#1987 Bolus 4 - Alcohol
Bolus 4: Alcohol
Beer, wine, liquor, cocktails and the canned stuff, with carb counts for each. Then the part that actually matters: why alcohol drops you hours later.
Jump to a moment
- The mechanism is the whole episode. Alcohol is a toxin, and the liver gives clearing it priority over its normal background glucose release — the quiet drip your basal insulin is dosed against. Take the drip away and leave the basal unchanged, and the math tilts low. So the risk is not while you are drinking. It is hours later. One drink is roughly one to two hours of processing; a heavier night can run six to twelve.
- Carb counts Jenny signed off on. White Claw is about 2 carbs a can — less than a single glucose tab, nothing to bolus for, in the same category as whiskey, gin, tequila or rum and Diet Coke. A BuzzBall is a different animal: roughly 200 ml of juice and sugar, call it 25 grams, and Jenny's shortcut is 25 per ball. Dry wine 3–4, Guinness 10, IPAs closer to 20, Long Island iced tea 20–30, frozen daiquiri or margarita 35–45, Mike's or Smirnoff Ice 32, twisted tea 26.
- Jenny's protective list, in order: don't drink on an empty stomach — eat carbs plus protein or fat before and during; tighten your CGM low alert so you get told sooner, because you will be paying less attention; keep fast-acting glucose or dextrose on you; set a lower temp basal or a higher target across the window where you have worked out the low will land; and have somebody with you who knows you have diabetes and knows where the glucagon is.
- Glucagon under alcohol works less well, but it is not useless, and the distinction is worth knowing. It has two mechanisms: breaking down stored liver glycogen, which still works with alcohol present, and promoting gluconeogenesis, which is the part alcohol blocks. Jenny's instruction is not to wait until someone is unconscious — if vomiting means nothing is going in and you know the alcohol effect is still coming, give it. And if you give it and nothing happens, call emergency rather than wait, because they can run IV glucose.
- On MDI the best single move is at bedtime: eat something with both carbohydrate and protein. The carbs lift you now, and the protein lands later, roughly when the alcohol curve is pulling you down. Some people also reduce their evening basal injection — safer overnight, but it is a 24-hour decision, so expect to run higher the next day and to need more rapid-acting to stay on top of it.
- Bolus 4 Series — Every Bolus 4 episode in one place, with a follow-along page for each
- Episode 789: Gvoke HypoPen — The glucagon episode Jenny points to — how it actually works, and when to use it
- Juicebox Podcast Pro Tip Series — Management fundamentals with Jenny Smith, episodes 1000–1025
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Every word of the conversation
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Somebody Asked This Morning1:58
But alcohol, I... Oddly enough, people won't believe this, but last night, I... Actually, before I went to bed, I I said, what are what are Jenny and I gonna bolus for tomorrow? And I thought I thought alcohol is gonna be a good one. And I put a little list together of different drinks and everything, I was prepared for today.
And then this morning, someone on the Facebook group said, I don't know how to bolus for this alcohol. And someone else said, well, maybe they'll make a bolus for episode about it. And I responded and said, doing that in, like, two hours. So here we are, Jennifer. I Awesome.
I have created a list of beer, wine, liquor, and shots, cocktails that all come with carbs. I don't know how you're supposed to know this stuff, but here we are.
Why Alcohol Scrambles the Math2:52
But I... It's a great topic, I think, especially... I don't know when this will be heard by all of your wonderful listeners, but we are in the time where many who are almost or of the age where they can be drinking alcohol legally. Mhmm. I will just put that in there.
Yeah. I know it happens otherwise, but, you know, many people are going off to college is the gist of it. Right? And so I think it comes at a very timely point, because alcohol is something that when you consider, especially type one diabetes, and alcohol, they they interact kind of in a way that messes up your thinking about what could happen to your blood sugar Okay. And what you should pay attention to.
So bolusing for is just a plan of what to do, but I think I think more so is important to understand some of the science behind why it's really valuable to understand what to do, how to bolus for alcohol if and when it might be needed. I I think they're all really important pieces.
Yeah. Because there's gonna... I mean, there's a spike, a dip, and a tail to it, I would imagine. But...
