Today, we bring you a special edition of our weekly advice column, Ask D’Mine. Your host, type 1 diabetes author and educator Wil Dubois has a few things to say about drinking with diabetes.
{Got questions? As usual, email us at AskDMine@diabetesmine.com}
Uncle Wil on Alcohol Consumption
One of my type 1 patients is in jail today. Something involving a firearm and a bottle of whiskey downtown. He was so drunk 
he was shooting into the air.
He’s 15 years old.
Before this happened, his mother had specifically asked me not to talk to him about diabetes and alcohol. He wasn’t that kind of boy, you see. She was afraid I might put ideas in his head. Ideas that were apparently very much there already. Ideas with no facts and information to balance them.
So today, instead of our usual Q&A format, I’m writing today’s Ask D’Mine as an open letter to all my little brothers and sisters. To tell you what I should have told him.
Dear Type 1 Teens and College-types:
Today I’m going to teach you how to get wasted safely. I’m not saying you should. I’m not saying I want you to. But if you are going to, I want you to know the dangers, and I want you to know how to do it right.
Why? Because no one else will frickin’ tell you. Your parents won’t. Your grandparents won’t. Your doctors won’t. Your educators won’t. Your teachers won’t. Your priests won’t. But I will.
I call all young type 1s my little brothers or sisters, but I today I’m thinking of you as my nieces and nephews. Yep, I’m the Uncle your mother really wishes would just join the Merchant Marines and never visit until after you’re all grown up. I’m the perceived bad influence. The tattooed guy who swears, smokes, drinks, flirts with all the women in the room, and makes politically incorrect jokes.
But God puts people into families for a reason. And the black-sheep uncle has an important role to fill: the adult who cares but does not judge.
To drink safely you need to first understand how alcohol affects you and me differently than it does the sugar-normals. Do you know anything about your liver? It does all kinds of things for your body. It has more than 500 different functions, actually. But most importantly to our discussion today: It’s a blood filter. It removes toxins from your blood. Toxins like alcohol.
But the liver only does one thing at a time. Everyone and everything else just has to take a number and stand in line until it’s finished the job at hand. And on that list of 500 jobs is “remove excess insulin.” Unless, of course, alcohol is in line first. Then the insulin just builds up in your blood while your liver is dealing with the alcohol. It takes hours for the liver to “clear” a good binge, and all that time the insulin stays in your system. It’s like taking an extra shot of basal. Big-time hypos hit 8-10 hours downstream from last call, when you’re sleeping it off.
Oh, and when you’ve been drinking, your body will respond more sluggishly to the treatment of those lows. The rebound will be a lot slower than you’re used to. So don’t panic, just be prepared for a 2-3 times longer “recovery” than you’d experience with sober lows. Booze also reduces your awareness of lows overall, and sometimes even triggers a temporary state of hypoglycemia unawareness. So be aware that you may not be aware, OK?
If you want to learn more about the biology of booze, check this out. But the important message is that booze screws with your diabetic body differently than it does for all your non-D friends. And you need to plan for that fact.
So Uncle Wil, you ask, how do I get totally shit-faced drunk off my ass safely? Look, the only way to play Russian Roulette safely is with an empty gun. Oh dear. Now I’ve gone and introduced your impressionable little minds to Russian Roulette, too. Your mother is going to throw me out of the house.
The stone cold sober truth: for people with type 1 diabetes, there is no safe way to get four sheets to the wind. Hang on! Keep reading! I 
know that sounds like a typical “adult” cop-out answer. But it’s true, and it’s why most adults just throw in the towel at this point and say “Just don’t drink!” But I’m a realist. I know you will still get wasted, no matter what the risks.
I don’t have any magic bullets, or secret formulas to let you binge in safety. No two young type 1s are alike, and no two binges are alike. That said, here are my tips for making this dangerous undertaking as safe as possible. Three things to consider before the first sip -
One: To bolus or not to bolus? Should you bolus for beer or mixers? Both have carbs. Sometimes a lot of carbs. Logically, you should cover those carbs. But the alcohol in the drink will supersize the insulin downstream, remember? What to do? There’s no right answer here, and the drunker you get, the worse you’ll count carbs, the worse you’ll calculate the bolus, and the less you’ll care. I suggest cutting your bolus down. Should you take half what you normally would? A third? Sorry, I don’t know. But some amount less should be in your game plan.
