Excessive Alcohol Consumption Leads To Hypoglycemia In Diabetics

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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  Ѕ cup of any fruit juice or fruit nectar  Ѕ 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.

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Dr Deryck D. Pattron is an author, researcher and public health scientist, in the Ministry of Health, Trinidad.

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