Checking Glucose with Beer Goggles

For some, "one too many" means a head splitting morning. But people with diabetes may need more than aspirin for their "morning afters."

By Owen C. Franklin

Like many people, Ehrin Kelly enjoys a good drink every now and then.

"I like going out, I like drinking," said the 23-year-old. "I don't drink an insane amount of alcohol, but I have a lot of friends and we all like to go to the same bar."

But, because Kelly has diabetes, the next day can bring more than a typical hangover.

"Sometimes I just won't wake up," said Kelly. "My parents will come into my bedroom to find me completely comatose. It scares the hell out of them."

Such reactions to alcohol can vary from person to person, day to day, and even meal to meal. When symptoms do surface, they often hide behind an intoxicated disguise. Different warnings, advice and lifestyles add to the confusion.

With the proper education, however, alcohol's ambiguity can be far easier to swallow.

Some people might offer a simple solution: just don't drink. But alcohol, like food, plays an important role in many social circles. Capping the bottle can carry deeper implications.

"I refuse to let this disease limit me, come hell or high water," said Kelly. "If I lose that mentality, I'll let this disease get the best of me."

According to diabetes educators, this philosophy works when matched with proper care.

"We don't want people with diabetes to see themselves as 'abnormal,'" said Karen Chalmers, M.S., R.D., C.D.E, director of nutrition services at Joslin Diabetes Center in Boston. "In moderation, and with good glucose control, most people should be able to fit in alcohol once in a while."

But before a person takes a swill from a bottle, s/he might want to know exactly how the spirits go to work on the flesh.

Most of what we eat and drink stays in the stomach for a while before moving to the intestinal tract. But alcohol quickly diffuses through the lining of the stomach and into the bloodstream, where it makes its way to the liver.

The liver carries out several functions. Throughout the day, it stores and releases extra glucose in the form of glycogen. However, the liver is also responsible for breaking down toxins such as alcohol.

When the liver focuses on breaking down alcohol, it stops releasing its regular amount of glucose. This can lead to severe low blood sugar levels.

"The liver is basically distracted," said Chalmers. "People with diabetes can have blood sugar drops for up to thirty six hours after drinking."

Alcohol's affect on blood glucose levels seems counterintuitive — for the most part, the more food and drink you ingest, the more sugar you have in your blood.

According to Chalmers, this misconception often results in inappropriate care.

"Most people think alcohol raises blood sugar," said Chalmers. "So what they do is cut out some food because they think that will keep the blood sugar from rising."

But alcohol will stay in the stomach longer when mixed with food, keeping it from flooding the liver with a rush of toxins. On an empty stomach, alcohol makes a quick jaunt through the stomach lining. This begins a reaction that can yield serious consequences.

"The symptoms of a low blood sugar reaction are the same symptoms you'd see in a person who's had too much to drink," said Chalmers. "Many times, people think they've just had too much to drink so they'll try to sleep it off. But really they're having a reaction and what they need is some quick attention."

While quick attention may prevent a disaster, it doesn't make for the best health management. Various tools and tactics can help people with diabetes blend alcohol into their lifestyle with more control.

First, people with diabetes can quantify their drinking. Alcoholic beverages all come with serving sizes that can enable people to figure out an "alcohol allowance." A portion of beer weighs 12 ounces, wine servings are five ounces, and a hard liquor portion fills a one and a half ounce glass.

"Everyone should check with their physician to see what they can drink," said Chalmers. "But the daily limit is two drinks for men and one drink for women."

People with type 2 diabetes must also watch each drink's calorie count to avoid weight gain. One gram of alcohol carries seven calories — a caloric ratio that nearly matches that of fat. According to this formula, one alcoholic drink equals two servings of fat.

But the different kinds of servings can spark very different results.

"I usually drink beer, it doesn't cause as many problems," said Kelly. "If I drink hard alcohol, forget it. If I drink mixed drinks, I just bottom out."

Beer, wine, liquor and mixed drinks metabolize with different rates and reactions. Mixed drinks with sugary bases, such as screwdrivers and pinã coladas, elevate blood glucose levels before the alcoholic reaction triggers a sharp dive.

"People often think that if they have a sweet drink then their blood sugar won't go down," said Chalmers. "But you'll just end up getting a greater drop, and the wider the fluctuation, the bigger the stress."

People with diabetes are all too familiar with regiments, portions and counting. But this vigilance, like many things, may blur and fade after a couple of pints. Because of this, gauging and calibrating alcohol in a diabetic health plan will always depend upon the person who pops the cap, uncorks the bottle or takes a gulp.

"Nothing is ever the same in diabetes," said Chalmers. "How alcohol affects one person is never going to be the same as how it affects another. What we can do is give general guidelines for people to figure out how alcohol affects them and their needs."