Depending on what you drink.
But it's... But that's what was gonna say. It's it's a... It's very dependent on the drink. Also, I'm sorry.
What Is a BuzzBall4:17
I'm not distracted. I'm over here trying to figure out what a buzz ball is. So I... Now I know. I figured it out.
It's, it's the thing that I once saw at the Buc ee's, I think, or some other gas station when I was in the South. Remember The South? I remember thinking, why are there pre chilled handheld alcohol drinks available like to pick and go at a gas station? And because around here, you could not do that. Right.
Yeah. Right. Like... And so I was like, well, that's interesting because it... It's also like, it's...
They're not big. Like, by volume, there's... By volume. Listen to me. It already sounds like I work for Anheuser Busch.
I've been talking about this by volume, Jenny. There's...
What are these called again?
Buzzball. Oh, I'm glad you don't know either. Buzzball?
I have... We don't drink. So...
Yeah. Yeah. So a Buzzball apparently has between twenty five and thirty grams of carbs in it, but it's this little disposable thing that only looks like it's about the size of a baseball. So Oh. A concentrated juice, there's a cream version.
They're, like, in, like, desert. So I went to buzzballs.com. Can't believe I'm saying buzz balls so much. I went to buzzballs.com, not a sponsor. Tropic Tang, Lime Rita, Berry Cherry, Limeade, Pink Lemonade.
Wow. Grapes gone wild. Is this hard to get drunk? It's like super...
I think it's a great one to consider. I would think of it like a mixed drink or a more sugary alcohol containing beverage, and I think we should go through... I think we should really look through each of the different types of alcohol you might consume. And are they bolus worthy
Okay.
Is a good way to think about it. But I think, you know, as I said earlier, the core issue with alcohol is knowing what does your body do with something that technically is a toxin. Mhmm. I mean, if you... If if we're just gonna be honest about it, that's what alcohol is.
Your Liver Picks the Toxin First6:19
It's it's a toxin in the body. And what's one of the organs you have that helps to navigate toxins?
Liver?
A liver.
Look at me.
So... Yay. Look at you. So what... I mean, do you know what
It's a filter.
Alcohol does?
Right. So...
You know?
Isn't it giving the liver something to do so the liver doesn't have time to do his other stuff? Like
Right. Pretty soon glucose done? Normally, the... Yes. Absolutely.
Normally, the give and take is in a functional body with functioning pancreatic beta cells. Right? There's a give and take. Right? The liver releases stored glucose to kind of buffer the insulin.
It's like a drip drip drip drip, and they balance each other if you will. But when you put alcohol in your body, your liver essentially gives priority to getting rid of that alcohol over its ability to drip drip, that that glucose. Right? So the buffering system kind of gets stalled as long as that alcohol is in your system. And if you consider, you know, one alcoholic beverage versus six alcoholic beverages, it could be one or two hours of processing.
It could be as long as six to twelve hours of processing with a heavier drinking evening or day.
Yeah. I...
So as you said, it could be a rise. It could be a fall. It could be what ends up happening. We usually... The biggest worry is the hypoglycemia.
Mhmm.
That could come because of what the liver is trying to do for you while it stalled and doing something else for you.
I I wanna just take a half a second here to give the marketing team at BuzzBalls a shout out. These are some twisted people who are really thoughtful. They have something called... There's a chocolate Buzzball, Jenny, in case you're wondering, but it's but it's called Choc Teas, c h o c teas. You see what you see what they're going here.
And you can get a larger one. So you can get a bigger ball... You can get bigger balls or smaller balls. The one thing you can't get on this website is any nutritional information about this stuff. So I'm like, I've been pressing through this site while you're talking because I thought, like, what is the creamy one?
I guess the chalk... I'm not gonna say chalk ball. I'm not... Anyway, I'm not saying chalk teas again. But what I'm gonna tell you is that, like, that one has cream in it and there's different versions of the cream in it too.
Like, you can go... Like, there's more, there's less. But as I go through all of these, what I don't see, PR team, is any ability to understand what's in this. So as far as, you know, carbs and and other stuff is going, I don't see nutritional information here. And if it's here, it's hidden away pretty good.
