Alcoholic drinks contain varying amounts of alcohol and glucose which will have an impact on blood glucose during and after drinking.
The most important thing to remember is that alcohol can cause nocturnal hypoglycaemia while sleeping or delayed hypoglycaemia during the following day related to the total units of alcohol consumed.
As there is limited research in this area, it is important that any action taken for alcohol should be based on your own experience and the information provided is a guideline only.
- Alcohol is a toxin and impacts the liver to prevent the conversion of stored sugar (called glycogen) into glucose in the bloodstream. This is how alcohol increases the risk of nocturnal and delayed hypoglycaemia.
- If after drinking alcohol you become unconscious with a hypo and require the use of the Glucagen Hypo Kit it is important for the family to know that it may not work and that 999 should be called immediately (Glucagen injection kit normally works through the release of liver glycogen stores).
- The approximate rate to process alcohol is 1 unit/hr + 1hr, for example, if you were to drink a large glass of red wine (250ml, 3 units) then that would take a total of 4 hours to process. You need to be aware of the total number of units consumed in order to calculate the duration of the temp basal rate to help prevent hypoglycaemia after drinking alcohol. For the units present in different drinks see drinkaware.
- Drinks which contain carbohydrates will cause an initial rise in blood glucose but alcohol can still increase the risk of nocturnal or delayed hypoglycaemia.
Safety guidelines when drinking alcohol
Do not drink alcohol on an empty stomach as increases the risk of hypoglycaemia.
You should always take your phone/CGM handset or glucose meter out with you if drinking. When you go to bed, always place your phone/CGM handset or glucose meter at the side of the bed with a high-sugar drink.
Plan to eat something before you go to sleep (either takeaway food or food you’ve made yourself when you get home).
If you use a CGM with an alarm function, ensure that the low glucose alarm is switched on and set to alarm at a glucose of 4.5mmol/L.
Do not correct high blood glucose before bed due to increased risk of nocturnal or delayed hypoglycaemia.
Set up temp basal rate reduction and time period based on total units from when begin drinking.
Be aware that when a large volume of alcohol is consumed that this could increase the risk of delayed hypo the following day and you may have to reduce basal insulin using temp basal rate in the morning.
Low blood glucose levels are commonly experienced during the night and up to lunchtime on the following day.
FAQ’s
Click below to see some answers to some frequently asked questions about alcohol.
You are at risk of having a hypo both while you’re drinking alcohol and afterwards. The ‘hypo effect’ can last for up to 16 hours after you stop drinking, so you may need to eat more carbohydrates or use a reduced temporary basal rate to counteract it.
It is sensible to have a carbohydrate-based meal or snack with your normal bolus dose before you start drinking. You may want to put your pump on a reduced temporary basal rate while you’re drinking if you are active (e.g. walking home or going dancing) or if you’re having sugar-free alcoholic drinks. If you use an HCL, you could set the system to the mode that you use for physical activity (“exercise”/”ease off”). This will have higher glucose targets.
To prevent overnight hypos after drinking alcohol, you can try having a bedtime snack with no additional bolus insulin. If you find that this leads to a very high blood glucose level at breakfast, then consider taking a very small bolus dose with your pre-bed snack next time you are in this situation.
You should discuss your plans with your pump team, as taking too much insulin will put you at risk of a hypo. They may advise you to use a lower temporary basal rate overnight.
Many people experience delayed hypos the day after they drink alcohol. To prevent this you could try a reduced bolus dose at breakfast and/or a reduced temporary basal rate. What works best will depend on how much you had to drink and what your activity levels are during the morning. Again, it is all a matter of trial and error until you can predict how your body will react.
Walking between bars, walking home, dancing, having sex – all these things can cause your blood glucose to drop further as they are forms of exercise. You may need to eat extra carbohydrates or use a temporary lower basal rate.
If you decide to drink alcohol-containing sugar, such as alcopops, normal mixers, cider, some beer or lager, you may notice your blood glucose levels rise initially. If this happens, you can consider taking a reduced bolus dose. If you take the full dose this may cause a hypo, so try lowering the dose and taking, for example, half your normal dose.
You shouldn’t need to take a bolus at all if you use a HCL as the system will bring your glucose down automatically. It is all a matter of trial and error until you see what works.
It is very important to be cautious with correction doses as taking too much is a common cause of hypos when drinking alcohol. You may need only a half or even a quarter of the recommended correction dose to lower your blood glucose to your target level. If you are on a HCL you are unlikely to need a correction dose.
It is safer to under-correct and gradually increase the correction dose as you become familiar with the effects of alcohol and insulin on your blood glucose. If your blood glucose is high remember to check for ketones.
The best way to work out how to adjust your insulin is by checking your blood glucose frequently while you are drinking, and keeping a record of the type of alcohol you drank, the amount, what you ate and how you adjusted your insulin.
This will allow you to see if it worked or if you should try something different next time by tweaking your insulin and/or carbohydrate intake.
It is interesting that HCL is now appearing whereaas it hasn’t been mentioned before
In my opinion it either needs to be there or it doesn’t -if you want my opinion you need to have a think about who this is aimed at as I am not sure we will have that many people JUST on a pump so some of this will be out of date already? -sorry (again!)