Wednesday, December 30, 2015

Drinking With Diabetes: Answers to the Questions No One Wants to Ask

Ah, alcohol.  One of the most hotly debated illicit substances in American history.  Growing up in a society where the drinking age is regulated legally but not enforced socially puts individuals, namely adolescents/teens, in a tough spot.  Many young people feel uncomfortable or guilty discussing underage drinking openly with their parents.  This is dependent of course on the parent-child relationship, and how the person was raised.  Maybe your parent/parents are accepting of drinking as long as you do it responsibly.  Maybe they hammered it into your head that it was not to be touched until age 21. Whether you fall into either of these two categories, or even if you are overseas where underage drinking (and drinking in general) is less taboo, one thing is for certain: if you are living with type 1 diabetes, you must tread carefully when it comes to alcohol.

While it's not impossible, drinking with diabetes is infinitely complicated.  It requires careful experimentation and constant monitoring.  Every body is different, therefore there is no cookie-cutter method for safe drinking.  However, some truths are applicable to most drinks and all PWD.

Bottoming out is very common.

Whether it's the next morning or an hour after your first drink, bottoming out typically happens after a night of drinking.  For me, a night of wine leads to all-night high blood sugars, then a drop after breakfast the next morning.  A night of vodka-cranberry leads to an evening of very high blood sugars, then a drop just before bed or in the middle of the night.  This can obviously be a risky situation, especially if you do not feel your lows at night.  Generally I try to air on the side of caution; keeping my levels higher and giving half-corrections.  Cautious experimentation should be had to figure out how certain drinks affect you.  In moderation, I've found beer to be the most steady course.  Typically if I give little bits of insulin for each beer, my blood sugars stay in the 200s and don't bottom out--unless I over-bolus, whether for the beer itself or for food consumed during drinking.

Snack often.

No one should drink on an empty stomach, but the risk of bottoming out runs extra high with type 1 diabetes.  When I was an infant, the diabetes educator who came to my house told my parents (because yes, they did ask about drinking even back then, as I've found many parents do) that he would snack on peanuts while drinking.  Of course, you don't want to make yourself sick by overeating.  Shy away from extra sweet sweets--not only will they make your hangover worse, they'll spike your blood sugar and make the regulatory process even more complicated.  But snacking on a bag of chips or even grabbing a late night slice of pizza can be good for soaking up some of that alcohol and keeping your sugar steady overnight.

Test often.

There's no piece of advice that I could give that is more simple or more important.  Test often.  Test every hour. At the very, very least, test before you go to bed.  The bottom line is, your judgement is impaired.  You cannot feel your highs or lows as well.  So test.  It's better to know where you're at than to be floating in BG-alcohol outer space; a complete mystery to yourself and others.  Especially test if you're vomiting.  Medical professionals typically suggest that if you're vomiting from drinking and have type 1 diabetes, you should immediately go to the ER.  This is a loaded judgement call.  But it's always better to be safe than sorry.  So again, at the very least, TEST.

Keep your eyes open.

This is another piece of advice I would give to all who are drinking, especially when you are in a new place or with unfamiliar people.  It's a good idea to have at least one buddy with you who knows that you are diabetic, and what diabetic means, if you plan on getting hammered.  However, no matter what excellent support system you surround yourself with, no one knows your body as well as you.  Therefore it's in your (and your diabetes') best in interest to keep your eyes open.  We all know how scary it is to not be in control of our bodies.  Blacking out or passing out from drinking wipes out your ability to consciously respond to your blood sugar.  Being outside of the locus of control both physically and cognitively is a dangerous place to be.

Above all, the general rules for drinking with diabetes are very similar to the rules for drinking without it:  be smart, be safe, and experiment cautiously.  If you're a parent, foster communication between yourself and your child.  Let them know it is okay to ask questions about drinking.  Zero communication means they may be more defiant, or go in completely blind.