Essential advice for people with diabetes from Accu-Chek Alcohol

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1 Essential advice for people with diabetes from Accu-Chek Alcohol and diabetes

2 The impact of alcohol on blood glucose If I have diabetes does that mean I can t have a drink? Enjoying the occasional drink should not be a problem for a person with diabetes but if you do choose to consume alcohol, ideally do so in moderation as it interacts with blood glucose regulation. Alongside the everyday effects of alcohol, there are a number of specific effects which you should be aware of as someone with diabetes. Whilst the carbohydrate content of an alcoholic drink leads to an increase in blood glucose (sugar) level, the alcohol contained in the drink has the opposite effect; four to six hours, sometimes longer, after consumption of alcohol it will inhibit the release of glucose from the liver. Having diabetes doesn t mean that you can t drink sensibly and manage your blood glucose. After consumption of alcohol, the lack of glucose provided by the liver can lead to hypoglycaemia in people who are on insulin or oral glucose lowering medication like a sulfonylurea. The duration of the blood glucose lowering effect of alcohol depends on the units of alcohol drunk and any food consumed with it and is often difficult to predict.

3 The impact of alcohol on blood glucose TOP TIPS It is a good idea to eat something containing carbohydrates during and after drinking to limit the effects of a potential hypo Keep some fast-acting carbohydrates with you at all times in case you need them in a hurry. Glucose tabs or other fast-acting carbohydrates are a good option If you are going on a night out, it is highly recommended you make sure a friend you are out with knows you have diabetes in case anything happens To avoid any confusion or if in doubt, test your blood glucose level regularly. Blood glucose levels can take 24 hours to settle down after drinking and this can be confusing. You may experience a high blood glucose level initially but this is likely to fall during the following hours when you are at increased risk of hypoglycaemia as a result of the glucose-inhibiting effects of alcohol on your liver. Frequent blood glucose monitoring is recommended, as is not over reacting to a high blood glucose level in the few hours after drinking alcohol. Remember to check your blood glucose before you go to sleep and take any required actions to avoid hypos whilst you sleep. As well as the usual effects of alcohol, such as drunkenness and reduced awareness, it can be difficult to keep track of whether you have done a blood glucose test or exactly how many units of alcohol you have drunk. The feeling of being drunk or intoxicated may have similarities to the symptoms you experience when you are hypoglycaemic.

4 Risks, reality... Drinking to excess over short periods of time or binge drinking is a trend sometimes associated with young adults; however there is an increased risk associated with this behaviour if you have type 1 diabetes. This is not to say that you cannot drink at all, you just need to be more careful than your peers without diabetes, something equally true for older people with type 1 diabetes and people with type 2 diabetes. Having type 2 diabetes and gaining weight or even being overweight makes it more difficult to control your blood glucose. Where you think weight may be an issue for you, reducing the amount of alcohol you consume may be a helpful step to manage your weight. It is important that everyone gets the chance to enjoy themselves and have a good time. However, you should always be sensible, particularly when going on big nights out, by being aware of the risks of hypos and the need to have snacks/food instantly available. Remember that alcohol can reduce your blood glucose level but so can physical activities like dancing.

5 ...and recommendations The NHS recommends that * : Men should not regularly drink more than 3 4 units of alcohol per day These recommendations, not specifically aimed at people with diabetes, mean that men should drink no more than 28 units a week and that women should drink no more than 21 units. Women should not regularly drink more than 2 3 units per day If you have had a heavy drinking session, avoid alcohol for 2 days *

6 ...and further recommendations The Government s healthcare regulator NICE provides the following advice for people with both type 1 and type 2 diabetes: Type 1 diabetes * Young people with type 1 diabetes should be told about the risks of alcohol on blood glucose control, particularly the risks of nocturnal hypoglycaemia. Alcohol education programmes should be offered to young people with type 1 diabetes ask your health care professional if there is a programme in your area. Type 2 diabetes People should receive individualised recommendations for their alcohol intake and reducing the risk of hypoglycaemia when taking insulin or oral medication stimulating insulin release like a sulfonylurea. Please speak to your diabetes specialist team. Young people with type 1 diabetes who drink alcohol should eat carbohydrates before and after drinking and need to be careful to monitor their blood glucose regularly and to eat carbohydratecontaining food to keep their blood glucose within recommended ranges. Young people with type 1 diabetes and their families should be informed that when alcohol causes or contributes to a hypoglycaemia, glucagon may be ineffective at treating the hypo and intravenous glucose will be required. * The advice is similar for adults where information on the effect of different alcohol containing drinks on blood glucose excursions and calorie intake is recommended as well as the interaction of physical activity and alcohol. Information from: Diagnosis and management of type 1 diabetes in children, young people and adults, NICE clinical guideline 15 and The management of type 2 diabetes, NICE clinical guideline 87