Two: To eat drink and be merry requires eating. If you’re not throwing up, and even if you are, I think you should eat a snack before you sleep it off. Something high in fat so that it takes a long time to work through your system. That slice of cold pizza on the floor will do the trick. Don’t cover it with insulin unless you are insanely high at bedtime. You’ll want carbs in your system to soak up the insulin that the liver isn’t filtering away.
Three: No alcohol and heavy machinery. If you’re wasted, can you drive a forklift safely? No? Then what makes you think you can drive an insulin pump safely? Or a glucometer, for that matter? If you are really out of it, can you make good treatment decisions? Smart adults choose a designated driver when they go out drinking in packs. Is there anyone in your group who can serve in that role? If so, does that person understand diabetes well enough to help? Is that person reliable? Is he or she the kind of person that’ll wipe the vomit off your hands and check your blood sugar at 3 a.m. while you’re sleeping it off? Or will they be passed out on the other side of the room?
Well, that’s it. Alcohol supersizes your insulin and sets you up for epic lows hours later when you’re likely to be asleep. It blunts your ability to feel those lows, and slows down your recovery if you do feel them and are sober enough to deal with it. But you can lower your risk of all of those scary things by thinking and planning ahead and…Oh, crap! I forgot to tell you about the Zombies.
My tattoo artist has a glass case in his studio with a faux chainsaw in it. Stenciled in bold red letters on the case is: BREAK GLASS IN CASE OF ZOMBIE ATTACK. So let’s pretend there’s been a Zombie attack. Steps behind you is a shuffling, stinking, moaning mob of the undead intent on tearing you to shreds, drinking your blood, and feasting on your flesh. You barely make it to the case in time, grab the hammer, and… Crap! The case is empty.
This doesn’t look good for the home team.
You know what? If you drink too many Tactical Nuclear Penguins, your glucagon emergency kit case might just as well be empty, too.
I bet your endo never told you, but, glucagon does not work when you are drunk.
A drunk liver won’t dump its stores of sugar on demand. I’m not saying your peers shouldn’t try giving you a shot if you have a seizure, but realistically, it won’t work. When you’re drunk, the break-glass-in-case-of-emergency cabinet is empty.
The only way to save your life if you have a severe hypo when plastered is to get an IV of dextrose in the back of an ambulance or at the hospital ER. So wear your damn medic alert when you go drinking—if the paramedics smell booze on your passed out carcass, they probably won’t think to check your blood sugar.
The lesson here, my dear nieces and nephews, is don’t let your drinking get to the Zombie attack point. Plan ahead the best you can. If you drink to get drunk—or find you’re way well down that road—please get the carbs in and get the insulin out. If you’re pumping, turn down the basal or take the pump off. If you shoot up and you haven’t taken your basal yet, take less, or maybe even skip it. If you’ve already taken your basal, skip the fast-acting insulin and eat a snack.
Can you get drunk safely? No. Not really. But now you have the tools to do it as safely as possible, because I want each of you to grow up and become a black-sheep uncle or aunt for the next generation.
Much love,
Uncle Wil
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.
THANK YOU for writing this, Wil. My T1 gal is only 10, but I was just reading about teenagers and drinking, and going to ask Gary Scheiner about it. I want my daughter to know all this, and to stay alive. Dear God, stay alive. I would rather be totally honest with her and have her live to see another day than to hide my head in the sand and pretend that she will never drink.
Thank you.
Bravo!
Great column and excellent advice for partying w/ D!
Good article. Aaaah, so much to remember, my T1 is only 8, but I worry about teenage drinking. I know I did it, got plastered as a teen, did all kinds of dumb stuff. Of course, I don’t want my kids to do these things, but I’m not naive enough to think they won’t. I am worried about her especially when she is a teenage T1 trying to be sneaky and drink behind our backs. Sigh…..
