Alcohol and Insulin

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sharp00782

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Hi All,

Just wondered how you guys cope with this. According to DAFNE, a pint of lager is roughly 1 carbohydrate portion (10g). So, if you were going on a night out and planning on having 7 or 8 pints (more than is advised I know but if we all give up what we enjoy we may as well just give up), generally speaking that 7 or 8 units of insluin in total.

My quesiton is this. When would you take the units of insulin? My blood spikes after the first 2 pints even if I take 4 units in advance with the first pint. Would you have 1 unit per drink or what do you think is best?

Also, at the end of the night, generally would have a doner kebab wrap. Would you even take insulin for this as alcohol will drop the BG, or maybe take half the dose for the carbs in that?

Thanks in advance.
 
I think DAFNE needs to go on a carb counting course 😎
Unless “she“ is drinking very watered down lager.

I find most beer is closer to 20g carbs per pint.

However, maybe the DAFNE course is suggesting counting it as 10g because of the lowering effect of alcohol on our BG overnight as our liver focuses on getting rid of the alcoholic toxin instead of dripping glucose.

As with most things diabetes related, we are all different. There is no way I would be standing after 7 or 8 pints - 3 pints is a lot for me and I drink half pints without knowing how many I rounds I am going to have when I start.
I will bolus for my drinks as they are ordered at 10g carbs per half and only for the first 2 pints (4 halves). After that, the BG lowering affects of alcohol will take over so I will take no more insulin for future beers.
I will also lower my basal insulin. As I use an insulin pump, i can do this at any time but when I was injecting, I would take my basal before I went to bed (which may be later than usual if I was out … I did not take it religiously every 24 hours) and would reduce it by about 10% if I had been drinking.
As I reduced my basal, I would bolus normally for any post drinking munchies but if you are concerned, you could have the diner without the bread and not need the insulin.

As I mentioned, we are all different so you may need insulin for more pints as I guess your body is used to more beer than mine. But you will need some trial and error to work out what you need and when. It might be a good idea to build up to the 7 or 8 pints until your have learnt how your body reacts.
 
Can's or bottles of Holstein Pils might suit better than pints, the advert at the time said all the sugar turns to alcohol if i remember correctly 😉 good reason to practise at home first 🙂
 
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What do you find happens after the first couple of pints?

If I go out for a pint or two which doesn't require me to walk miles around town and then go dancing and then walk home (rare these days!), then I would need to take sufficient bolus to cover the carbs (say 4U for a couple of pints.)

I went for after-work drinks and a pub quiz last week. I had 4 pints (pale ale) and a small glass of wine, I took no bolus at all (no supper either) and my BG stayed below 6 for the whole evening (I did have some active bolus on board when I started drinking from a post-lunch correction) and it was only when I eventually got home (late bus) that my BG started to rise and I took a small correction dose before bed - but I shouldn't have bothered as I then ran low overnight. I did quite a bit of walking into and around town though (~7 miles), no dancing! 🙂

I think I'd err on the side of not taking too much - perhaps enough for the first couple of pints, then see what the CGM says and only treat if going high quickly (which I have found in the past with cider). I'd definitely not bolus for the kebab unless I was actually high, and then I'd probably only take 1/3 of the dose or less, because of the long tail and potential to go low overnight.
 
Before my amputation and the constant painkillers for phantom pain meaning no alcohol I often had a pint or two or three. Although I tried other beers I found with Guinness that a couple of pints needed a packet of crisps to balance the BG lowering effect. In the 60's my exchange list said half-a-pint was 10gm CHO. At 14 I discovered this was nonsense. I got away with drinking pints as I was pretty tall (in fact today a physio said I was super-tall although some of today's youngsters make me feel short!) My father was asked if I was underage in one pub and he said "Michael isn't, he just looks young!".
 
One thing to keep in mind is the after effects the following day. My favourite tipple these days is dry red wine. Doesn’t require any insulin at the time, but I have learned to reduce my morning insulin to avoid low blood sugar after breakfast. Sometimes, blood sugar the following day can drop in the morning and stay persistently low for some hours. Other’s mileage may vary, but that’s what I have observed over the past few years.
 
SimonP said:
What do you find happens after the first couple of pints?

If I go out for a pint or two which doesn't require me to walk miles around town and then go dancing and then walk home (rare these days!), then I would need to take sufficient bolus to cover the carbs (say 4U for a couple of pints.)

I went for after-work drinks and a pub quiz last week. I had 4 pints (pale ale) and a small glass of wine, I took no bolus at all (no supper either) and my BG stayed below 6 for the whole evening (I did have some active bolus on board when I started drinking from a post-lunch correction) and it was only when I eventually got home (late bus) that my BG started to rise and I took a small correction dose before bed - but I shouldn't have bothered as I then ran low overnight. I did quite a bit of walking into and around town though (~7 miles), no dancing! 🙂

I think I'd err on the side of not taking too much - perhaps enough for the first couple of pints, then see what the CGM says and only treat if going high quickly (which I have found in the past with cider). I'd definitely not bolus for the kebab unless I was actually high, and then I'd probably only take 1/3 of the dose or less, because of the long tail and potential to go low overnight.
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Hi Simon,

This is where I seem to differ. If I do have say 8 beers on a Friday night, if I take 4 units of novorapid when I start drinking (and even with this, after 2 pints I guarantee I will be at 10-11mmol), then 4 more units and continue, my blood will then lower to around 5 and then start to rise again. Then I will bolus for my kebab or whatever I am having, and most of the time, I will NOT go low, but will stay at like 12-15 all night when in bed!

I asked my question based on what I have read online and not my previous experience as utilising the method in my original question, is far less insulin than I currently take so can only assume using that method I would be even higher than 12-15 all night when in bed.
 
It shows everyone can be quite different.

Drinking ales, I find a pint of jail ale will rapidly increase my BG so I’d bolus for 1.5 to 2 (at the moment cause I’m not doing as much sport as usual) and usually not that far in advance. Then I’d bolus 1.5 or so for each pint. I’d also bolus for food post drinking as well but maybe 75% of norm. For basal, I take a reduced amount or not really ideal no basal at all (which typically worked out for me). I’d more than likely be high but not hypo’ing which I’d accept for an odd night of a decent drink.

Having said all that I’d rather and do drink dry white wine now as it’s so much less hassle with carb counting.
 
I think the BG-lowering effect of alcohol does seem to vary between people. I have known people with T1 who have to be really careful around alcohol. and actually eat additional carbs to stave off the risk of hypoglycaemia.

Actually this was something one of my first DSNs suggested I did, but I soon found that resulted in higher levels than I wanted.

I never bolused for beers, ales or lagers while on injections, and jly started cautiously when on an insulin pump, because I could dose in such small amounts.

Like @helli I find I have to deliberately underestimate the carbs in ales to avoid going low. And only dose anything at all for the first 2 pints, by which time I’m usually slowing down.

Do make sure you give your liver a breather @sharp00782 every now and then. I think the recommendation is 2 days a week without, and to spread your allowance out rather than splurging it all in one session?
 
Thinking about it, it's quite hard to differentiate between the effect of the alcohol and the effect of the exercise (of being on a night out.)

While my 4 pints + walking around Bath last week did mean I didn't need any insulin, thinking about it and consulting with Tidepool, I can see that the previous time I had ~4 pints (again of ale) was on New Year's Eve (at a party at a friend's house - no exercise involved aside from walking to the fridge.)

I logged 80g CHO for supper (and I was high when I ate) and I took a total of 20U of Novorapid over the course of the evening (which is probably twice what I'd expect for the food, though I'd need a bit more for a correction as I started high.)

I did go slightly low overnight though (but only needed 5g's worth of Skittles.) So it appears that I do still need some insulin to cover beer if I'm not very active. Quite whether the going low overnight was due to overcorrection or alcohol I don't know.
 
everydayupsanddowns said:
I think the BG-lowering effect of alcohol does seem to vary between people. I have known people with T1 who have to be really careful around alcohol. and actually eat additional carbs to stave off the risk of hypoglycaemia.

Actually this was something one of my first DSNs suggested I did, but I soon found that resulted in higher levels than I wanted.

I never bolused for beers, ales or lagers while on injections, and jly started cautiously when on an insulin pump, because I could dose in such small amounts.

Like @helli I find I have to deliberately underestimate the carbs in ales to avoid going low. And only dose anything at all for the first 2 pints, by which time I’m usually slowing down.

Do make sure you give your liver a breather @sharp00782 every now and then. I think the recommendation is 2 days a week without, and to spread your allowance out rather than splurging it all in one session?
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I completely understand what you are saying in relation to the days off. I actually dont drink at all Monday - Thursday so it is very much a weekend thing. I was only diagnosed in August 2022 and I guess old habits die hard! Plus, in all honesty, I have given so many things up becuase of this "life sentence" I kind of refuse to give that up. I have the mentality if I give up everything I enjoy, I may as well give up on life lol.

I am aware of repurcussions in the future but one thing this has taught me is to enjoy life as much as possible as it is very short, and possibly shorter becuase of T1! Cynical perhaps, but that is just how I feel about it mate.
 
SimonP said:
Thinking about it, it's quite hard to differentiate between the effect of the alcohol and the effect of the exercise (of being on a night out.)

While my 4 pints + walking around Bath last week did mean I didn't need any insulin, thinking about it and consulting with Tidepool, I can see that the previous time I had ~4 pints (again of ale) was on New Year's Eve (at a party at a friend's house - no exercise involved aside from walking to the fridge.)

I logged 80g CHO for supper (and I was high when I ate) and I took a total of 20U of Novorapid over the course of the evening (which is probably twice what I'd expect for the food, though I'd need a bit more for a correction as I started high.)

I did go slightly low overnight though (but only needed 5g's worth of Skittles.) So it appears that I do still need some insulin to cover beer if I'm not very active. Quite whether the going low overnight was due to overcorrection or alcohol I don't know.
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It is crazy how it affects different people in massively different ways! Whether I will ever get my head around it, god knows. I am still in range 84% over last 7 days, 80% over last 14 and 83% over last 90 I suppose it isnt all doom and gloom, and that is with the highs a very beers can bring from time to time.
 
littlevoice359 said:
One thing to keep in mind is the after effects the following day. My favourite tipple these days is dry red wine. Doesn’t require any insulin at the time, but I have learned to reduce my morning insulin to avoid low blood sugar after breakfast. Sometimes, blood sugar the following day can drop in the morning and stay persistently low for some hours. Other’s mileage may vary, but that’s what I have observed over the past few years.
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Thanks for this. Again, I never have an isse the following day! Most bizarre.
 
SimonP said:
Thinking about it, it's quite hard to differentiate between the effect of the alcohol and the effect of the exercise (of being on a night out.)
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I occasionally have a couple of pints of beer and a short (Plus a few bags of crisps), and find that a walk home from the pub afterwards send BG down into the low 3s. I thought it was the exercise, but when I wore a sensor I saw that BG hits a peak (Around 8) and then suddenly falls right down before leaving the pub.
 
Do you think that's the alcohol or the expectation of exercise? I find knowing that I'm about to go and do something can make my blood sugar drop (or at least plateau/not rise as quickly as I'd expect for a pre-exercise snack/meal) - I really have to believe that I'm about to do something active though, so it's not a magic get-out-of-exercising trick!

There's doubtless some literature about how quickly/at what concentration alcohol prevents glycogenolysis, I'll do some digging. Probably for a different thread, but I also wonder if anyone else gets a BG drop before they actually do any exercise.
 
sharp00782 said:
Hi All,

Just wondered how you guys cope with this. According to DAFNE, a pint of lager is roughly 1 carbohydrate portion (10g). So, if you were going on a night out and planning on having 7 or 8 pints (more than is advised I know but if we all give up what we enjoy we may as well just give up), generally speaking that 7 or 8 units of insluin in total.

My quesiton is this. When would you take the units of insulin? My blood spikes after the first 2 pints even if I take 4 units in advance with the first pint. Would you have 1 unit per drink or what do you think is best?

Also, at the end of the night, generally would have a doner kebab wrap. Would you even take insulin for this as alcohol will drop the BG, or maybe take half the dose for the carbs in that?

Thanks in advance.
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The reason why it still spikes after 2 pints even if you take 4 units of insulin rather than two if that the alcohol itself is an issue, not just the carbohydrates. Even if you were to drink vodka (which has 0 carbs), you can still get a spike.
Alcohol is very unpredictable and can cause your blood sugar to go way up or way down.

I wouldn't necessarily advise this as I am by no means an expert, but when I drank like that I'd take my blood sugar readings at the end of the night (maybe like 30 mins after your kebab) and take insulin according to the result. Usually I find taking 1 unit for every 2 numbers you need it to go down works well. For example, if my blood sugar was 19, I would take 5 units to get it down to (below 10) 9ish.
 
Austin_98 said:
Usually I find taking 1 unit for every 2 numbers you need it to go down works well. For example, if my blood sugar was 19, I would take 5 units to get it down to (below 10) 9ish.
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Correction ratios vary a lot from person to person.

1u:2mmol/L is quite a strong one. Mine is more like 1:4 (so I’d only want 2u or so for that correction). Plus my corrections sometimes seem extra lively at night, so I opt for 1:6mmol/L at night time to be on the safe side.

Individual variation is one of the reasons why suggesting doses is very tricky on the forum 🙂
 
everydayupsanddowns said:
Correction ratios vary a lot from person to person.

1u:2mmol/L is quite a strong one. Mine is more like 1:4 (so I’d only want 2u or so for that correction). Plus my corrections sometimes seem extra lively at night, so I opt for 1:6mmol/L at night time to be on the safe side.

Individual variation is one of the reasons why suggesting doses is very tricky on the forum 🙂
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That's why I added that I was by no means an expert and didn't recommend it lol. It's just what I personally did in that situation.
Why IS it that corrective insulin has such a bigger impact on some people than others?
 
Austin_98 said:
Why IS it that corrective insulin has such a bigger impact on some people than others?
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It can be something as simple as how physically large or small someone is, but there are a host of other factors too… including genes, muscle mass, and just good old fashioned diabetes randomness! 🙂
 
everydayupsanddowns said:
It can be something as simple as how physically large or small someone is, but there are a host of other factors too… including genes, muscle mass, and just good old fashioned diabetes randomness! 🙂
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And what colour socks you are wearing 😛
 
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