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Excessive Alcohol Consumption Leads To Hypoglycemia In Diabetics
ABSTRACT It has been hypothesized for a long time that drinking
excessive alcohol can lead to decreased blood glucose levels in
diabetics, resulting in the condition called hypoglycemia, which
if not managed properly can severely impair human health and
well being. This present paper explores this hypothesis and
provides information on its validity and proposes ways to better
manage diabetes and hypoglycemia.
INTRODUCTION Hypoglycemia, also called low blood sugar occurs
when blood glucose levels drops too low to provide the body with
enough energy for normal bodily activities. Hypoglycemia can
result from medications, diseases, hormone or enzyme
deficiencies or tumors, but this particular treatise deals
specifically with hypoglycemia as a consequence of excessive
alcohol consumption. Hypoglycemia often occurs as a side effect
and often complicates diabetes because diabetics are unable to
properly regulate their blood glucose levels. According to the
American Diabetic Association, diabetes and its complications
including hypoglycemia is the sixth leading cause of death in
United States, affecting 18.2 million people. In Trinidad,
according to the Central Statistical Office, diabetes is the
second leading cause of death and the disease affects 1306
people each year. Diabetes and its complications, hypoglycemia
exerts a tremendous economic burden on economies worldwide, for
example in the United States $132 billion is spent in treatment
of diabetes and its complications each year. For Trinidad and
the rest of the Caribbean the economic burden is most severe,
but documentation of actual figures are lacking. It is however
reflected in the high death rates and unavailability to
healthcare institutions and inability of these healthcare
institutions to actually provide adequate care due to limited
resources.
There are basically two types of diabetes: Type 1 diabetes where
no insulin is produced and Type 2 where some insulin is produced
but it is ineffective. Type 2 diabetes is rapidly becoming more
common. It is commonly believed that even though diabetes is not
immediately life threatening the long term effects of
fluctuating high blood sugar and low blood sugar levels can put
severe strain on major organs and organ systems such as the
eyes, nerves, and the heart, which if not controlled may lead to
premature death and disability. It is now estimated that 2 in
every 100 people have diabetes and half of these people do not
know that they have the disease condition.
Sugar in the form of glucose is the main form of fuel utilized
by all cells in the body. The brain is very sensitive to glucose
fluctuations and even brief periods of low glucose can cause
brain damage. Glucose in the body comes from three sources,
namely food, synthesis in the body and breakdown of glycogen.
Blood glucose levels are maintained at a constant level in the
body (70-110 mg/dL). This is achieved through the action of
hormones; insulin and glucagon. Insulin and glucagon are
secreted by the pancreas and they operate in an antagonistic
manner to regulate blood glucose levels. Insulin lowers the
blood glucose concentration in the blood and glucagon raises it.
Because maintaining blood glucose sugar levels is of extreme
importance for maintaining bodily functions, there are also
other hormones released from the adrenal and pituitary glands to
support glucagon's function. Research has shown that alcohol
disrupts the delicate balance between glucose building-up
hormone e.g. insulin and glucose breaking down hormones e.g.
glucagon, adrenal and pituitary hormones that serve to maintain
a constant level of blood glucose in the body.
In acute alcoholism, the body experiences difficulty in making
glucose because it is expending energy breaking down alcohol. In
addition alcoholics who do not eat when consuming alcohol, the
glycogen stored in the liver is used up within a few hours. Both
of these effects of alcohol can result in severe hypoglycemia in
6 to 36 hours after a binge drinking episode. In chronic
alcoholism, the effects of alcohol on blood glucose levels may
be reversed, when compared to blood glucose levels in diabetics.
Consuming alcohol occasionally may cause blood glucose levels to
increase initially and may result in hyperglycemia or increased
blood glucose and then decrease. Both hypoglycemia and
hyperglycemia episodes are common. Increased frequency of
alcohol consumption can reduce the body's sensitivity towards
insulin and
cause glucose intolerance in both healthy
individuals and alcoholics. This can aggravate and cause further
degeneration of liver function resulting in cirrhosis in
susceptible individuals. Research has shown that 45-70 % of
patients who have cirrhosis or alcoholic liver disease are
diabetic. Treatment of diabetes can only be achieved by strict
control of blood glucose levels, which is achieved through the
use of drugs/medications, diet and exercise.
PREVENTION AND/OR TREATMENT OF HYPOGLYCEMIA 1. Avoid the use of
alcoholic beverages. If alcohol is consumed it must be done
sparingly and must not exceed more than one drink per day or not
more than two drinks per week. A suggested rule of thumb may be:
12 oz bottle/can beer or wine or 1-5 oz glass
wine or 1.5 oz 80 % proof distilled spirits Drinking on
an empty stomach can cause hypoglycemia a day or two later. It
is always important to have a snack or meal at the same time.
2. Adopt, implement and manage a proper diabetic plan. This can
be done with the assistance of a competent healthcare provider
that may involve administering the right medication at the
appropriate concentration when necessary. It may also involve
eating regular meals and having enough food at each meal every 3
h. It is important not to skip meals.
3. If you think your blood glucose is too low, use a reliable,
calibrated blood glucose meter to check the level of blood
glucose in the blood. If it is 70 mg/dL or below immediate
action is necessary to prevent complications such as hunger,
nervousness, shakiness, perspiration, dizziness, sleepiness,
confusion, difficulty speaking, feeling anxious or weak,
collapse, shock, coma that may eventually lead to death if not
treated urgently. Some "quick fix" foods that may cause the
blood glucose to return to normal levels include: 2 or
3 glucose tablets ˝ cup of any fruit juice or fruit
nectar ˝ cup of soft drink 1 cup of milk
1 or 2 teaspoons of sugar or honey
For patients who are unable to swallow, it may be necessary for
a physician or healthcare provider to administer 1.0 mg glucagon
subcutaneanously or intramuscularly.
4. Exercise regularly. Before doing any kind of exercise check
your blood glucose level and healthcare provider. People who
have diabetes should have the following average blood glucose
levels: (i) blood glucose levels before meals at 90-130 mg/dL
(ii) 1-2 h after a meal, less than 180 mg/dL; (iii)
hypoglycemia, 70 mg/dL or below.
5. Eat a variety of foods which should include meat, poultry,
fish, non-meat sources of protein, starchy foods such as
whole-grain bread, rice, potatoes, fruits, vegetables and dairy
products. Choose high fiber foods. Avoid or limit foods high in
sugar, especially on an empty stomach.
6. Patients and family members should be made aware of signs and
symptoms of hypoglycemia and know how to treat it.
REFERENCES American Diabetic Association, Center for Disease
Control and Prevention. (Web site: www.cdc.gov/diabetes).
Carroll P, Matz R. Uncontrolled diabetes in adults. Diabetes
Care. 1983;6:579-585. Casparie AF, Elzing LD. Severe
hypoglycemia in diabetic patients. Diabetes Care.
1985;8:141-145. Central Statistical Office. Port of Spain.
Trinidad (Web site: www.cso.gov.tt) Consensus statement of
self-monitoring of blood glucose. Diabetes Care. 1987;10:95-99.
The DCCT Research Group. Diabetes Control and Complications
Trial (DCCT): results of feasibility study. Diabetes Care.
1987;10:1-19. Foster DW, McGarry JD. The metabolic derangements
and treatment of diabetic ketoacidosis. New England Journal of
Medicine. 1983;309:159-169. Keller U. Diabetic ketoacidosis:
current views on pathogenesis and treatment. Diabetologia.
1986;29:71-77. Kitabchi AE, Matteri R, Murphy MB. Optimal
insulin delivery in diabetic ketoacidosis and hyperglycemic,
hyperosmolar nonketotic coma. Diabetes Care. 1982;5(suppl
1):78-87. Physician's Guide to Insulin-Dependent (Type I)
Diabetes: Diagnosis and Treatment. Alexandria, Virginia:
American Diabetes Association, 1988. Physician's Guide to
Non-Insulin-Dependent (Type II) Diabetes: Diagnosis and
Treatment. 2nd ed. Alexandria, Virginia: American Diabetes
Association, 1988.
About the author:
Dr Deryck D. Pattron is an author, researcher and public health
scientist, in the Ministry of Health, Trinidad.
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