I am concerned about the glucagon message in this post. Because the low often comes HOURS later, you are not drunk when it happens. Does glucagon work then?
Also I am a big fan of two things:
A) run high on purpose; crashing in and out of the 20′s sweating and shaking is no fun. Surely going to bed at 250 or higher for the rare binge is better. Stop trying to stay under 200; as soon as that third drink goes in your system, your new target should be closer to 300. That is, don’t correct your highs aggressively OR stack boluses.
B). Temp basals are your friend – much like after a day of intense exercise, try running a lower basal after a night of drinking; if you are 300 @ bedtime, it is probably not neede, but if you are under 200 it is!
I think it’s fine to reduce a basal injection or use temporary basals on the pump. However, I disagree strongly with the idea of eliminating a basal injection and even more strongly about the idea of removing the insulin pump. DKA comes to visit pumpers very quickly when basal insulin is stopped because there is no Lantus or Levemir to cover that background insulin. If a young person (or old person) is totally sh*t-faced, they’re probably not going to remember to re-attach the pump. Add dehydration and puking to the menu and you’ve opened the door to a catastrophe.
Thank you sooooo much for writing this. My daughter has had the D for thirteen years. She is now 17. Also my sons best mate is Type 1. Will be showing both of them this article. Taught me a thing or two. Can’t thank you for your wisdom. X
Thank you for the information. As the parent of a 15 year old T1d I appreciate the frankness of your article and will be sure to share it with him.
Thank you for this candid and realistic post. I will definitely share with my T1D kids.
Thanks for being honest. One additional item to remember:
Related to the liver comments, a Type 1 diabetic will usually get wasted quicker than a non-diabetic. Yup, lots of diabetic friends and all of them are light weights. Don’t binge or try to keep pace, your friend will just throw up in the bathroom, you will come to in the hospital… if you are lucky.
Thank you!! As a 26 year old diagnosed less than 1 year ago, I appreciate this. I still drink like a college student once in a while and I’ve been looking for some practical advice like this.
I think it should also be said that nobody NEEDS alcohol. I’ve devoted myself to a life of wine, women and song—but I haven’t got to the women or wine yet.
I’ve been around people who don’t drink, people who drink moderately and those who shouldn’t be drinking and not one of these groups has more fun because of the amount of alcohol ingested, though it causes a lot of ruined lives for the latter group. This is just to say that there ARE people out there who don’t feel the need to drink and THAT’s alright, too.
I was surprised to find that my brother-in-law felt the same way I did: Never liked the taste, didn’t see the point, so I don’t. For those kids out there who feel that way, stick to your guns! Choosing not to drink and sticking to it is a completely valid way to go–especially if you have a family history of alcoholism or other addictions. You truly are not missing out on anything.
Very interesting – but my burning question – how bad is it for a T2 to drink? Is the reaction similar? I’ve hardly had a drink since I’ve been dx’d but I’d like to know – just in case I ever decide to have one or two … too many, that is …
I knew there was a reason I hung out with you at the bar…
I do not ever recommend taking a pump off… you still need basal, even if it is reduced. DKA can start in 3-5 hours…. so then you have a vomiting, drinking teen on your hands…or a blood sugar of 500+ the next morning……yuck
I suggest decrease basal before you even leave the house or have your first drink and food with alcohol if its available… and Skittles in both pockets/purse.
For Lantus/Levemir take less that evening… a lot less…
The things us moms won’t tell you Uncles straight to your face? We both need and adore you. Even if we could say this straight to our T1D kid’s face, they’re simply not going to hear it the same from us. From Uncle Will, though? Yes, and with a much more open mind – cuz Uncle’s cool and a whole let less, umm, judgey. So, yes – thank you for this. It’s been printed, laminated, and left under the pillow for the teens to find on their own time. (Us moms have to keep up images, too.)
Wow so I found this on Pinterest the day after visiting the E.R. bc of a night of drinking gone bad.
Whenever I’d drank before I always ended up going to bed not caring about my BS but this time my husband took care of me & gave me insulin. I woke up fine the next morning with a sugar of 131 & ate a bagel. Later on I drank some water & after that I couldn’t keep anything down & eventually went low & couldn’t come up. I’ve only been a T1D for a year now so I wasn’t sure what to do. Now after meds, iv & sugar I’m much better.
Lesson learned though.
Alcohol & diabetes isn’t the best combination.
The real problem with drinking is that nobody will know if you are in trouble or how to help! They won’t know if you are low or loaded, if you are passed out drunk or just passed out. You will go low while you’re sleeping it off and your friends will think you are just sleeping it off and you won’t wake up and no one will know and you’ll die. Or you’ll be suffering a low and sluring your speech and falling down and your friends will think yoy’re drunk but you’re too low to ask for help.
My advice to D folk who drink is the same as for anybody who drinks: Have friends you can trust to take care of you. Someone who won’t let you go home with someone creepy. Someone who will make sure you make it home. Have a best friend who will hold your hair back while you puke and who knows YOU ARE DIABETIC! Someone not afriad to call an ambulance if they think something is wrong. Someone who knows when you are loaded and makes sure that you don’t drown at the pool party. This is when young ppl really need to look after each other. and when parents have to make it clear that they can call you anytime no matter what. Thanks so much for the info.
We have a 15 year old as well. And you taught me quite a few things I didn’t know about Type 1 and drinking such as the fact that the effect of drinking is like taking more basal. Is there a carb amount per drink to ingest (I had heard a suggestion of 20) but I’m sure they were figuring on one or two drinks. So far we have been lucky but what young adult has never gotten drunk at least once? Thanks Uncle Will. PS. Will a slice of pizza at 25 grams a slice be enough to hold them? If drunk, will they remember to reduce basals? Maybe just get into the habit of not dosing for alcohol and eating 20 grams free every few drinks? Very scarey styff,
Good information.
I’ve been a T1 diabetic since the age of 9. I went to college, joined a sorority, moved tothe UK, etc. and at the ripe age of 27, am a teetotaller, having never drank.
When I was a teenager, an endo straight up told me, “You can never drink.” And that was basically it.
But it was cool, because I was already neck deep in the Straight Edge hardcore movement, and it was a moot point. http://en.wikipedia.org/wiki/Straight_edge . I just wish I would have had this info a little earlier so I could sidestep some of the more awkward conversations of my younger years.
Now I can use it in awkward conversations with my business clients, because “Hey I’m involved in a punk rock subculture blah blah blah covered in tattoos blah blah blah…” is perhaps not the best approach!
@Julia – terrifying for my friends, but way back in the day in college, I would actually remember to do ‘all of those things’ to stay safe, including eating or dropping basals. Somehow, after 20 years of being diabetic, it’s engrained in me. Now granted I would get drunk, but not to the level of passing out.
Denise’s comment is spot-on; if you want a ‘back-up system’, you have a very good friend who won’t let you go to sleep without testing and/or eating. Even better if they have the phone number of a diabetic to call for advice if they test your blood and things aren’t so hot. If you can be that awesome mom who is willing to help in that situation, even better, but yeah, an ‘uncle’ works too.
If you are not diabetic, drinking buddies are essential if you are a young college women, and a common occurence. Now you are just asking that buddy to take it one step further.
While I appreciate those that refrained from drinking in college, and admire your point of view, reality dictates that not all diabetic children will grow up to be such upstanding citizens. Therefore – this dialog is pretty crucial. No, no one HAS to drink. But in college many do, so let’s make sure our kids are aware of the consequences before sending them off to college!
I never bolus for alcohol. I’d rather coast up a little and give a small correction. If I bolused 20g for a beer, I’d be on the floor in an hour.
But I also don’t drink sugary alcohol drinks; I find managing a temporary high from a sugary drink, and a possible super low later from the combo of insulin & alcohol is not worth it. I’d rather not be bolusing a lot, and sticking to beer/wine is a great way to do that.
glucagon doesn’t work when you’re drunk?! I feel like this should be advertised more, because I had absolutely no idea.
Freaking awesome. Thank you for posting. A few things to add. First, you can use glucagon once the most drunken stage has passed. I know because I’ve gotten sick before AFTER bolusing (while still fairly wasted) and had to take glucagon to counteract the insulin in my system. Worked, except I threw up even more. I’m not the only person who’s done this apparently – Jacquie over at TypicalType1 wrote a post last year about an eerily similar incident. For us, glucagon did the trick.
Second, avoid sugary mixed drinks. I always stick to beer, wine, and gin. They will still mess with your BG, but you won’t have as much of a mess to deal with.
Third, eat, eat, eat!! Food helps things considerably.
Fourth, practice. That’s right, practice getting drunk with someone around you trust. Understand how alcohol affects YOU. We’re all different and all have different thresholds for what our bodies can tolerate. Find what combination of food, drink, and fun works for you.
Fifth, I cannot emphasize enough how important it is to let people around you know that you’re a type 1 diabetic. If the EMT’s show up, they will think you’re just another wasted idiot. Hypos and drunkenness look very similar.
Sixth, never sleep alone when you’ve been drinking. Only drink heavily if you know you’ve got someone next to you for the rest of the night. T1s have died this way.
If you’re old enough to go out and party, you’re old enough to take responsibility for yourself and your actions. Have fun, but be an adult about it. No one looks cool wasted off their ass, and neither will you. You’ll look even less cool if you die. Personally, I’ve always had just as much fun watching everyone else get wasted while I nurse a beer or glass of wine.
This is a great conversation. I’m one of those who did drink during college… quite a bit. This wasn’t a specific conversation with my parents beforehand, but they weren’t afraid to have it – we just didn’t get into it too deeply aside from the general “be safe and know what alcohol will do to you.” My endo(s) refused to acknowledge this reality and opined that I not drink at all. So, I really learned through trial and error… but it didn’t matter much, since I typically ran High anyhow in those years (not just while drinking) and so when I did see a BG drop, it didn’t make me crash. I did avoid the sugary drinks with mixers and usually went with lighter beer or something with diet soda, and did make sure that I had eaten enough to get me through the post-drinking excursions. Anyhow, thanks for writing this, Uncle Wil! Wish I’d had it when I was younger!
thanks, uncle wil !
wish i had heard this 30 + years ago (in my party years) when I almost died on a bathroom floor from too much rum and too little information about alcohol and diabetes
For the most part, I think you’ve covered the bases pretty darn well Mr. Wil Printcrafter Dubois!! However, I would just add that alcohol, like pretty much anything when it comes to diabetes, is something that one learns from experience. The best advice I ever got was when I was an exchange student in Finland where they not only have lots of type 1s, but they also like to drink their Salmiakki kossu, vodka, which is basically grain alcohol with salty licorice infused, as well as other hard liquors. My fellow T1 Finns advised that I should drink and eat, just as you did, but they also advised not to worry about correcting high BGs until I’m well into hangover mode. Of course, that exaggerates how lousy you’ll feel the next day, but it also meant I didn’t pass out from hypos and the only bed-spins I was having was from the booze. You can always correct highs later, but its tough to correct a low with a room full of drunks including yourself. There’s risk in everything we do; drinking is one of them, but learning how booze affects us is an important learning process that all type 1 people should learn about from experience.
I have two kids with T1D. My older daughter was 15 and got drunk and passed out at a party. Nobody knew she was actually drunk and severely hypoglycemic at the time. Her sister happened to find her unconscious on a couch and got her to the ER where they promptly cut off her clothes and had to resuscitate her to save her life. It really sucked. Now we talk all the time about drinking. I really think your approach is best. Thank you Uncle Wil
Bless you for saying the things that no one else has the guts to say!! The world (in all fields) needs more people who can face reality & deal with it. Denial gets no one anywhere useful.
