#596 Diabetes Variables: Alcohol

December 17, 2021Scott Benner

Diabetes Variables: Alcohol

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 596 of the Juicebox Podcast

so this is it. This is the last episode of the diabetes variable series with me and Jenny Smith. And today's topic is alcohol. You see how I've timed that to coincide with New Year's? Huh? That's right, I'm thinking. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Today I'll be speaking with Jenny Smith, Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast. So come proper. I really hope you've enjoyed the variable series, if in the future, Jenny, and I think other ones will add them. But if not, they're always there for your needs and enjoyment.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn, find out more at G voc glucagon.com. Forward slash juicebox. Jenny, this is the last variable we're going to record. It's very exciting.

Jennifer Smith, CDE 1:51
That is very exciting. A whole year of recordings of variables. That's that's a lot of variables.

Scott Benner 1:55
I'm not kidding about it. At one point, I looked at the list and I was like, Why do I like this is not a good idea. But it ended up being great. And I really did enjoy it, you obviously brought a ton to it. So last one alcohol. How was alcohol a variable for for using insulin?

Jennifer Smith, CDE 2:15
Well, alcohol is a variable because alcohol can lower your body's ability to respond to the typical turnaround hormones that would raise blood sugar, you know, if you have a low, and so alcohol in and of itself, and we're talking like several drinks, or even just wondering, depending on how your body tolerates alcohol. And many people I think are kind of confused what to do about alcohol because they feel like well, if they're drinking like hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it. And should you know not not necessarily unless it's mixed with like cranberry juice or orange juice or something like that, right. But other types of alcohol such as beer, have a fair amount of alcohol to them. carbs, or sorry, yes, alcohol, carbs. Yes, thank you. I was thinking Alcohol Alcohol. Yes. So there's, you know, I mean, anywhere between 12 to maybe like 22 grams, depending on the size of the bottle or the can or whatever you're drinking, really. So do you cover the carbs? And then what happens later, right? Do you take insulin to cover the bottle of beer that you're drinking? Do you not what happens most people who don't cover the carbs initially will have a higher blood sugar.

Scott Benner 3:42
So is the concern around bolusing for carbs that are an alcohol that at some point, you become a knee braided and are not the best shepherd of your blood sugar if it gets low?

Jennifer Smith, CDE 3:52
Those are the good questions to always be thinking about. Yes. Because in terms of low from alcohol, low from alcohol is a delayed low. It will tend to happen later on. So our typical recommendation on a normal conventional pump. It's a little more a little more, I guess difficult if you're doing injections, but on a pump, it would usually say at the end of the night, let's say you've had several drinks over the course of the evening. It's midnight you get home at that point, you want to really decrease your Basal insulin delivery, because that's when alcohol is likely to come into the picture in terms of hitting you and causing you to go low.

Scott Benner 4:41
And is it the actual alcohol that's bringing you down or is it your or is it the Bolus that you used or know if even if you didn't Bolus you would get low afterwards.

Jennifer Smith, CDE 4:51
It shouldn't really be the Bolus I mean again bolusing has a definite like end point of action right let's call it four hours, just give or take three to five hours, four hours. So if you left Bolus at 10 o'clock, you're low at 2am. Sure, it could have something to do with some of that Bolus still being left in the system. But it could also have to do with the way that the liver turns around and deals with, let's call alcohol a toxin, right. So as the liver is dealing with turning that alcohol around and getting rid of it in the body, your liver is also not putting out the typical turnaround for drop in blood sugar, right? You don't have that counter regulatory hormone production, so that your body has some glucose drip coming out of it saved stores to help you. So in that, we usually say for every alcoholic beverage consumed, we really want to take the Basal rate down by a certain percent for about two hours per beverage consumed. Okay, so if you had three beverages at the end of the night, the percent that we would take it down would be by 40% of a decrease. And then the timeframe to decrease would be about two hours per beverage.