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Twenty-Five Grams Per Ball11:21
I mean, my... You said it's about the size of a baseball.
They say the suggested serving size of the cocktail version is 200 milliliters.
Which is about... So one cup is 240 ml or milliliters, which is eight ounces or a one cup portion, which is why I said the baseball is... Mhmm. It was a good estimate on your part. And if that's juice, which it sounds like there's a fair portion of either juice or some type of juicy sugary in it, I'm just thinking about orange juice as an example, eight ounces of orange juice depending on the brand and, you know, how it is, somewhere between 30 to 36 grams for a one cup serving or about 240 mls.
Okay.
So that makes me think that a drink like this would be comparable. My estimate would probably be to be on the safe side because we're also considering something that has alcohol in it. I'd say aim for 25 grams per ball. Did I say that?
You did. So if you... So, Jenny, are you telling me that if you had both of the balls in your hand, it would be about 50 carbs?
There you go.
Okay.
Two balls is worth $50.
I... Listen. I don't wanna be punitive in these podcasts ever, but you Pretty funny. You can DoorDash one of these things. And And please, if you have ever found yourself DoorDashing a buzz ball, call a friend and tell them you're in trouble.
Okay? I mean... Yeah. Oh my gosh. Okay.
Let's move on to something else.
Okay.
But but I'm gonna stay in the canned variety right now. So Okay. White claw is definitely words I've heard before. So what's that, like, seltzer based? I have here, like, two to four grams for a can.
Does that sound right to you?
Again, I know what White Claw is.
Alright. Hold on.
My estimate only knowing the basics about it is that it's carb... It's fairly carb free if I remember correctly.
Mhmm.
So maybe four grams at the most, but I think... I actually think it's less than that.
Yeah. I have two to four on here.... Four? Oh, okay. I...
On their website, they tell you there's two grams of sugar in a White Claw black cherry. Oh, and they have nutritional information. Good for you, White Claw.
Well, good for them. Yay.
Carbs. Two two carbs, two sugars. There's a little bit of sodium, and that's pretty much it. Purified carbonated water, alcohol, natural flavor, citric acid, cane sugar, natural blackberry juice concentrates, sodium citrate. I
would compare that then to more of a consideration as we're talking about bolusing for something. Right? This would be more like whiskey, gin, tequila
Okay.
There Is No Bolus For This14:19
Or something like, a Ramen Diet Coke, so to speak. Right? That kind of thing where you're not bolusing for this.
Okay.
There there is no bolus for this. The risk being later on, it is alcohol, and there have to be some considerations for the later effect, which is low blood sugar.
Yeah. So talk about that a little more when... Explain to me why the later effect is low blood sugar. Is it all about taking the liver out of the process? That's it?
It is.
That's all? Okay.
Don't Drink on an Empty Stomach14:53
Mhmm. And, you know, something that honestly helps to buffer some of this and some, things to keep in mind overall, I generally teach people try not to drink on an empty stomach. Right? Eat some carbs, protein, or honestly protein and fat before you start drinking, as well as if possible during. So if you are a bar person and you're out drinking with friends or whatever it is, and you've got the bar chips and salsa or whatever, absolutely have it, please, with your drink.
Okay. Because you...
Which brings in the potential that you're bolusing for that. But if you have something like the White Claw that you're drinking with it, you're not bolusing for alcohol.
Are you... Like, do people generally... Like, if they drink, I don't know, the the thing before, or let's go with the White Claw. Say that...... Ball?
That had too many carbs. Don't... Well well, yeah, let's let's go back to the balls for a second. So if you're drinking the the buzz ball and you've got a bolus for it because there's carbs in it and then your liver function shifts, are you telling me, like, it's is it a coin flip you're getting low later or is it a probability you're getting low later?
It's a higher probability that your blood sugar is going to go low later. Yes.
Alright. Well, I have here that also these websites are, I guess, should not, surprise anybody, but they're not real big on putting their nutritional information.
No. Many alcoholic beverages don't have nutrition facts available. You can do some digging to find it.
Yeah.
But in general, again, as most people have a... Have an issue looking up information even just for food when they're out. Right?
