Several issues have come up recently with teens in our clinic population regarding the use of alcohol, since more and more teens are drinking. The issue becomes even more worrisome with teens going off to college where alcohol intake seems to be part of the college “freedom from home ritual”. How does alcohol intake affect blood sugars? Any specific articles you could refer me to would be most helpful.

This information was posted several years ago, and it still is true:
In figuring out how to best manage your food and insulin when drinking alcohol, it may help to understand a bit more detail about what’s happening. Alcohol does not, in itself, lower or raise blood sugar. The body handles it much like fat. Alcohol is processed by the liver — detoxified actually. While the liver is processing alcohol, it cannot release glucose to the blood stream — and that is where the risk for hypoglycemia comes from. The liver’s ability to release glucose to the blood stream when you haven’t eaten for a while is an important protection against low blood sugar.

If you drink alcohol on an empty stomach, your insulin may keep lowering your blood sugar, and your body will have no way to prevent hypoglycemia. Snacking on carbohydrate foods along with your alcoholic beverages will keep glucose coming into the blood stream while your liver is busy handling the alcohol.

The suggestion of one carbohydrate portion for each drink is as reasonable a place as any to start. You will need to test your blood sugar before and after to see how it’s working. Crackers, pretzels, chips and salsa, potato skins — these are all things that could work (although it doesn’t take very much of any of those things to give you 15 grams of carbohydrate!). Some people also mix their drinks with half diet and half regular mixers (such as “Rum and Coke” made with half diet and half regular coke) so that they are getting a small amount of carbohydrate the whole time they are drinking.

If you’re eating heavier snacks or hors d’oeuvres with your alcohol, you will need to bolus (give a meal insulin such as Humalog) for the food. You may need to subtract a unit or two from what would be your normal bolus if you are drinking alcohol at the same time.

Blood glucose monitoring is your best tool for figuring your own body’s exact response — and whenever you’re drinking, it is best to make sure that someone you’re with knows you have diabetes and that you are wearing and/or carrying diabetes ID. It could be easy — and really unfortunate — for someone to mistake a bad hypo for being drunk just because you’d been having a couple of drinks.

You’re to be congratulated for seeking out the information on how to be safe while still enjoying yourself in your customary ways!

Betty Brackenridge, MS, RD, CDE

As to references, most diet advice books discuss alcohol, including Betty’s.

LD

[Editor’s comment: In Control: A Guide for Teens With Diabetes by Jean Betschart, Susan Thom (Contributor), P.S. Mueller (Illustrator) and Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin are excellent references for all teen issues.

SS]