Scott Benner 6:08
Okay, so So you're basically people might not recognize that your liver is making glucose in, you know, and giving it is giving it off, like glucose, is it glucagon or glucogenic? Or I forget the word,

Jennifer Smith, CDE 6:23
right? I mean, your body's counter regulatory hormones essentially coming from the liver or helping your body to essentially put out in the TR in terms of a low or a drop like that, it's helping your body to put out the glucose, right? I mean, that's why we have glucagon kits, right glucagon kit is a really quick turnaround of telling your body to spit out the glycogen and to turn it around into glucose to sort of bring you up from the low.

Scott Benner 6:51
But if you're, if you're taxing your body with enough alcohol, the liver gets focused on that. And then as your blood sugar gets low, it doesn't go through that process. In the same

Jennifer Smith, CDE 7:02
way, it doesn't go through that big process of counterregulatory. But also remember, the reason that we're taking Basal insulin is to counter the production and natural drip drip of glucose into our system to begin with. So if the liver is busy taking care of alcohol, it's no longer going to help with that normal drip, drip drip of glucose, and thus, your Basal is going to be too heavy for you. Okay, in layman's terms, right. I mean,

Scott Benner 7:29
listen, it's not a it's not a deep dive into how the liver works. But it is something I don't think people think about for certain, you know,

Jennifer Smith, CDE 7:37
and I think it's something that often isn't even brought up like I, I try really hard with a lot of the teens and those heading off to college that I work with, I try to bring up alcohol at some point, because it will come into the picture. Yeah, I mean, unless you're unless your kid has really sworn off, because they just don't have any interest in that. At some point, alcohol will be something they need to think about. And it's really important that they know better how to adjust if needed, than just say, Well, I'm never going to do it.

Scott Benner 8:12
Right. Okay. Does this? Does this need a bigger episode? Or? What do you think?

Jennifer Smith, CDE 8:19
Come on. What do you have more? More questions?

Scott Benner 8:22
No, I just I don't know if it's, I don't know. I mean, it's like, you know, it's if you're, if it's beer, beer has carbs. If you're drinking, you know, some harder liquor, there's no carbs in them. But you have to look and see if you're going to add fruit juice just seems like maybe I could understand that when I start. But what happens when I'm like three drinks into it? Like, where do I? You know, what do I do when the when the room starts spinning? You know what I mean?

Jennifer Smith, CDE 8:45
Right? I mean, the big things with alcohol, too, that we always recommend is definitely have something to eat with it. Right? So it's not just alcohol. I mean, you you probably know that. Or maybe you don't, I don't know, whether you drink or not. But if you don't, if you drink something on a pretty empty stomach, the impact of the alcohol is faster, right? You will feel the impact. Versus if you have it with a meal or at the end of the meal. Are you drinking along with the meal? It's much of a dumbed down impact. Yeah. Which may also then if you were expecting the impact of alcohol may lead you to drink more, because I'm

Scott Benner 9:23
also that there might be people who are wanting to get to that spot too. It's a really difficult thing to talk about, because you're talking about it from the perspective of how do I do this responsibly? And I don't know that everybody starts an evening of drinking with that in mind to begin with, right?

Jennifer Smith, CDE 9:40
Correct. And you also have to consider like, i i much feel like if I and I've only been drunk a handful of times, I'm not a drinker. I I'm, in fact, I came I think the last time I was drunk was probably at my brother's wedding in Aruba. And that was a long time. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar.

Unknown Speaker 10:10
Okay, those tip sees

Jennifer Smith, CDE 10:13
types of maybe that's not a symptom of yours, but I very much have a similar feeling with alcohol as well as with a low blood sugar. Yeah. So then comes into the equation, you're also already not really thinking very well, because you have alcohol on board. Is your symptom of being drunk? Also a symptom of a low that you're not paying attention to?