Yeah. That's exactly right. Yeah. Yeah.
You... Who's gonna look up their drink in a bar setting or on a vacation when you're drinking on the beach or whatever it is? You are less likely to look it up. So then it becomes a true estimate or you just don't even consider it, and then there are issues.
Beer, Wine, Liquor, Cocktails17:00
So what I did before we started recording is I had my my close personal friend Claude put a list together. Mhmm. And he gave me, she. I don't think they identify. I gave you?
It it it told me... I guess, we shouldn't say he or she. The the machine, the box, it's the I felt like my grandmother for a second. So I got a list of beers. Right?
Michelob Ultra 2.6 carbs. Corona 13 to 14. Blue Moon Wheat 13 to 14. Belgian Triple Quads 15 to 25. Double IPA, 18 to 22.
Sours, 12 to 20. Malt liquor, 15 to 20. Nonalcoholic beer, there's something you don't think about, 10 to 20. Guinness drought, 10. And then it did wines.
If if I'm saying anything that you're like, that doesn't seem right to me. Just stop me. Dry, red...
No. These all sound these all sound appropriate
Okay.
In terms of what your little friend has looked up for you. In fact, if I was going to have alcohol, which is pretty rare Mhmm. My preference in beer is Guinness. Okay. And I also really liked it.
We went to Ireland years ago and had really good Guinness.
And and 10 sounds right.
And 10 is actually pretty good because I was super excited to hear that it wasn't like the IPAs, which are closer to almost 20 grams for a whole, like, bottle, so to speak.
Yep.
That my Guinness was pretty low in carb considering.
Mhmm.
It's like, Guinness.
Hey. Guinness. That's a t shirt. Dry red or white wines, three to four carbs. Mhmm.
Moscato, sweet riesling, riesling, six to 14. A port or desert wine or just... Excuse me. Dessert wine, 10 to 14. Mimosas, eight to 12.
Mold wine, 12 to 18. Sangria, 15 to 25. Mead, 10 to 20. I guess if you're one of those things where you're pretending to be from the sixteen hundreds. Sake, which I don't even know what that is.
Seven to nine. Sake. Sake. Is that what it... Thank you.
My god. What is wrong with me today? And then pure... What is s o j u? I don't know.
Zero to three. Soshu?
Yeah. Yeah. I don't know what that one is. That one I've not heard of.
Liquor and shots, fireball, eleven. Bailey's, eight to nine. Kalua, fifteen. Jagermeister, eleven. Amaretta, schnapps, eleven to fifteen.
Triple sec, eight to 11, a flavored vodka, zero to two. Mhmm. A cocktails, old fashioned, four to eight, a martini, zero to three, regular... What is this? Gin and tonic, 15 to 16, A Moscow Mule, 20 to 25.
A Mojito, 20 to 25. Whiskey Sour, 12 to 20. Cosmo, 10 to 13. Let's see. Frozen Daiquiri, 35 to 45.
Like a hurricane or a zombie, they're saying here, 25 to 40. Long Island, iced tea, twenty to 30. Bloody Mary, five to eight. Espresso Martini, 15 to 20. Hot Toddy, which I haven't heard since I watched television in the seventies, 15 to 20.
Spiked eggnog, 20. And then the canned stuff, white claw, we said two to four. Some of the Truly lemonade styles, to 13. Canned cocktails, 25 to 35. Twisted tea, 26.
Mike's, it's like a Smirnoff Ice or a Mike's, 32. The buzz balls aforementioned 25 to 30. Hard kombucha five to 12. Jell O shots four to six. So I looked at all that, and I was like, that's a lot of stuff.
I don't know how I'm supposed to remember all that. You you know what I mean? Correct. So... You know,
Look Up Your Two Drinks Once21:05
you could as I've done with some of the college students I've I've worked with who are definitely wanting of trying even if it's not a lot or often. I usually ask them if you were going to drink or you have had a drink before, what are your preferences? So then you can really have an idea going forward. Even if you look it up once, most often your brain can recall, oh, I looked up beer and in general, it sounds like it's like 15 grams for a bottle. Great.
15 is better than nothing as a bolus.
Right.
Right? So if you can get a general amount for the types of things you have preference for, that can be easier to remember than to say, okay, I have to remember 30 different things.
So now here's the next thing is there's no world where I'm gonna have one white claw. Right? Like, this is a thing where I really don't... Like, I don't have context for this. I...
If I go to a picnic, I'm not having three sodas. Like, it's... I'm like, ugh, so much liquid. So... Right.
A Prompt You Can Reuse22:09
Yeah. But that's not gonna be the case. So I I... Listen. I don't know how this is gonna work because I have not tried it yet, but I asked Claude to make a prompt to prompt itself to help people with type one diabetes to drink, and it gave back a fairly, like, significant prompt.
So it leaves a space for you to put in your drink. So I'm gonna put in White Claw, but I'm gonna say that I'm having... I'm gonna say I'm having four of them over three hours, four hours. I don't know. Like, three to four hours.
Okay? I'm gonna tell it that. And then it asks optionally for time of day if it... If it's with food, if you have an empty stomach. So let's say...
I'm gonna say starting at noon with a burger in my belly. Okay. I actually typed that just so you know. And it asks if you're on a pump AID system or MDI. I'm gonna say MDI.
And then I'm gonna hit go and see what happens. So the the prompt is really exceedingly. Like, you guys should look at stuff like this. I said, make a prompt, make an AI prompt, build a perfect LLM prompt that a person could use to get this info for a drink if they have type one diabetes. And it gave me back the prompt.
It told me to fill in that stuff, and I'm gonna... It's just a little entailed, but it's basically broken... It's taken the fun out of drinking is what it's... It's gonna stop you from drinking. You're gonna go like, if this is it, I don't wanna I don't wanna be involved.
But here's what it said. One white claw, 12 ounces, 5% alcohol by volume, two grams of carbs, zero fat, 100 calories, about one standard drink worth of alcohol, 14 grams of ethanol. You are four... Over three or four hours should be eight carbs, blah blah blah. No real uncertainty here.
It's a labeled consistent product. The only variable worth flagging is if any of the four is a surf surge or a lemonade refresher variant, then the math would change. Essentially, there won't be a spike. Two grams of carbs per can is less than a single glucose tab. It goes on to explain that.
The dip moderate trending towards the serious end of moderate. Four standard drinks is a real alcohol load while your liver processes it. It downshifts in its normal background glucose release, the steady drip your baseline insulin is calibrated against. With the drip reduced and your basal unchanged, the math tilts low. At roughly one drink metabolized per hour, four drinks finishing at 4PM, keeps your liver occupied into early evening, and the suppression effect can linger six to twelve hours after your last sip.
So roughly into the 8PM to 2AM window, starting at noon is generally your best structural advantage here. It says it it doesn't expect there to be a tail because there's no fat in the drink. Noon to 2PM, your curve is the burger curve, your meal spike possibly... Plus possibly a fat driven drift upwards. The claws are invisible two to 5PM.
Five to 9PM, this is your watch window. The burger's done. The alcohol suppression is still active. Nine to two... 9PM to 2AM.
Lingering suppression means a lighter than usual glucose floor overnight. If dinner was bolus normally and the drift already started, this is where a surprise low was going to land. Next morning, most people are back to baseline. Does that make... That all sounds right too.
It makes sense.
Yeah.
Yeah. Again, you know, what it's really using is the clearance of a particular alcohol drink. Right?
Mhmm.
With... I expect since you gave the type of you gave the type of alcohol to the system to acknowledge, it also knows the alcohol content
Mhmm.
Of that particular kind. And that can make a difference in kind of what you're seeing in the curve of effect. Right? You gave it what? How many?
Three or four
of the clients? I'm gonna drink I'm gonna drink four over the next three to four hours. Mhmm.
I asked... So it takes a long time for that alcohol to clear. Absolutely.
I said put it into a simple paragraph to hand to my college aged child. Four White Claws over an afternoon won't spike your blood sugar. That's barely any sugar, so there's nothing the bolus for. Yeah. The thing the thing to worry about is what's gonna come later.
Alcohol makes your liver pause the background glucose. It's always quietly releasing, and your basal insulin is dosed assuming that glucose is there. So the risk isn't high while you're drinking. It's just like... And it just broke it down and it made it simpler.
So... Yeah.
And I think it makes it harder. I mean, this was a fairly easy one to evaluate for when to expect something to happen. When you when you combine alcohol with a drink that has carbs, such as if you go to a daiquiri or you go to a blended margarita or, you know, any of those, even like the Long Island iced tea.
Mhmm.
Does that look terribly carby? No. But 30 to... I think you said, like, 32 grams for the Long Island iced tea.
Mhmm.
That's a lot of carbohydrate. And if you are sipping that over the course of an hour or two, that's not that's not as much of a big deal. But if you're drinking that pretty quickly, you definitely have to have a bolus for that. And then it's a decision about are you eating with it, what kind of bolus. You still have the potential for that later hit.
Yeah.
But again, you may not be drinking four of them.
Three Long Islands27:54
Yeah. I I saw... I just asked it again. Was like, now start at 8PM, three Long Island iced teas between then and midnight. What do I need to bolus for and watch for?
Keep it simple. You're bolusing for each Long Island iced tea that roughly has 20 to 30 grams of carbs in it from the cola and the sour mix. So call this somewhere between 65 and 85 across the three. Don't cover it all. Each one carries about two to three standard drinks of alcohol.
So three of them is, like, seven to nine drinks of liver suppression stacking up behind the sugar. Yep. Well, that really does make it interesting, doesn't it?
It's a huge hit effect. And I... It's a really important piece to understand because as you... You may start out drinking beer. Right?
Or you may start out drinking like the White Claw or something like that. But if you are someone who enjoys drinking or as you get into a career and that becomes something that's social in the evening with colleagues or work events or something like that, your alcohol desire
Yeah.
Changes in most people. You get a little bit more, I guess, adventurous with
what kind of drinks you eat.
You try different things, and you have to have these pieces as a base understanding. Mhmm. I I have something that I wanna ask, but it may be later in the conversation. So Okay. What else do you want to explore with alcohol?
What do you mean what else do I wanna explore with alcohol? You're right.
We're we're bolusing for different kinds
of alcohol.
Right? So are there other drinks that you wanted to look at?
I mean... Or... Yeah. Like, yeah, let's pick through a a couple of extras here. Like, so we'll go to...
What about a...
Go ahead.
Oh, go ahead. No. You... No. No.
I was gonna say, what about a daiquiri?
Oh, let's do a daiquiri. Go ahead.
Or kind of at the end of, like, a summer vacation going off someplace, although some people do that over the winter too to get away from the cold, so they might be going to a desert island someplace.
Frozen dac... I... I'd love to be on an island. Frozen daiquiri margarita, 35 to 45. Mhmm.
It's interesting. It says the blended ice will slow your sipping, but it's still 40 grams of syrup and juice. So maybe you're gonna see, like, a long slow... Like, a steady spike while you're drinking it. Does that seem right?
Yeah. Yeah.
That seems about right. Whereas a drink that's just more liquidy, again, Long Island iced tea, you're gonna drink it faster because it's not so cold on your...
Yeah. Yeah. Yeah. I thought you were gonna say, aren't these people gonna have sex after they're drinking? That's what I thought you were getting at.
I was like, don't you think these people are gonna get, like, you know, lubricated and then, you know...
Well, then we have to discuss the activity factor that might be factored in there and what you might plan to do.
What If You Throw Up30:47
Well, yeah. What about what about if you, I mean, what if you throw up too? Right? Correct. So now you've got stuff in your stomach you're hoping to hold your blood sugar up.
You vomit once or twice. That's gone now. And now that... That's probably a free fall at that point then because now the liver's impacted. There's nothing in your stomach.
Oh, interesting.
Now what do we do?
Don't know. I just I just found myself thinking, I don't know. Yeah. Yeah. Because what if you can't eat.
Right?
And What if you can't eat?
And your glucagon isn't gonna have the same impact on you. We didn't even go over that yet. Go ahead.
Me. Was the piece that I was... That I thought was gonna be more of like, well, what are some things we should pay attention to, right, in terms of protective considerations, keeping in mind. We already said... Or I said, try not to drink on an empty stomach.