7 Where to look for carbohydrates You may be well practiced at looking for the carbohydrate content of foods and drinks. Whilst alcohol units are commonly labelled on drinks, it is rare to find the carbohydrate content. It can be useful to think about what you will be drinking and to look up the carbohydrate and alcohol content on the relevant manufacturers website before you go out. The amount of carbohydrates in different types of alcoholic drinks can vary considerably. For example, there is more than double the carbohydrate content in a pint of ale compared with a pint of lager. If you are looking for a low carbohydrate option rather than the higher carbohydrate options dry wine or extra dry sparkling wine are especially low in carbohydrates. When choosing an alcoholic drink, you should also think about what else is going to be in the glass. The difference in carbohydrate content between light/ diet mixers and regular juice mixers may be very large. You can always test your blood glucose reaction towards different types of alcohol, which will be explained later. Drinking some regular mixers/fruit juice on a night out may compensate towards the impact of alcohol consumption on blood sugar level. Nevertheless you should not forget to eat, especially long-acting carbohydrates. Overall it is important to remember that alcohol has a glycaemic lowering effect. This is the same for everyone if they have diabetes or not but for people with type 1 diabetes it can be a real problem. TOP TIPS It is a good idea to keep checking your blood glucose when you are drinking Always remember that different drinks may affect your blood glucose by differing amounts

8 Alcoholic drinks and their carbohydrate content Some of the common alcoholic drinks and their approximate carbohydrate content are given in table opposite, to help illustrate the contrast between different drink types. Please refer to individual manufacturer s product information for specific values. KEY FACTS There is a dramatic difference between dry and sweet wines in carbohydrate content. A dry wine can have a carbohydrate content as low as 1 2 g in a 200 ml glass, whereas a sweet wine will have a much higher carbohydrate content for the same volume Spirits such as gin, vodka, whiskey and even rum are highly distilled drinks and so should not contain carbohydrates. When consumed pure they do not result in an immediate increase of blood glucose. However their high level of alcohol content will inhibit the release of glucose from the liver (as explained on pages 2 and 4) and potentially increase the risk of hypoglycaemia several hours later. Drink Carbohydrate content Units of Alcohol Approximate to both Carbohydrate content and to Alcohol units 1 pint of lager (4% ABV*) 1 pint of ale (4% ABV*) 1 pint of stout (4% ABV*) 1 pint of dry cider (5% ABV*) 1 pint of sweet cider (5% ABV*) 1 large glass of dry white wine (250 ml) 1 glass port (50 ml) WKD vodka blue (Alcopop 275ml) [4% ABV*] Vodka (25 ml) Gin (25 ml) 1 small glass of Red wine (125 ml) 1 large glass of Red wine (250 ml) 8 g 2 17 g 2 9 g 2 15 g 3 24 g 3 2 g 3 6 g 1 36 g 1 0 g 1 0 g 1 0 g g 3 *Alcohol by volume (abbreviated as ABV, abv, or alc/vol) is a standard measure of how much alcohol (ethanol) is contained in a given volume of an alcoholic beverage. Information referenced from Carbs & Cals (5th edition), 2013 by C Cheyette and Y Balolia.

9 Drinking and the law TOP TIPS It is a good idea to find out what one unit of alcohol will do to your blood glucose level. Try drinking one unit of alcohol in the evening - perhaps after dinner - and then test your blood glucose levels every 2 hours for the rest of the evening. This will give you a guide as to how much one unit will drop your blood glucose level and may help you plan what you need to do to avoid hypoglycaemia when drinking. Please tell your Diabetes Team before you do this test! In the UK it is against the law to drink alcohol in licensed premises (such as pubs and clubs) if you are under 18 There is an exception for children aged 16 or 17 who are accompanied by an adult. In this case it is legal for them to drink, but not buy, beer, wine and cider with a table meal. Laws regarding underage drinking may differ in ROI. It is against the law in the UK & ROI to buy or attempt to buy alcohol if you are under 18 Please note that this is not an exhaustive summary of the laws surrounding underage drinking.

10 General advice TOP TIPS It s a good idea to make sure that someone you are with knows you have type 1 diabetes or type 2 diabetes and take insulin Wearing a diabetes ID bracelet or carrying some diabetes ID in your purse/wallet is helpful in case of an emergency. It will help the emergency services give you the right help quickly Make sure that your friends know the signs of a hypo so they can help you quickly if you aren t aware that you are going low Set limits and stick to them if at all possible Where to go for more help? Speak to your diabetes specialist team

11 Alcohol and diabetes Having diabetes (type 1 or type 2) doesn t mean you can t drink alcohol Different alcoholic drinks will contain different amounts of carbohydrates Alcohol can affect your diabetes control Knowing how to minimize the risks associated with alcohol can help you to stay safe whilst drinking Date of prep: March 2015 For more about the range of free diabetes information booklets, please log on to: or call the Accu-Chek Customer Careline: (UK) (ROI) ACCU-CHEK is a trademark of Roche 2015 Roche Diabetes Care Limited. Charles Avenue, Burgess Hill, West Sussex, RH15 9RY. Company Registration Number: