Drinking alcohol whilst on injections with type 1 diabetes
When outside of preparations for an extreme challenge, it is no hidden secret that I do quite enjoy a good old jolly up; it is a part of many young adult’s lives – my opinion is that in living with type 1 diabetes we should not have to miss out on winding down and being social. Whilst this is my view, we still of course do have diabetes and therefore DO NEED TO BE RESPONSIBLE!
Being responsible and being drunk is quite the juxtaposition… but with diabetes we cannot afford to completely switch off the ball, at any time.
…So what do I do when out on the jolly?
I feel that my brain is in such a way that even when pretty bladdered, my responsibilities today are still drilled into my head. That’s life with diabetes. Having recently passed a course and began some part-time work as a London Tour Guide, whilst the DiAthlete empire grows, I was out to celebrate quite recently and got speaking to a man named John, who has type 1 diabetes too. Despite being in a merry state, I was still able to share some useful advice! The key for me, however, is all about knowing what I am doing and being prepared for it – and that’s what counts with diabetes long term overall, down any walk of life.
If I am going out to a nightclub, which perhaps includes a few starting drinks in the local boozer beforehand, before leaving I will prepare for it in my diabetes. I’ve always been prepared to make a few tweaks, take a few risks and find the results in my own diabetes – this is how I expanded my knowledge in sports for control. My preparations are built around the fact I am on Levemir with my basal rate of insulin on MDI and take this on a twice daily split.
On an average day, without crazy marathons or a jolly up, my split dosage of basal consists of 14 units in the morning time and another 14 units injected in the evening – roughly 12 hours apart.
The twist I make for a night out is firstly making a decision on what I intend to drink. This would normally be beers. I enjoy a pint of lager, Guinness my preferred option. The ingredients in many lagers and bitters host barley, hops and yeast – which entails flavourings and ultimately means there’s levels of carbohydrates included to the ingredients. As we know with type 1 diabetes control, carbohydrates do make blood sugar levels rise and that is why we have to inject insulin to counteract it, as we do not produce our own insulin. Yet, the likes of ingredients such as barley particularly can actually spin the effect of carbohydrates and lower blood sugar levels. On average with lager there will be a slightly higher percentage in the balance of carbohydrates, which means blood sugars will gradually rise. This will not be instant, perhaps mirroring the delayed blood sugar rise of a fatty meal, yet with every two pints that would be when a single unit of quick acting insulin may be required (on average and depending on the person of course). For a Guinness, it includes more water and barley then perhaps the average lager does, which means blood sugars won’t increase as strongly as other drinks. The likes of Stella and Fosters, for example, have a slight element more sugar included in the mix, but again with similar ingredients such as the yeast and barley – so it is a delayed increase in blood sugar levels.
My method of controlling blood sugar levels on a night out is to decide pre jolly-up what I am going to drink. So for a night on the lagers, preferably remaining on the same lager, I would decide to increase my basal insulin – so where my evening amount is on average 14 units, to boost it up to 15 or, if going for it, 16 units of levemir. This way I have a stronger amount in the background to counteract the increase of blood sugar levels throughout the night. My advice would be, if you are sticking to the lagers whilst on injections, to start with just one extra unit – if in a nightclub you might go dancing, having too much background insulin whilst participating in exercise can cause a crash in blood sugar levels. And furthermore, if you are on the pull and accomplish your drunken goal… you don’t exactly want too much basal insulin in your system if you return home with a partner. Just saying!
The responsible move is to remain on the same drink.
Another form of lager that is around in some pubs is called ‘Pils Lager’ – and this appears to have the balance of yeast, barley, hops, slight carbohydrates and no sugar – meaning it will not really increase blood sugar levels. It isn’t my preferred choice of taste but is a good plus for people with diabetes – particularly those with type 2 as well actually.
Now I cannot make it more clear here but to say if YOU DO TAMPER WITH INSULIN, make sure you keep on the right track. It is an initial risk, trial and error, and if drunk, you have less control over yourself as well. So knowing your plan for the night is crucial. Stronger lagers, (most) wines, cider, yes, go for a slight basal increase to prevent high blood sugar levels. I’ve done this and it works.
What you DO NOT WANT, is a basal increase when on a night out and drinking spirits, shots, Jack Daniels, Vodka… even some types of Champagne. These drinks will cause the opposite effect, in fact if you are going for a night out and those are the drinks you are setting yourself on, you may find you need slightly less basal insulin. Normally people do not drink these straight. You will have a ‘JD and Coke’ – and although generally a normal Coke is something with diabetes we look to avoid unless seriously hypo, when it is mixed with whiskey, it isn’t going to be as harmful. I wouldn’t advise drinking normal Coke all night though, this can be unpredictable: the whiskey could cause a hypo, the Coke a hyper.
Alcohol can and in many cases will cause hypos to happen if under prepared for them. So on one hand whilst playing it safer and drinking beers might be where the increase of basal works, in any other context, do not increase the basal with alcohol.
Hard liquor such as Vodka has no carbohydrates – absolutely nothing! So there is nothing included in the ingredients to increase blood sugars. In cases, such as what I often share regarding sports, the body can react and release glucose from the liver when it thinks blood glucose levels are crashing – but under the influence of alcohols such as whiskey and various liquors, the hormonal response is impaired and unable to react at all. Spirits are well known for lowering blood sugar levels and therefore I would normally try to avoid them. Normally…
An interesting part is that you usually associate people who drink the whiskeys and spirits as being quite grouchy, perhaps trouble starters, when drunk on the spirits – this is without diabetes. The reason being that whilst being completely drunk and not in control of their minds, they are also in a state of hypo as the spirits can increase insulin secretion as well. And in living with diabetes we all know, if we are hypo we tend to be grumpy gits!
Whilst I am normally on the beers, there has been occasions where I’ve been out and felt quite high in blood sugar levels, the feeling of saliva increasing in my mouth an indication I get, and so have made the decision to actually swap tactics. I found myself high on the beers, and so have one or two Vodka and Diet Cokes to lower blood sugar levels. The last time I done this I arrived home, tested my blood sugars, and went to bed calling myself a genius with a level of 9.4!
The negative effect was of course the hangover the next day though!
Wine shares similarities to beers – some are worse than others. Generally, wine tends to include more sugar and includes fruits, with natural sugars. So a night on the wine is likely to increase blood sugars slightly more effectively than lager. Some wines have a far greater amount of sugars, an example being Port Wine. It has a lot of grapes in there – recently on a night out with family, my Uncle Al opened up a few bottles of Port. It was tasty, I liked the stuff, I’ll give my Portuguese friends credit… my Grandad polished off a bottle to himself! But my blood sugars rocketed and I had to take a correction dosage. Knowing what you’re drinking is the key!
Similar to the sugar-fruit effect is Cider. Cider, although sharing similarities in some ingredients of lagers, is on the whole different and much, much sweeter, so again a greater increase to blood sugar levels and the extra unit(s) to basal insulin if remaining on the ciders is important.
My best advice that I can pass on is to go out, have fun, we all live once – but ultimately try to not get completely trashed as the more trashed we are, the less responsibility we are able to keep up! We are more likely to get drunk faster when living with diabetes as well. It is your diabetes, you make the decisions, you take the control. It can’t stop us from having fun – but know your body, limits and what you are putting into it for the greatest results.
I’m now going to finish my jolly up season and aim to get the fitness levels up to standard, there may be some more challenges to come soon enough