Right? Pay attention to your glucose meter or set your alarms on your CGM for higher low alerts. You get notified sooner. Right? Especially in a state where maybe mentally you're not paying as close of attention.
You could, obviously, and hopefully, have your fast acting carbs on hand from, you know, glucose or dextrose specifically.
Mhmm.
And then insulin wise, if you know enough ahead, this goes into setting an adjusted temporary basal or an adjusted target for the hours in which you defined really nicely, where is the potential for the low going to hit?
Yeah.
So... Right? Setting a different target. All those things are important along with... I always say, have a friend who knows what they're doing with you, at least knows that you have diabetes, that this is here and that brings in, goodness, glucagon.
Glucagon Still Works, Just Less32:41
How many people walk out of their house with glucagon in their pocket or their purse or whatever? Somebody should know where it's there or where it is. Yeah. Because while glucagon will work less effectively, it doesn't not work at all.
Okay. Still some impact from it. It's worth it's worth trying.
It is still worth giving absolutely if it is needed and you can. And this is where I always say, you do not have to wait until you are passed out if you you brought up vomiting or anything like that. This is the case where if that's what has happened and you can't physically get anything else in and you know the effect of alcohol is coming, give yourself the glucagon. Do not wait.
Yeah. Yeah.
And, it's gonna have a little bit of a delay. I mean, it's it's got kinda two ways that it works, which I... We've gone over in one of the episodes. Was a pro tip or a...
We did a glucagon episode about this.
We did. Yeah. Yeah. Yeah. I was gonna say go to that episode, listen to how its mechanism action kind of is working.
Right? So one, the glucagon essentially helps to break down the liver stored glycogen. It helps to break it down. Right? It's still working even with the alcohol present.
It also promotes something called gluconeogenesis, the glucagon does, and that's a piece that can sometimes get more blocked Mhmm. Overall, in what ends up happening. But if you've been drinking for a while, obviously, the more alcohol that's there, as we've already talked about,
the more
potential for a bigger hit in something that you're using as a rescue that may not work as well as you think it should.
Doesn't matter if it's nasal or the injected, it's gonna have the same... Nope. Yeah. The episode you and I made was seven eighty nine important things to know about Gvoke HypoPen. Seven eighty nine.
I put up nineteen thirty five the other day.
Wow. That was a... I... Yeah. That is a really long time ago.
Yeah. I make a lot of content, but also we're old. And so, also, if you if you you go to the website, juiceboxpodcast.com, and go to search and click... Just type in the word glucagon, you'll get that. But you'll also get
Pop up.
What I think is pretty interesting. It's a small series of people who came on just to tell a story of when they used glucagon. So Okay. Yeah. They're like...
There's, like, these glucagon stories. One of
the that I remember that I did listen to was a woman who... I think she gave it to herself, and then she walked over to the neighbors with a really low blood sugar, and then was... Like, she was traversing outside after having, I think, given the glucagon to herself, or maybe she went to her neighbors and then came back and then gave it to herself. I don't... It was one that I do remember listening to.
Yeah.
Everyone's stories are crazy. So don't don't miss the stories. I... There was a... The the number of people who have told me that I've got...
I've gone out for a walk and had to have somebody drive to me sitting on a curb, I've lost count of that. Like, just... You know, I went for a walk. I got low. I realized I didn't have everything with me, and then I had to call somebody, and I sat down, tried to stay still, and waited for somebody to come get me.
It's... That... That's that's that's a common tale for people. So these glucagon stories, you know, when I I... When I tried to get people to come on to talk about it, a fair amount of people reached out.
Actually, it was really... It's very kind of them because it's not a... They're never fun stories to retell. No. Yeah.
Yeah. You know?
They're they're not. They're scary, and they bring up a lot of, you know, sort of even forgotten, like, feelings about things.
Mhmm.
One... The the last thing that I would say about glucagon is if you've used it and it seems like it's not really working, again, it could have a delayed, but it is also a time to absolutely call emergency.
Okay.
It is not a time to wait if you've used it and you're waiting and you feel no effect or whoever's with you sees nothing happening, absolutely get emergency help.
