Ask D’Mine: Safe Alcoholic Beverages, Treating Lows (Also in the Bedroom)

Just a reminder: we don’t shy away from much of anything here at Ask D’Mine, our weekly diabetes advice column.

So buckle up for another wild ride today with your host veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Jackie from North Carolina, type 1, asks: I know there are a million ways to treat low blood sugar… but what works the FASTEST? And how long should it take you to recover from low blood sugar?

Wil@Ask D’Mine answers: A liquid sugar is fastest, minimal digestion required. So drink yourself back to normal blood sugar, instead of eating your way back.

But beyond that, I think something in the glucose family is faster than something in the garden-variety sugar family. So I’d rather you drank something like a Dex4 product; but failing that, I’d rather you had a “real soda” with real sugar, than a soda sweetened with corn syrup.

Liquid sugar stops dropping blood sugar in minutes. But how long it’ll take your body to climb back out of the hole it’s in varies quite a bit from person-to-person and low-to-low. The “rule” is to re-test your BG in 15 minutes, but the goal at that point is just to make sure you’re not continuing to drop. It can take 30-45 minutes to return to a normal blood sugar level from one sugar “treatment,” and it might be hours before you are feeling yourself again. Of course, that assumes you don’t have a caveman low where you go crazy and eat everything in the fridge out of fear, hunger, panic, and reduced neural activity from the low.

If that happens, you’ll end up super-high and feel like shit again. How long will it take you to “recover?” It might not be until the next day. For FASTEST recovery, my advice is to drink your sugar and avoid the pantry and the fridge.

… and speaking of drinking…

Danielle from California, type 1, writes: I am 28 years old and newly insulin-dependent. What is a safe alcoholic beverage??

Wil@Ask D’Mine answers: Red wine. White wine. Tequila. Lager. Whiskey. Vodka. Beer. Rum. Brandy. Scotch. That’s my day so far, and it’s only 9:15 in the morning.

Seriously, any type of alcohol is safe for you, my newly insulin-dependent sister. What you need to think about is what you mix it with, and how much you drink.

Many of the world’s most fun-to-drink alcoholic beverages are very high in carbs. Daiquiris come to mind. Rum and Coke is bad news, unless you mix with Coke Zero. The unofficial state drink of New Mexico, the frozen margarita, packs a hell of a carb punch.

As you’re new to the family, I’ll just warn you now, it’s almost impossible to bolus for liquid sugars. Our fast-acting insulins are not nearly fast enough to keep up with the surge in blood sugar that comes from drinking calories instead of eating them.

On the volume front, when you are boozed up, your body gets so busy filtering alcohol out of your blood stream that it forgets to filter out insulin. Having a lot of alcohol in your blood has the effect of “supersizing” your insulin, leading to epic low blood sugars hours downstream—often when you are sleeping it off. So that could be, like, fatal.

Bottom line: Moderation. Drink what you enjoy. Watch the carbs. And don’t overdo it.

… and speaking of drinking too much and low blood sugar…

Brad from Montana, type 1, writes: I have lousy erections when my blood sugar is on the low side. Everything works just fine the rest of the time. Is it just me, or is this common?

Wil@Ask D’Mine answers: Not common. In fact, I’d never heard of such a thing so my first thought was for me to try taking too much insulin and calling an escort service. You know, for research for the column.

Then the clinical part of my brain took over and my second thought was, now wait-a-cotton-pickin-minute, erections are controlled by blood pressure, not blood sugar. So how, physiologically, could low blood sugar give you erection performance issues when you’re fine the rest of the time? Could low blood sugar lead to low blood pressure, I wondered?

Of course, then I switched into diabetes educator mode and my third thought was maybe when you are hypoglycemic isn’t really the best time to have sex.

For lots of reasons.

Among things that come to mind is that when your blood sugar is low, your cognition is not at its best. That means you might have sex with someone you really shouldn’t be having sex with. And if your IQ and your blood sugar are both at 60, you might also engage in unsafe sex.

And of course, rigorous exercise when your blood sugar is low is only going to make your blood sugar lower, so your roll in the hay could end up putting you six feet under.

But back to how the bod works, there seems to be quite a bit of confusion as to whether or not low blood sugars can cause low blood pressure. Part of the problem is that the symptoms of the two conditions can be similar. Most of the literature I could locate dealt with sorting out whether or not various symptoms are likely to be caused by one or the other. The relationship between the two seems elusive. Certainly, if low blood sugar does cause low blood pressure, then in a roundabout way, low blood sugar could cause low erectile performance.

To get to the bottom of the blood pressure and blood sugar issue, I checked in with noted endo Dr. Kathleen Colleran, and she told me that lows actually raise blood pressure as your system releases assorted hormones to bring you back from the brink. (Actually, I paraphrased that a bit. Her answer was dryer and more clinical with lots of big words.)

My next step was to enlist the help of a diabetes sex expert. Oh, get your hands down, I wasn’t asking for volunteers. I emailed Janis Roszler, RD, CDE, LD/N, author of Sex and Diabetes (along with several other books), and asked her if she’d seen anything like this. She told me that for a good erection, “a man needs good blood flow, good nerve communication between the brain and the penis, and enough energy to participate in sexual activities. That’s what is missing if his glucose level drops—the energy required to be sexual.”

And like any good sex worker (stop it, you know what I mean), she also had a fun tidbit to add, telling me, “I knew someone who would estimate his glucose level by trying to think about sex—if he had no interest, he was definitely low!” Thanks, Janis, but I’ll stick to my CGM and meter on this one…

And of course specifically for Brad from Montana, Janis has this final piece of advice, “Fortunately, this problem has a simple remedy—he should check his blood glucose level prior to sexual activity and treat any low with an appropriate snack.”

So eat up and get it on, Brad.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.