Thanks for the “Keeping it Real” column. I’ve always read about how alochol is suppose to react to my Type-1 body, but I find the opposite to be true for me. Whenever I go drinking (beer mostly), I find that I must bolus. I also find that either I don’t bolus enough or alcohol doesn’t allow my insulin to be absorbed as efficiently. Either way, I always end up being super high (even overnight). Didn’t mean to add to the confusion, but it just seems to me that alcohol hinders the effectiveness of insulin, more than gives me lows later or anything of that sort. Maybe you can comment on this with your thoughts?
Amazing and much needed post, really wise. Thank you for writing this.
I’ve found it very hard to get straight answers from healthcare professionals about issues where there’s a social judgement attached to a lifestyle choice. Even with less charged topics like eating fast food or sleeping in late I have had struggles to get conversations past “just don’t do it” and get any meaningful information. I’m really grateful that you’ve written this.
I know WilD has been kicking around the DOC for quite some time now. While I see he offers good advice, I have always been unclear as to what regulated health profession he is a member of and how it is he has patients.
I remember at one point reading that he informally counseled underprivileged / uninsured type 2 patients. Now I see in this article is treating / counseling pediatric type 1 patients. I am just concerned about the ethics / logistics behind how that works.
Honestly, as I recall this gentleman has not even had diabetes for very long.
A quick search for Wil Dubois tells you everything you need to know. Author of several D books (national award winning books), Diabetes Coordinator at Pecos Valley Medical Center, author of multiple D columns, and a veteran T1D. Wanting to ensure the advice you read comes from someone knowledgeable makes perfect sense; casting aspersions on one’s ‘right’ or qualifications to author advice columns carries a different feel. Complete profiles are available here, on tudiabetes, blogger, and LinkedIn.
Advice columns are great; and this one includes a disclaimer. It is treating pediatric type 1 patients when you are not a member of a regulated health profession that concerns me.
[...] I'm not a Type 1 and I've never been on insulin, so I don't know how accurate this article is, but I found it interesting reading: D-Teens and Alcohol: No Bull from Uncle Wil : DiabetesMine: the all things diabetes blog [...]
Thank you thank you for writing this! I too wish I had gotten this when I was younger (the internet existed when I started drinking but was still in dial-up mode and there certainly wasn’t this information readily available… in fact there still is NOT enough about this stuff on the internet).
One thing – I really disagree about taking off the pump. I’ve learned my lesson the hard way, and I think people should NEVER take off or suspend the pump. I think that’s dangerous when you’re sober (I’ve woken up with large ketones this way) and much more so when drinking. You GOTTA DO A TEMPORARY BASAL because you do not want to forget to turn it back on, especially if you’re out of it and gonna sleep for a long time. I also think the risk would be increased for DKA because that involves your body bein too acidic and so does alcohol poisoning.
My endos (or anyone else) didn’t talk to be about alcohol. At one of my first college parties, I had a lot of questions in my head. And then the perfect opportunity! I saw a guy testing his blood sugar on top of the keg. I was so excited and said hey I’m diabetic and I want to learn about drinking and stuff and his friend slapped him on the back and said “Well THIS is your guy! He knows all about it!” and then the fire alarm went off and I never saw him again. I figured some things out, and like many others here I often ran too high in general so that helped avoid some crashes. And I didn’t drink as heavily as many of my peers.
Also, my riskiest diabetes issue from drinking came from taking off my pump. It was annoying me while I was dancing (making my skirt sag), and I figured I didn’t need much insulin between the alcohol and dancing so, I took it off and set it down. Because I was drunk and distracted with a potential makeout, I left the party without it. Didn’t realize it til a few hours later, and was too tired/lazy/poor judgmenty too go look for it. Luckily I took some injections and didn’t sleep too long so was fine, and my friends helped me find it (in the grass behind the house party) the next day. But it coulda been much worse.
These are the exact reasons I struggle to educate my T1 son about having a healthy relationship with alcohol.
The biggest challenge to his safety is, tragically, my well-meaning family. They think that abstinence is the best approach. But, as you point out, drinking happens. This leads to arguments at family gatherings but, for my son’s safety, I’m sticking to my guns.
Being prepared is way safer than pretending something will never happen.