Somebody needs to get a line into you so they can...
They can always get IV glucose.
Right. Yep. So Jenny, last thing on this one. Besides, maybe I'll make a blog post out of this list of alcohols and just let people, like, go imagine how they could go find out more for themselves somewhere. But I I I took it on the Internet this morning because apparently the last time you and I talked about alcohol, you said it's...
You know, here's what you do on an a I... On an AID system or here's what you would do on a pump, like, you know, maybe do a temp basal decrease, do this, do that. And then we never got back to talking about MDI. So people... Yeah.
Drinking on MDI37:27
So people on MDI who wanna go drinking, are there... I don't know. Are there tips, tricks, stuff that might help them out?
Yeah. Typically, you know, we would usually say in the evening... If you've consumed alcohol in the evening to start out with, to definitely have before you go to sleep or if somebody can help you before you go to sleep, have something that's got some good protein to it. Have something that also has carbohydrate in it because despite that actually boosting your blood sugar up, the goal being that the carbs are gonna get in boosting you up. The protein is going to help to continue to keep things a little bit more stable or higher.
By the time the protein gets in, it's about the point at which the alcohol is probably possibly causing that curve down or the low blood sugar.
Mhmm.
It's one of the best things that you can do with MDI. Some some people toy with adjusting if you take your basal injected insulin in the evening, not not taking it away, but reducing the amount of it. Mhmm. Yes. The whole next day is going to also be impacted by that.
But at least for the overnight time, there will be less basal insulin there.
So it's a safe decision to be made there for overnight, but you are gonna be higher the next day when you wake up.
And you may need more rapid acting with your meals or correctives between, Yeah.
Okay. And because that's also tough for people who shoot it at night because now you didn't take it. You didn't you didn't take enough at night, and you're waiting to get back to that next twenty four hour period to take it again. So you did... That next day might be more fast acting to kinda get on top of that problem.
Okay. Mhmm. And there's... Know, it's funny. I...
A New Pro Tip Series in 202739:21
Actually, that conversation made me think online that maybe it's time, like, when we made the pro tips, for example, like, AID systems really didn't exist. And I thought, like, it might
You're right.
It might really be time to either, like, rethink some of those and update them or to, I was gonna say amend them. But I honestly, I'm starting to think that maybe in 2027, you and I are gonna like make a new pro tip series that...
It's kind of funny because I actually have a note on my desk to meant to talk to you. About that?
Oh, okay. Well, then we're in the same spot.
Okay. It actually... My notes my notes says, go through pro tips episodes. Pick out those that need updating based on AID.
That's what
my notes says.
That's what... Well, listen. I'll put that on my to do list.
I'm curious if it was... I'm curious if the only ones that were out, if they even were at that point, Medtronic had suspend on low. So I wonder if that one was there. And then Tandem had Basal IQ.
Yeah. Yeah.
Right? Which had a predictive kind of nature to just suspending based on what it was kind of seeing or when blood sugar was low. But, yeah, I haven't listened to the pro tips in a
long time. It's... I haven't either, but it's gonna be, it's gonna be interesting because that's... It's a tall order because that series works so well for people. Like, we're gonna have to update it without losing its.
So whatever it is about it that helps people, like, we can't lose that in the retelling of the stuff, and we can't, like No. Retell... We'll figure it out. I mean... Yeah.
We'll figure... Well, my idea truly for considering a big portion of it may be AID specific, we could do it by doing an overview of AIDs.
Mhmm.
And then the next steps or the next episodes, in my opinion, would be each particular AID system and the pro tips within each system.
Okay. To do one for each one?
To do one for each one, I think would hold value because they are different enough and each of them holds value enough to really cover in a more in-depth rather than kind of glossing over it just as a general, this is an AID and this is what it could do.
You know? But talk about the algorithm specifically.
Yeah.
Alright. I'm in. Alright. Let's do that. We'll do that next year.
Yay.
Yeah. Alright. Well, thank you for talking about it. Two people who don't drink talking about drinking. Must be really must be really frustrating for people.
Sorry, guys. Alright. Hold on. Thanks. Yep.
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