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Alcohol and Diabetes

Diabetes mellitus is a chronic disorder in the blood level of insulin, a pancreatic hormone, that helps convert blood glucose into energy. Diabetes occurs when the pancreas doesn’t produce enough insulin, or the insulin it does produce doesn’t work properly. Insulin is a hormone that transfers glucose from the bloodstream into the cells to be used for energy. If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood instead of moving into your cells.

The chances of developing diabetes may depend on a mix of your genes and your lifestyle. It’s a manageable condition. But when it’s not well managed, it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations.

Diabetes affects around 2.9 million people in the UK. It’s likely there are another 850,000 people who have the condition, but aren’t aware of it. It affects between 10-20 million people in the US alone and worldwide, its incidence is projected to increase to 300 million in 2025.

There are two main types of diabetes

Type 1 diabetes develops if the body can’t produce enough insulin, because insulin-producing cells in the pancreas have been destroyed. It can happen:

  • because of genetic factors
  • when a virus or infection triggers an autoimmune response (where the body starts attacking itself).

People who have this type of diabetes are usually diagnosed before they’re 40 and there’s currently no way to prevent it. Type 1 or juvenile-onset or insulin-dependent diabetes mellitus is a disorder characterised by a lack of insulin production by the beta cells of pancreatic islets. It’s the least common type of diabetes – only 10% of all cases are Type 1 in the UK.

If you suffer from diabetes, you can consume alcohol, but preferably with a meal. The consumption of alcohol without a meal can cause blood sugar level to fall unexpectedly (hypoglycaemia), in particular, if you're on insulin.
If more than a light to moderate amount of alcohol is drunk, alcohol can react with many of the prescribed diabetic medications and worsen the side effects of diabetes such as increased blood pressure.
Recommendations are a maximum of two standard drinks per day for men and one standard drink per day for women. For further information visit www.healthline.com or www.diabetes.about.com.

Which drinks?

Dry varieties of wine and cider are recommended. These include still and sparkling styles and dry sherry, but not a sweet or medium dry/sweet sherry or sweet dessert wines. Beers and spirits (avoid sweet mixers) are fine but high sugar liqueurs and fortified wines should also be avoided.

Type 2 (late onset) diabetes develops when the body can still make some insulin, but not enough, or when the body becomes resistant to insulin. It can happen:
  • when people are overweight and inactive.
  • People who are an ‘apple-shape’ (with lots of fat around the abdomen) have a greater risk of developing type 2 diabetes
  • because of genetic factors.

Type 2 or adult-onset diabetes mellitus, which accounts for more than 85% of all incidences of diabetes mellitus, is a disorder characterised by resistance to the effects of circulating insulin. This disorder leads to a substantial increase in risk of cardiovascular disease, which is the major cause of mortality, accounting for up to 80% of all deaths in individuals with type 2 diabetes mellitus; the age-adjusted relative risk of death due to cardiovascular disease is approximately three-fold higher than in the general population.

Apart from obesity and physical inactivity there are few well-established modifiable risk factors for type 2 diabetes mellitus. Recent evidence suggests, however, moderate alcohol consumption may be a potentially protective factor against contracting type 2 diabetes mellitus. A J-shaped relationship has been observed between level of alcohol consumption and risk of developing late onset diabetes in both men and women whereby if you drink moderately you have a decreased risk, but is you drink heavily your risk increases.

What the experts say...…

A recent meta-analysis by Pietraszek et al (2010) concluded: "light to moderate alcohol consumption seems to reduce the risk of type 2 diabetes by 30%, while heavy drinkers have the same or higher risk than total abstainers." Crandall et al (2009) have also shown that pre-diabetics who consume alcohol are at lower risk of developing diabetes. The analysis was from the Diabetes Prevention Program, involving patients from 27 centres throughout the US.

Another recent paper by Joosten et al 2010 showed that moderate drinking considerably lowered the risk of developing type 2 diabetes even among subjects who are otherwise following a healthy lifestyle (not obese, non-smokers, physically active, eating a healthy diet). The authors suggest that moderate drinking should be considered as a complement, and not as an alternative, to other healthy lifestyle habits that lower the risk of chronic diseases such as diabetes and coronary heart disease.

Cardiovascular disease remains as the leading cause of death among diabetics. Thus, it may also be important to comment on the very convincing and consistent data over many decades indicating a much lower risk of cardiovascular disease among diabetics who drink alcohol in comparison with abstainers.
However, binge drinking increased the number of diabetes cases. Excessive consumption can impair glycaemic control, and increase the risk of diabetic neuropathy and retinopathy.

People with diabetes don’t usually have to give up alcohol

Doctors usually advise diabetics that they can safely drink alcohol in moderation. So, if you have diabetes and drink, it’s particularly important to stay within the government guidelines. It’s also important to eat a healthy diet and take exercise to help control blood sugar levels.

Tips

Eat well. A healthy meal before you start drinking, and snacks between drinks can help to slow down the absorption of alcohol. It’s particularly important if you’re diabetic. Alcohol lowers blood sugar levels, so eat plenty of food, preferably carbohydrates, to make sure blood sugar levels stay steady.
Keep track of what you’re drinking. Use one of the online tools to help you keep track of the calories and units in your drinks:

change4lifedrinkaware calculator

More information on diabetes (click here).

For more information about diabetes, contact Diabetes UK. www.diabetes.org.uk

Please visit the gateway to sensible drinking and health, alcoholinmoderation.com for specific studies and summary papers.

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