Can I ever drink wine again?! Hypo/alcohol issues

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StephanieMLW

StephanieMLW

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Relationship to Diabetes
Type 1
Hello,

I have been diagnosed T1 since mid September this year, so am still in my ‘honeymoon period’. I’m currently taking 5 units Lantus at night, and bolus with Novorapid. Overall I feel like I’ve been doing well - my time in range on an average day according to my Libre is 90%+, but I eat low carb foods and the same breakfast and lunch each day so I think that helps!

However, I am really really struggling with alcohol. I love a glass of wine with my dinner or on a Friday night with friends, but I can’t seem to even have one now without having a horrible 24 hours to follow. I have followed all the advice I can find - only having alcohol with a meal, eating something before bed etc (my choice being wholemeal toast). I am not even consuming much alcohol at all, 2 glasses of wine max!

Yesterday I met friends for a day out and had a 125ml glass of wine at 17:00 and another 125ml glass at 19:00, with a three course meal. My low glucose alarm went off every 1-3 hours in the night from midnight to 7am, when I decided just to get up as I was getting no sleep! I was treating the lows with dextrose and orange juice overnight, which seemed to work fine, but only for an hour or so and then BG would plummet again. It’s nearly 21:30 the day after and I am still getting regular low alarms.

I am super fed up as even if I just have one wine I am paying for it for the next 24 hours, not with a hangover just with low BG! I don’t feel I can leave the house or do anything because of it. If anyone has been through this and has some tips I would greatly appreciate it. It seems I might have to give up wine for good otherwise at this rate - which is a bit of a problem for the wine tour I’m going on in New Zealand next year!!
 
Have you tried reducing your Lantus on the nights that you drink wine? I find I have to lower my basal, else I hypo. Not to such a
extremes as you are finding, but my nurse told me that for every unit of alcohol you consume, your liver doesn’t put any glucose out for an hour while it deals with breaking down the alcohol.
The other thing to consider, is whether these are genuine hypos. Have you checked them against a meter reading? Alcohol is a diuretic, and I find if I’m at all dehydrated, my Libre reads lower than normal, and can show me as hypo when I'm actually not.
 
Hi and welcome. How much are you reducing your basal insulin by with alcohol? Hypos always mean you’re having more insulin in your system than is needed.
 
Perhaps try cutting your insulin and also having some protein before going to bed 🙂
 
Thank you everyone!

I’ve not tried adjusting my insulin actually; as I’m still pretty new to this I feel a bit nervous tampering with my basal unless my nurse has told me to I assume this would be gradual - eg next time I fancy a wine with my dinner, reduce my lantus from 5 to 4 to see what happens?

I have been checking my Libre lows with a finger prick and have definitely found that sometimes they are quite off. Hadn’t thought about dehydration as part of this though, thanks for the tip @Robin. I have been trying to make sure I check them before immediately treating them to avoid a rollercoaster effect - I think again being newly diagnosed I can panic a bit and treat a ‘hypo’ straight away. Today I did notice that I seemed to have a pending hypo that then corrected itself (I had a 4.2 Libre reading with a downward arrow, but when I checked it ten mins later to see if I needed to treat it, it was 6.8 on my Libre and 7.4 with a finger prick - weird!)
 
Sorry you are having such a rough time with it @StephanieMLW :(

The crash in BGs does seem to affect some people more than others unfortunately. It may be that the honeymoon period may be exacerbating things with your pancreas ‘helping out’ when you need it least!

Lantus has a reputation for being a bit sluggish to reflect a changed dose, taking up to 3 days. It may be that Levemir might be more flexible and tweakable - as you could have separate daytime and night time doses, which would respond to adjustments straight away?
 
Thank you @everydayupsanddowns . It feels a bit silly being so bothered about not being able to have a drink, but I think when you’re trying so hard to get life back to ‘normal’ it really can make you feel like the diabetes is getting in the way when you feel you can’t do something any more!

I didn’t know that about Lantus, I will discuss Levemir with my nurse - I have a review in two weeks so I can bring it up then. Again - feels a bit silly asking my nurse about changing my insulin to accommodate alcohol, but she is always telling me our mission is to make life as normal as possible!
 
StephanieMLW said:
Again - feels a bit silly asking my nurse about changing my insulin to accommodate alcohol, but she is always telling me our mission is to make life as normal as possible!
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It's not at all silly! As you say, the idea is to try to allow us to do what we want to do, and enjoying a glass or two of wine with a meal is definitely something that you ought to be able to do.
 
Pizza is a great bedtime meal after drinking alcohol. The correct balance of carbs, protein, and fat, and it tastes great. Cheese on toast will also work. And don't take any extra insulin to cover the pizza, the food is to cover the expected night hypo. Libre will show your progress.
 
StephanieMLW said:
Thank you @everydayupsanddowns . It feels a bit silly being so bothered about not being able to have a drink, but I think when you’re trying so hard to get life back to ‘normal’ it really can make you feel like the diabetes is getting in the way when you feel you can’t do something any more!

I didn’t know that about Lantus, I will discuss Levemir with my nurse - I have a review in two weeks so I can bring it up then. Again - feels a bit silly asking my nurse about changing my insulin to accommodate alcohol, but she is always telling me our mission is to make life as normal as possible!
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Ever since being diagnosed some 40 years ago always enjoyed alcoholic drink, mostly now it's red wine & only on weekends. Doesn't have any effect on my bg, just wondering as your still in honeymoon phase that is why it's effecting you for so little drink, maybe once your out of HP things will improve.

Having been on lantus Mike is right about giving it couple of days to take effect.
 
I see you mention eating “low carb foods”. I’m not sure what you mean by this exactly or how many carbs you’d have for dinner, but I find alcohol works best with some carbs to “soak it up” (they don’t actually soak it up but they help offset the alcohol). As an example, if I were to have a glass of wine on its own during the evening I usually have some crackers or crisps with it and I find that works well.

Having such a prolonged effect is unusual though, and I think I’d start by reducing my bolus when I had dinners with wine, and possibly adding some more carbs too, either then or later in the evening. The amount you’re drinking is very moderate so things should be ok.
 
When you have a night time hypo do you have a snack once the hypo has resolved? You should be having 15g of slower release carbs from things like crackers to maintain your BG after the hypo. I didn’t see it mentioned so thought it worth checking.

It sounds like a larger late night snack is needed. Have a mix of carbs and protein so maybe some cheese with your toast and see how that goes.
 
Thank you for all your helpful responses 🙂

I do agree I must still be in the honeymoon phase - I’ve been warned strongly by my diabetes team not to get used to this and it will change!

@Thebearcametoo In terms of night time hypos I would usually treat the initial dip with dextrose or fruit pastilles…but to be very honest, I’m sometimes so exhausted I fall back to sleep and miss the 15g of slow release carbs. My Libre alarm goes off at 4.2 so I am still not entirely sure whether I need the extra carbs for that - if it goes below 3.9 though then I always do make sure to follow up with the 15g carb snack. I have found keeping a carton of orange juice by the bed for this has been helpful as I don’t have to venture down two flights of stairs to the kitchen!

@Inka by low carb, I tend to never eat more than 150g of carbs a day - not necessarily because I give myself a limit, but I just checked my MyFitnessPal and over the past couple of weeks I’m usually having 100-120g of total carbs a day (including vegetables etc). I’ve been vegan for six years so my meals are very veg and protein replacement heavy, which doesn’t always leave much room for lots else! I usually take 7-10 units of Novorapid a day. I was on 5 units of Lantus, but I’ve taken that down to 4 last week and it seems to have had a positive impact on the night time drops - I’ve had two full nights sleep!!

I actually did treat myself to 250ml of dry white wine on my birthday last week; I had this with a vegan chili, avocado, vegan cheese & Oatly sour cream. I stayed up late playing party games with my friends and went to bed at 3am (don’t judge me! ) - my sugars were a very normal 6.8 before bed and usually the big drops would have started by then, so I had a small snack (wholemeal toast) and no issues with hypos! This was since I switched my Lantus down to 4, so I’m wondering if that’s been the underlying problem all along and the wine was just tipping it over the edge?
 
It could well be the Lantus. I’m only on small amounts of basal too (I’m on a pump) and I find even tiny changes can have a surprisingly big effect. Perhaps that combined with the small amount of alcohol was enough to tip you over into hypo territory. Apart from your improved nights of sleep, it’s best to avoid hypos as much as possible not just for safety but because you’ll keep your hypo awareness sharp.

I’m glad you had a good birthday and were able to enjoy some wine 🙂
 
@Inka i was able to enjoy it thank you!

I’ve actually started to have evening hypos now - it’s all very strange. My lantus is down to 4 which seems to keep me stable overnight, so that’s great. But my new ‘thing’ is that I’m having hypos in the evening after dinner - quite nasty ones as well where I feel terrible! It’s only been happening the past week, but I’m using the 1:10 Novorapid carb ratio that I’ve used since diagnosis and I’m having hypos about 2/3 hours after dinner. No idea why this is happening, but I have my 3 month checkin with the diabetes team next week so hoping they can help me out! Maybe need to reduce my Novorapid with dinner?
 
StephanieMLW said:
@Inka i was able to enjoy it thank you!

I’ve actually started to have evening hypos now - it’s all very strange. My lantus is down to 4 which seems to keep me stable overnight, so that’s great. But my new ‘thing’ is that I’m having hypos in the evening after dinner - quite nasty ones as well where I feel terrible! It’s only been happening the past week, but I’m using the 1:10 Novorapid carb ratio that I’ve used since diagnosis and I’m having hypos about 2/3 hours after dinner. No idea why this is happening, but I have my 3 month checkin with the diabetes team next week so hoping they can help me out! Maybe need to reduce my Novorapid with dinner?
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Change your carb ratio 🙂
Rule of thumb is if you go low 2 hours after a meal then look at your carb ratio. There's no law that says you have to have a 1:10 ratio. Mine is 1:16 for some parts of the day. You also do not have to have the same ratio for every meal. 🙂
 
StephanieMLW said:
Brilliant, thank you @Pumper_Sue ! I did read about this and was wondering whether I should try a 1:12 for dinner and see if that helps.
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You are more than welcome 🙂 if you are too high after 2 hours then try 1:11
Diabetes is very frustrating at times, isn't it? You will get there though so have faith in yourself and make your changes one at a time see what happens then adjust as needed.
 
It took me a while to get the confidence to adjust my insulin, but the libre will see you right. You don't need to do down under 4 to treat a possible hypo..i find half a dextrose when going into the 4s can head one off quite nicely. I find low carb is good because if you take correspondingly low insulin it means that you are playing for 'low stakes'...harder to go wrong with 2 units of mealtime insulin than, say, 10.
Props for getting back on the booze, i've been T1 for nearly a year and i'm too nesh to reintroduce alcohol. I have my libre set to alarm at 4.5 which works for me, but you could set it higher for earlier warning, up to you.
 
This happened about a year after I started insulin:
One evening I had a couple of pints of beer, which usually would be no big deal, but I suddenly felt a bit hypo, stumbled half way down the stairs, slid against the bannister and broke my lower jaw. It could have been worse, I could have broke my neck.
I still allow alcohol for special occasions and weddings, etc, but I always eat more than enough to cover any potential lows.
 
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