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Partying with T1D

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It’s inevitable; people drink in college - before and after they turn 21. If you choose to drink alcohol, there are ways to do it safely without T1D ruining the fun.

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Alcohol and T1D: What’s the Lowdown?

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It’s no surprise that drinking happens on campuses all over the country. If you plan on drinking while at school, make sure you understand how to do it safely with diabetes. It is important to know that Glucagon won't work when drinking and that alcohol can lower blood sugar hours after it is consumed. Any “correction doses” of insulin should be taken with extreme caution to prevent hypoglycemia.
Check out our FAQ below, which includes many of the common questions young adults have regarding drinking, and make sure to check out our partners at Drinking with Diabetes for additional information.

FAQS: Courtesy of Gary Scheiner MS (T1D since 1985!), CDE and his team at Integrated Diabetes Services
We know it’s hard to bring up certain questions in the doctor’s office. But often, the hard questions are the ones we most need answers to. Below is an exhaustive list of questions you might be thinking about, but may or may not have asked a healthcare professional. If your question isn’t here, we’re happy to help – send it along, and we’ll get it answered.

How can I tell the difference between being low and being drunk? And being low while drunk?

Being drunk and being low can look the same. And both conditions can severely impair your judgment as well as your ability to function. Intoxication, however, does not usually cause the “shaking/sweating/rapid heartbeat” associated with hypoglycemia. Unfortunately, drinking can actually suppress these symptoms. The only way to know for sure is to do a BG check. And it is certainly possible to be hypoglycemic and intoxicated at the same time. In fact, alcohol tends to reduce the liver’s output of glucose hours after the alcohol is consumed, which can make blood sugar drop.

To stay safe:
Check your BG frequently when drinking. This is the best way to keep yourself clear of danger and learn how different types of drinks affect you, keeping in mind that the impact can last into the next day.
Wear diabetes identification at all times. It should be conspicuous enough that a first responder will not overlook it. Don’t rely on a wallet card, or even on wearing an insulin pump. A “Medic Alert” necklace or bracelet is optimal.
Make sure that the friends you are with know what hypoglycemia is and how to treat it…and that an appropriate treatment is readily available. Keep some glucose tablets or sweet candy on hand.
Don’t drink on an empty stomach, as this can cause more severe intoxication and hypoglycemia. Also, if you plan to be dancing or walking a great deal, plan accordingly with a reduction in your insulin or compensatory snacks.

*Editor’s note: having a CGM (such as Dexcom) is a great way to stay on top of what your numbers are during and after drinking, with the added safety net of alarms to wake you up throughout the night if you are high or low.

What should I do if I throw up after drinking?

Drinking too much or having unusual combinations of alcoholic drinks can produce nausea and vomiting. This can cause blood sugar to drop, as food eaten previously may not have an opportunity to absorb into the bloodstream before being vomited. Check your blood sugar at least once an hour for several hours. Drink non-alcoholic beverages to rehydrate yourself, and take in some light carbohydrates (crackers, cereal, bread, sports drinks) to keep your blood sugar stable. Wait until 15-20 minutes after eating before taking insulin just to make sure the food stays down. If hypoglycemia occurs and your stomach is too upset to keep food down, you may need to give yourself an injection of glucagon. Of course, if nothing seems to be working, or you don’t feel that you can deal with the situation, call 911. Paramedics can easily administer dextrose through an IV. This is guaranteed to bring your blood sugar back up very quickly.

Sometimes when I go out drinking, my blood sugar winds up really high. What’s the best way to deal with a high after drinking?

When drinking alcohol, the body may become dehydrated. This can make it harder than usual to bring a high BG down. Besides giving insulin to correct the high reading, try to drink water or electrolyte beverages that have low or NO carbs (something like Propel, Powerade Zero or Vitamin Water Zero). After giving insulin to correct a high, check your BG again in 60-90 minutes to ensure it is coming down. If it isn’t, drink more carb-free beverages. If your BG is still elevated 3-4 hours later, give another correction dose. Stacking insulin too closer together can cause a nasty low BG hours later.
What should I expect the morning after drinking?

Consuming small amounts of alcohol (1 or 2 drinks) usually produces no unusual symptoms the next day. Drinking larger amounts at one time can cause headache, dry mouth, fatigue and lower-than-usual blood sugar levels the next day (aka a hangover!). To minimize these symptoms, drink plenty fluids and eat regular carb-containing meals the day after a night out. Check your blood sugar more often than usual so that minor highs and lows can be corrected before they become severe. Note: If you choose to take pain medicine the day after drinking, check the label for acetaminophen if you use a Dexcom CGM. In some models, acetaminophen causes the Dexcom to read inaccurately high for several hours.

How long after drinking can it affect your blood sugar?

The carbs in most drinks (including beer, sweet wine, and mixed drinks) tend to raise the blood sugar quickly – within an hour in most cases. Giving rapid-acting insulin for the carbs will help prevent a sharp rise in blood sugar.
The alcohol can cause a gradual reduction in blood sugar well into the next day. In general, the more drinks you have, the less your “tolerance” for alcohol, and the less you weigh, the longer the effect will last. Plan to check your BG’s more frequently the day after drinking to evaluate its effect on your control for future reference.

Someone told me I shouldn’t exercise the day after drinking. Is that true?

If you have enough energy to exercise after a night out with alcohol, it is usually fine to do so. Best to wait until later the next day to ensure the alcohol from the night before is no longer affecting your blood sugar. And best to stick with a workout you’re used to. Try not to do anything more strenuous than usual, as your body’s energy stores may be compromised the day after drinking.

Is it a good idea to eat while drinking?  If so, what is best to have?

Alcohol is better tolerated with food in the stomach regardless of the type of alcoholic beverage. Try to have drinks with a meal or with snacks that include a bit of fat and protein (chips w/dip, cheese, nuts, etc.) That way, the food will have a more lasting affect through the night, and will help protect you from hypoglycemia while you sleep.

Does drinking affect the accuracy of  a continuous glucose monitor?

Alcohol itself should not affect the accuracy of a CGM (unlike acetaminophen*, which does affect some systems.) In fact, using a CGM is a great way to keep yourself out of harm's way when you drink. Pay attention to the trend lines and high/low alerts after consuming alcohol. Knowing where your BG is headed is just as important as knowing where it is. And don’t forget to calibrate your CGM before you go out drinking – you may have other things on your mind later that night! Acetaminophen is found in all “Tylenol” products as well as many prescription and over-the-counter medications used to treat colds, flu, fever, aches & pains. Check the ingredient list on all medications to see if they contain acetaminophen.

This information  is not meant to replace the advice of your healthcare team. Individual responses to diabetes management approaches can vary considerably. Speak with your physician before making any changes to your therapy.