health care team about their substance use.1 In one study of 164 adolescents with T1D, only 26% reported using alcohol when asked in the clinic setting; but when asked on a survey, 55% reported using alcohol.4 The adolescents in this study also had a notable gap between the knowledge of what they should do versus what they actually do in real life. For example, 75% reported knowing they should be concerned about hypoglycemia but only 42% knew recommendations for preventing hypoglycemia after drinking.
Adolescents and young adults with diabetes reported a desire to have unbiased educational information provided to them in the health care setting, and the research supports continued dialogue and education from both health care providers and parents or caregivers.1,4 This is something that we at CWD tend to focus on at Friends for Life with teens and adults with diabetes because of the concern that they may not get this information in their clinic. There are many barriers to health care providers having these conversations including time, lack of resources, and inability to have private discussions without the parents in the room.1 If you are a parent of an adolescent with diabetes, it could be to your child’s benefit to allow them to have some individual time with their health care provider to ask questions that they may be too embarrassed to ask while you are in the room.
There are some great resources available including:
- CWD’s document on Diabetes & Alcohol
- DiaTribe’s article Drink to That: How to Safely Consume Alcohol with Diabetes
- Beyond Type 1’s guide on Alcohol & Diabetes
- T1D Toolkit’ section for Teens and Young Adults
Having honest, non-judgmental conversations with your family and healthcare team can make a huge difference in determining what education is needed to keep your family member with diabetes, or yourself, safe and healthy. The easiest way to figure out what works best for you is trial and error with safety nets in place. Cheers to staying safe!
There’s a study looking for more people with diabetes to participate to help create guidelines for consuming alcohol safely. The survey is aimed at people with type 1 diabetes of ages 16-35. Its main purpose is to identify patterns of behavior associated with alcohol consumption. The questionnaire can be found here: t1drink.umed.pl/en
- Substance Use among Adolescents and Young Adults with Type 1 Diabetes: Discussions in Routine Diabetes Care
- Alcohol Consumption Patterns in Young Adults with Type 1 Diabetes: the SEARCH for Diabetes in Youth Study
- Prevalence of alcohol, tobacco, cannabis and other illicit substance use in a population of Canadian adolescents with type 1 diabetes compared to a general adolescent population
- Knowledge and practice of harm-reduction behaviours for alcohol and other illicit substance use in adolescents with type 1 diabetes
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES