Hittin’ the sauce when your pancreas is off…
One of the most frequent questions I get from readers and other people with diabetes is “what are the effects alcohol has on me and my diabetes?,” and this question is more pertinent than ever with the holidays in full swing and New Year’s Eve creepin’ closer. I could offer my personal experiences and opinion all day long, but none of it would be founded in science. Luckily, my boyfriend happens to be a Yale-trained physician assistant, which means he’s got the scientific know-how to break down exactly what goes on when you hit the sauce this season. Check out his guest post below for the deets, and (obligatory disclaimer) please remember that nothing on this blog can sub for medical advice from your doctor. You should always consult your physician before changing your diabetes regimen.
Hittin’ the Sauce When Your Pancreas is Off
by Jacob Hauptman, PA-C
Yale University School of Medicine
Master of Medical Science, 2007
As we approach one of the most alcohol-laden seasons in the United States, it might help to have some inside information on the interaction between alcohol and diabetes before strapping on your drinking shoes.
First, a quick review of the effects of that bite of Auntie May’s famous holiday cake in people with diabetes, just so we’re all on the same physiology page:
Type I- the glucose levels in the bloodstream rise, however lacking the insulin-producing beta cells in the pancreas. So, an outside source of insulin (either that basal or bolus dose you give yourself) is required to help glucose enter cells, promote glycogen formation (a form of stored, quick energy for your body), and inhibit gluconeogenesis (the body’s way of recycling products in the blood to form even more glucose).
Type II-the glucose load enters the bloodstream, but to varying degrees the cells have decreased their insulin receptors and become insulin resistant. The beta cells in the pancreas produce insulin, however the glucose levels in the blood remain elevated because of the resistance to normal quantities of insulin. Medications to stimulate more insulin production from the pancreas and to increase the insulin sensitivity of cells are among the standard methods to help the glucose move out of the bloodstream.
Now, on to what those cocktails are doing to you and your diabetes:
For type II diabetics that sip that glass of their favorite alcoholic beverage, the results are…
-alcohol increases insulin sensitivity: target cells are more receptive to the effects of insulin, making it easier for glucose to enter and supply energy. This leads to decreased insulin levels in the blood overall as less is needed to achieve the same blood glucose levels (1). Through this process, alcohol has been associated with a decreased risk for development of diabetes (2).
-alcohol decreases fasting blood sugar: lower fasting blood sugars (up to 20mg/dl) have been documented as well as improved postprandial blood sugars (3,4). Over time this could translate into a lower hemoglobin A1c (5).
-alcohol may decrease risk of coronary artery disease (CAD): the risk of death due to CAD was shown to be lower in older diabetic individuals who consumed alcohol(6).
But wait, these findings are not a license to burn through the whole bottle of red wine night after night, because, as with most of the favorable effects of alcohol, only small amounts are needed. One drink per night provided the maximal benefits. In absence of moderation, there is a decrease in the beneficial effects (2).
In both type I & II people with diabetes…
-alcohol could lead to higher adiponectin levels – this is a hormone produced by fat cells which has been shown to improve insulin sensitivity (7).
-alcohol inhibits gluconeogenesis- this can lead to lower blood glucose levels in general.
Before you start thinking “what’s not to like about alcohol and diabetes?” you should know that some effects can be negative, as shown in research of type I diabetics where…
-alcohol may increase the risk for delayed hypoglycemia: as mentioned earlier, alcohol affects the sensitivity of cells to insulin, which may be a problem if a type I diabetic doses a standard amount of insulin in the setting of alcohol intake (4). Also among other reasons, there might be a decreased ability of the intoxicated diabetic to recognize a hypoglycemic episode. (8)
Regardless if you’re a type I or type II diabetic, alcohol can be a scrumptious and healthy addition to the holidays and beyond. However, before kick’n back that bottle of Jack with Grandpa Joe, remember moderation is the key.
Bibliography
1)Kiechl, S, Willeit, J, Poewe, W, et al. Insulin sensitivity and regular alcohol consumption: Large, prospective, cross
sectional population study (Bruneck study). BMJ 1996; 313:1040.
2) Koppes, LL, Dekker, JM, Hendriks, HF, et al. Moderate alcohol consumption lowers the risk of type 2 diabetes: a
meta-analysis of prospective observational studies. Diabetes Care 2005; 28:719.
3) Shai, I, Wainstein, J, Harman-Boehm, I, et al. Glycemic effects of moderate alcohol intake among patients with type
2 diabetes: a multicenter, randomized, clinical intervention trial. Diabetes Care 2007; 30:3011.
4) Brand-Miller, JC, Fatima, K, Middlemiss, C, et al. Effect of alcoholic beverages on postprandial glycemia and
insulinemia in lean, young, healthy adults. Am J Clin Nutr 2007; 85:1545.
5) Ahmed, Ameena T., Andrew J. Karter, E. Margaret Warton et al. The Relationship Between Alcohol Consumption
and Glycemic Control Among Patients with Diabetes: The Kaiser Permanente Northern California Diabetes
Registry, J Gen Intern Med 23(3):275–82
6) Valmadrid, CT, Klein, R, Moss, SE, et al. Alcohol intake and the risk of coronary heart disease mortality in persons
with older-onset diabetes mellitus. JAMA 1999; 282:239.
7) Pischon, T, Girman, CJ, Rifai, N, et al. Association between dietary factors and plasma adiponectin concentrations in
men. Am J Clin Nutr 2005; 81:780.
Richardson, T, Weiss, M, Thomas, P, Kerr, D. Day after the night before: influence of evening alcohol on risk of
hypoglycemia in patients with type 1 diabetes. Diabetes Care 2005; 28:1801
Did you enjoy this post? Why not leave a comment below and continue the conversation, or subscribe to my feed and get articles like this delivered automatically to your feed reader.
So after not drinking any EtOh for 28 years, now I learn it would be better for T2 betes to take a glass of wine with dinner?!?!?! Thanks Jacob, for a well researched blog entry. Love the links to the references as well – especially how the emoticon turned reference #8 into smiling sunglasses