Scott Benner 10:38
Yeah. And how are you going to be able to handle that I'm so I'm just thinking of a person I met recently, whose son was away at college and was not a drinker, not a drinker. And then all of a sudden, one night just dove headfirst into it. And then this person had to, like, driving to a place to like, rescue the kid and take them to a hospital. Yes, you know, because then the next problem is, is that you're now around a bunch of drunk people, no one's gonna be able to help you. Like, you know, the, it's not like you have a designated, what if my blood sugar gets low person here? You know,

Jennifer Smith, CDE 11:11
right? I mean, it's the reason in college that I 98% of the time, I offered to be the driver, when we would go out. And I might have knowing that we are going to be out for a fair number of hours, I might have like, half a beer when we got there. And then I had nothing else the rest of the night giving it a good like four hours of clearance time to be able to be like the driver hole.

Scott Benner 11:39
I can say with confidence that in my life, I haven't had the equivalent of a case of beer. Like I just don't drink for no reason that I can particularly point out to you other than it's not interesting to me. It's just not a preference. Yeah, it's not for me, I I just I don't know, like, I don't even know how you like consume that much. Like, I have a bottle of like, flavored like peppy water here. Uh huh. And if I tried to drink this whole bottle, I'm like, Oh,

Jennifer Smith, CDE 12:05
I can't really be too much. Yeah,

Scott Benner 12:06
happens when you start putting, like hops and barley. And don't I be like, Oh, I'm so full. But yeah, but anyway, alright, I appreciate this. I know, it's, it's not an easy, it's not an easy conversation, because there's a lot of perspectives that didn't need to be taken to account. But I think in general, I mean, at least you could try to follow what Jenny was saying about decreasing your Basal. And, and, you know, I would add, you know, you gotta have I would want to have somebody there that understood my diabetes a little bit who wasn't drinking,

Jennifer Smith, CDE 12:35
but correct. Absolutely. And I mean, even people ask even about wine, you know, a glass of wine, typical table wine is somewhere between three to five grams of carb, per, you know, glass, should you cover that? I think a lot of it is also experience, right? What do you know about what has happened, and along with what you said, make sure somebody is there who knows, you knows you have diabetes knows how to help you if you don't seem to be acting, the way that you normally would be acting? Because all of those things very much like all of the things with diabetes in general, take a little bit of experimentation. And you have to figure out what works the best for you.

Scott Benner 13:17
Let me let you I know you have to go. But let me ask you this, because I think I remember that this is true. When I'm drinking. My glucagon won't work as well, right? That is, right. Yeah. Okay. So if you're thinking doesn't matter, if I pass out, I'll just use my glucagon, it might not help.

Jennifer Smith, CDE 13:35
It will. I mean, will it turn things around versus nothing at all? Yeah, but it's not going to be the same impact from what I recall. And I would, I mean, it certainly would look it back up, but I'm quite certain nothing has changed about the recommendations and what we know about your glucagon kit and alcohol in the mix

Scott Benner 13:56
together. Yes. So read the label on your glucagon if you're expecting it to save you when you're, you're drunk, because it might not be as impactful as you're hoping. Okay, Jenny, that somehow we made drinking sad, and I'm sure everybody oh

Jennifer Smith, CDE 14:14
well, people don't see us so they can't tell whether we're smiling or not.

Scott Benner 14:18
Having a great time talking. I'm like I just started thinking like we're taking the thing where people like oh my by Saturday night happy place. These guys are bumming me out. All right, well, thank you so much. G voc hypo pan has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G Vogue glucagon.com slash risk, and the diabetes variable series began, I guess technically at episode 231 with the pro tip called diabetes pro tip variables, but then the variables proper began at 491 with trampoline followed by temperature travel, exercise hydration, food quality leaky sites and tunneling video games, stress masturbation school bad sites growth hormone sleep pumps like placement of full moon, diabetes, tech weight change, Walmart, the final episode, sort of the last episode menopause and today's episode, alcohol. Check them out. They're all available in your podcast player. We're at Juicebox Podcast calm. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.