September 6, 2011
Question from Philadelphia, Pennsylvania, USA:
I am a 29-year-old male with type 1 diabetes on a NovoLog/Lantus regimen. My question has to do with how beer affects my blood sugar. I see from several answers to questions that, ordinarily, beer results in an initial blood sugar spike based on the carbohydrates but then decreases as the liver processes the alcohol. My blood sugar, however, remains high and I have never had a low blood sugar after drinking. My doctor has advised me to take half the amount of NovoLog (half a unit instead of one) based on how many beers I have. Why does my blood sugar stay high after drinking beer and what are your thoughts on my doctor’s advice?
I suspect that you have not experienced a low because you have either cut your insulin appropriately so as to avoid a low, or you do not drink enough alcohol at one sitting to experience the pharmacologic effect of the alcohol. I try and counsel my patients on the disruption of blood sugar control that occurs with large amounts of alcohol consumption. It is almost impossible to predict the correct amount of insulin adjustment downward. Since people generally drink and eat in the evening, food is usually consumed with the alcohol. It is generally recommended to consume food with alcohol to prevent lows, but how much do you adjust your insulin? The best way to work this out is to use a fraction of the usual amount and test often to understand how it works in you. Changes up or down will have to be made based on trial and error. You can see this process might become difficult if you drink alcohol in excess and lose your ability to think through the process.