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Alcohol,Drugs & Diabetes


As parents of older children and teens with type 1 diabetes, we may worry about missed boluses, misplaced priorities, mistakes and missed opportunities.Alcohol, drugs and type 1 diabetes

Life as an older child or teen isn't easy either, especially with diabetes in the mix. Before they're on their own, our kids need to learn about background insulin, correction factors, I:C ratios, carb counting, exercise accommodations and more. But there is one more factor you may not have thought to include in your adolescent's tool box: how to manage the effects of mind-altering substances on blood glucose.

"Wait!" you may shout. "My child would never use illicit drugs!" And you may be right. But the use of alcohol, street drugs, and off-label-use prescription drugs is a reality for thousands of youth each year. For those who also have type 1 diabetes, the effects of these drugs on blood glucose must be known if they are to manage their diabetes safely.


Alcohol

"Alcohol has carbs in it so it raises my blood sugar, right?"

Not exactly.

The effect of alcohol on blood glucose is one of the most misunderstood concepts in the type 1 diabetes community, from youth to the elderly. To clear up the confusion, here is the short and skinny on alcohol:

  • Under normal conditions, moderate consumption (1-2 drinks per week) of alcohol will have little effect on the blood glucose of an adult with diabetes.
[1 drink = 1 (45ml/1.5 oz.) shot of hard liquor = 1 (360ml/12 oz.) bottle/can of beer = 1 (150ml/5 oz.) glass of wine]
  • If you drink more than 1 drink per hour, the liver cannot process it fast enough, so you become "drunk".
  • If alcohol is mixed with sugar-containing beverages like regular cola or ginger ale, blood glucose will rise in the short term.
  • Alcohol increases the risk of LOW blood sugar (hypoglycemia) for up to 14 hours after drinking.
This is the point that a person with type 1 diabetes most needs to understand if they are drinking more than moderately. Usually, your liver will release small amounts of glucose if you haven't eaten in a while, providing some protection against lows. But the liver cannot make new glucose while it is processing alcohol. So if you are out at a party or club, dancing, drinking and not eating: your body has physical activity, alcohol, and lack of carbs to deal with... a recipe for hypoglycemia.


What Young Adults Need to Know About Alcohol Use and Diabetes


Know the facts about how alcohol affects your blood sugar (above).

Know what you need to do - before, during, and after drinking alcohol - to reduce the chance of a dangerous low blood sugar. The BC Children's Hospital has an excellent resource on Alcohol and Diabetes, that tells you exactly what you need to do to keep yourself safe when you're drinking - make sure you check it out before you head out for a good time.

Note for Insulin Pump Users:
The above handout has lots of useful recommendations around food/drink intake, setting limits, and checking blood glucose often to reduce the chance of a low. Also, a temporary basal rate could be another useful tool to offset the blood-glucose-decreasing effect of alcohol. How much and how far in advance to set a temp basal reduction into your insulin pump depends on a variety of factors, and varies lots from person to person. If you have used temp basals before, we suggest trying a small reduction as a starting point, noting the blood sugar results, and then adjusting the amount and timing of the temp basal based on those results, if needed. If you have not used the temporary basal feature much before, we suggest you experiment with this feature in non-drinking situations before applying it to your night out. For more information on how to use a temporary basal rate, check out the WaltzingTheDragon.ca article Temporary Basal Rate, read your insulin pump owner's manual, and/or consult with your diabetes health care team.

If your drinking is interfering with your life and you want help to deal with it, we encourage you to talk to your diabetes health care team (nurse educator, doctor, social worker, psychologist) and/or contact the provincial health authority in your province.


What Parents Need to Know About Their Adolescent's Alcohol Use and Diabetes

Managing their diabetes when drinking is an important skill for your adolescent with diabetes to learn - just as important as how to manage blood sugars when exercising or when they are ill. Though many of us would prefer our kids don't drink at all, and though the law forbids adolescents under a certain age (18 or 19 years old, depending on the province they live in), the reality is that many young people drink before this age, and drink without their parents' knowledge. Given the risks, it's important we educate our kids on how to do so safely, while still sharing our own values about whether or when they should start drinking alcohol at all.

For an excellent resource on Alcohol and Diabetes, again we highly recommend the BC Children's Hospital website. This handout gives the facts about the effect of alcohol on blood glucose, as well as providing practical and specific tips on how to reduce the risk of hypoglycemia before, during and after consuming alcohol.

If your adolescent's drinking is interfering with her life and you want help to deal with it, we encourage you to contact your adolescent's diabetes health care team and/or the provincial health authority in your province.


Smoking (Tobacco)

Adolescents with type 1 diabetes who smoke may not realize the effects that smoking has on managing their diabetes. Smoking can:
  • raise blood sugar
  • change the way insulin works in your body, including less absorption, less effective use of the insulin that is absorbed, and a change in the timing of insulin action. All of this can lead to unexpected high and low blood glucose.
  • smoking can compound the risk of long-term diabetes complications (ex. heart disease, kidney disease, vision loss)
For an excellent resource on Smokes, Tokes & Other Drugs, we highly recommend the BC Children's Hospital website. This handout gives the facts about the effect of smoking on managing diabetes and provides some valuable resources for quitting.

If your child needs help with quitting smoking, we encourage you to contact:
  • your adolescent's diabetes health care team,
  • the division of the Canadian Lung Association in your province,and/or
  • the provincial health authority in your province - ( ex. Alberta Health Services has a How to Quit resource).


Street Drugs and Narcotics

Since we, as a society, rarely talk about drug use, the effect of street drugs, narcotics, and prescription drugs (for off-label use) on managing type 1 diabetes is even less understood than that of alcohol and smoking. But given the considerable risks of drug use for those with diabetes, if there's any chance your teen or young adult is using, or may start using drugs, it's a conversation worth having.

In addition to the considerable health risks that drug use poses for those without diabetes (memory and cognitive impairments, increased heart rate, psychological and physiological dependence), the use of street drugs (like marijuana, heroin, cocaine, speed, morphine, crystal meth, ecstasy) poses additional risks for those with type 1 diabetes. Various street drugs can:
  • increase blood sugar levels
  • make it harder to recognize a low blood sugar, which may prevent you from treating it
  • impair judgment and problem-solving skills, making it less likely that an individual will respond appropriately to a diabetes emergency
  • lead to high blood sugar if you get the "munchies"
Similarly, some youth use prescription drugs (such as anti-anxiety medications, anti-psychotics, anti-depressants, sleeping pills) for off-label purposes (that is, use by a person for whom they were not prescribed, and for a recreational or mind-altering purpose, rather than for their intended purpose).  In this case, the effects and risks are as varied as the drugs themselves, and include a number of dangers in addition to the ones outlined above.

For an excellent resource on Smokes, Tokes & Other Drugs, we highly recommend the BC Children's Hospital website. This handout gives the facts about the effect of street drugs on managing diabetes and provides some valuable resources for dealing with drug use and abuse.

If your family needs help dealing with drug use/abuse, we encourage you to contact your adolescent's diabetes health care team, and/or the addictions department of the provincial health authority in your province.


Any questions? Comments? Feel free to Contact Us.


The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

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