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Tuesday, December 10, 2013
Alcohol and Diabetes
HOW DOES ALCOHOL AFFECT A DIABETIC?
This is another one of those seemingly simple questions that has many different implications. I will try to address this in an orderly manner. We will discuss how alcohol affects blood sugar control, how alcohol may affect complications of diabetes, both negatively and positively, how alcohol can be involved in causing diabetes, and finally how to come to a practical conclusion about individual alcohol use in the person with diabetes.
Alcohol ingested usually in the form of wine, beer or distilled spirits interacts with several of the same mechanisms involved in sugar production and metabolism in people. First, it represents a source of calories. One concern is that excessive intake of alcohol contributes to weight gain and that may worsen blood sugar control. It may also indirectly reduce the ingestion of other nutrients. Depending on the net balance of the diet, alcohol may be detrimental to health in general and may cause the blood sugar to run either higher or lower at different times. Alcohol can interfere with the mechanisms that work to release glucose into the bloodstream that protect against low blood sugar. Hence, alcohol can worsen the risk of experiencing hypoglycemia.
Alcohol is associated with certain forms of peripheral nerve damage or neuropathy. It can manifest as numbness and tingling or pain in the legs or arms. Diabetes can be associated with the same kinds of neuropathy. I am not aware of studies that look at the combined effects of both alcohol and diabetes on neuropathy but it is hard to imagine that it would be any better than either alone. The same can be said about erectile dysfunction in men with either diabetes or excessive alcohol use or both.
There are intriguing studies that suggest that people from countries with a routine small wine intake every day have a reduced risk of heart disease. These studies are controversial and nobody knows whether it is the alcohol itself or something specific to the types of wine used which confers the effect.
Under circumstances of excessive alcohol intake for prolonged periods of time, alcohol can lead to damage to certain parts of the pancreas. Initially, the damage done by this pancreatitis affects the "exocrine" pancreas which produces enzymes released into the pancreatic duct and then into the intestine which are necessary for digestion of food. In extreme and prolonged pancreatitis, the inflammation destroys not only the cells producing the digestive enzymes but also the so-called "endocrine cells" which produce the hormone insulin. It is rare but possible to develop diabetes as a result of this process. Some people can develop pancreatitis for reasons other than alcohol and those people are also at risk for developing diabetes.
How should you take all this into account in making your own decision whether to drink alcohol and how much to drink? If you are pregnant, have liver disease, have a lipid (blood fats)condition which is very sensitive to alcohol, have problems preventing hypoglycemia, have neuropathy or erectile dysfunction, or require a drug which should not be taken with alcohol, those would all be among the reasons to restrict alcohol intake. For many people with diabetes, it should be possible to enjoy prudent amounts of alcohol and maintain reasonable blood sugar control. Prudent is hard to define. The wine studies are based on 1-2 glasses of wine per day. My own arbitrary definition of prudent (not sanctioned by any organization) is four drinks per week, with a maximum of two in any day. Because people with type 1 diabetes may be signficantly more brittle, they may in general have greater difficulties with blood sugar control after alcohol ingestion than people with type 2 diabetes.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati