Newly diagnosed type 2 drinking question

[rickydoo]

Hey guys! I’m back with a question regarding drinking. I know as a type 2 drinking can raise your BG levels but I recall reading something that mentioned it could also possibly make you hypoglycemic, without it showing on your BG machine? Can’t seem to find the article again. I guess, in short I’m asking, if becoming hypoglycemic, even after I’ve eaten well today and my numbers are healthy, is a possibility. And some tips on how to go about having a couple drinks safely would be appreciated. Thank you guys!

 

[EllieM]

Hi @rickydoo. Hypoglycemia can be an issue after drinking because alcohol can inhibit the liver's ability to make glycogen (sugar that is released when the pancreas produces glucagon to tell the liver that your bg is too low). Having said that, it shouldn't be an issue unless you are on certain medications, so what meds are you on?

 

[VashtiB]

Hi @rickydoo - are you on any medication? Most type 2s who are not on any medication don't need to worry about hypos. In relation to having a few drinks my tip is to keep it low carb so gin and soda water or diet tonic water or Diet Coke with Bacardi are probably my go too when out. Some wine is also low carb. Here in Australia there is a company selling 'keto wine'- I had to buy some- just to test for this site you understand.

What do you normally drink?

 

[rickydoo]

Hi @rickydoo. Hypoglycemia can be an issue after drinking because alcohol can inhibit the liver's ability to make glycogen (sugar that is released when the pancreas produces glucagon to tell the liver that your bg is too low). Having said that, it shouldn't be an issue unless you are on certain medications, so what meds are you on?

I’m on one metformin pill a day! I believe 500mg. I take it in the morning!

 

[rickydoo]

Hi @rickydoo - are you on any medication? Most type 2s who are not on any medication don't need to worry about hypos. In relation to having a few drinks my tip is to keep it low carb so gin and soda water or diet tonic water or Diet Coke with Bacardi are probably my go too when out. Some wine is also low carb. Here in Australia there is a company selling 'keto wine'- I had to buy some- just to test for this site you understand.

What do you normally drink?

Yes! I’m on one metformin pill a day in the morning 500mg. My doctor says my numbers are good though and he’s possibly taking me off them. I normally drink beer but I’ll drink whatever is least hazardous in terms of hypoglycemia.

 

[EllieM]

Yes! I’m on one metformin pill a day in the morning 500mg. My doctor says my numbers are good though and he’s possibly taking me off them. I normally drink beer but I’ll drink whatever is least hazardous in terms of hypoglycemia.

I don't think one 500mg pill of metformin is going to put you in much danger (disclaimer I am not a doctor). TBH, I'd be more concerned about the carbs in beer (as in hyperglycemia) for a T2er, though I suppose you can get low carb beer?

But, Dr google says you are at mild risk, both of hypoglycemia and lactic acidosis, so I'd certainly refrain from binge drinking while on metformin....

Having said that, a hypo would certainly show on your bg machine, so I wouldn't worry about it not showing up. The problem would be if you went to bed on a blood sugar of 4 and it went much lower overnight.

 

[KennyA]

Hey guys! I’m back with a question regarding drinking. I know as a type 2 drinking can raise your BG levels but I recall reading something that mentioned it could also possibly make you hypoglycemic, without it showing on your BG machine? Can’t seem to find the article again. I guess, in short I’m asking, if becoming hypoglycemic, even after I’ve eaten well today and my numbers are healthy, is a possibility. And some tips on how to go about having a couple drinks safely would be appreciated. Thank you guys!

Hi. My experience is that alcohol lowers my BG, but not to hypo territory. I've succeeded in never going out of normal levels (which these days for me is 4.0-6.0) - I think you're in the US so apologies in advance for using the UK measurements I'm familiar with..

Things get complex with a high carb item like beer. After some controlled testing it seems that on one pint of 5% beer (estimated 18g carb) I initially have a rise in BG - from 4.6 to 5.8 after one hour followed by a fall to 4.3 after two hours. My analysis is that this represents an initial hit of glucose causing the rise, then the liver switches off processing glucose to deal with the alcohol, causing the fall. If I drink a non-carb alcohol (whisky etc) , there's no rise, only a fall. This might or might not happen for you, you'll have to test and see. You might well have a different experience, and have to adjust expectations accordingly.

There is a halfway decent low-carb (3.5g/bottle) beer in the UK called Marston's Resolution, and several more which are watery and almost undrinkable. I have read that there are low-carb beers available in the US but have never tried any. I'd be interested in any US info you might find.

 

[Mr_Pot]

My analysis is that this represents an initial hit of glucose causing the rise, then the liver switches off processing glucose to deal with the alcohol, causing the fall.

I didn't think the liver processed glucose. Doesn't it go from the stomach and intestine direct to the bloodstream?

 

[Andydragon]

I didn't think the liver processed glucose. Doesn't it go from the stomach and intestine direct to the bloodstream?

https://www.diabetes.co.uk/body/liver-and-blood-glucose-levels.html

 

[Mr_Pot]

https://www.diabetes.co.uk/body/liver-and-blood-glucose-levels.html

From your reference....

During absorption and digestion, the carbohydrates in the food you eat are reduced to their simplest form, glucose.

Excess glucose is then removed from the blood, with the majority of it being converted into glycoge (sic), the storage form of glucose, by the liver’s hepatic cells via a process called glycogenesis.

So, the liver is "busy" with the alcohol and it cannot process the glucose. But the process is to remove excess glucose from the bloodstream which would mean that it would increase not decrease.

 

[Andydragon]

From your reference....

During absorption and digestion, the carbohydrates in the food you eat are reduced to their simplest form, glucose.

Excess glucose is then removed from the blood, with the majority of it being converted into glycoge (sic), the storage form of glucose, by the liver’s hepatic cells via a process called glycogenesis.

So, the liver is "busy" with the alcohol and it cannot process the glucose. But the process is to remove excess glucose from the bloodstream which would mean that it would increase not decrease.

Fair point, Here's some info on why it can cause hypos:
https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-sugar

Lots.of negative stuff about alcohol and diabetes, but the site is I think.more to try and stop people @rickydoo was this simar to what you were looking for?

Not an expert, not much of a drinker. Just find the debate interesting

 

[KennyA]

I didn't think the liver processed glucose. Doesn't it go from the stomach and intestine direct to the bloodstream?

It does. But if like me (and I was talking about my experience) you are on less than 20g carbs/day and in ketosis then glucose is produced by the liver via gluconeogenesis.

 

[Mr_Pot]

It does. But if like me (and I was talking about my experience) you are on less than 20g carbs/day and in ketosis then glucose is produced by the liver via gluconeogenesis.

Good point.
( On 20g per day it doesn't leave much scope for a pint of normal beer anyway).

 

[kevkevkev]

I've been on metformin (4x500mg per day) for years and drink lager every time I go out sometimes that includes drinking day and night and I have never had an issue, as already said you get an initial rise then a drop which generally puts my numbers where they are before hand. My advice is eat before and after you drink. Afterwards I actually intentionally eats carbs, maybe a pizza or something like that to keep my numbers up. This is only my experience and I'm certainly no doc but it works for me. The food is very important I believe in my experiences

 

[KennyA]

Good point.
( On 20g per day it doesn't leave much scope for a pint of normal beer anyway).

Unfortunately not. But 20g is roughly the equivalent of 6 or 7 bottles of Resolution (or unlimited neat scotch, which we're not doing). So on a day like today which has been all meat and cheese, a couple of bottles of low carb beer or a bottle of real beer as the sun goes down won't bust the carb budget.

 

[Oldvatr]

I’m on one metformin pill a day! I believe 500mg. I take it in the morning!

Alcohol does not sit well with Metformin. It increases the amount of lactic acid in the blood, and the kidneys reduce clearance so it is possible to pass out with acidosis buildup. Had this happen to me and now I drink in moderation.

I use whisky since this has low sugar content, but most spirits are low carb compared to beer or wines. I can drop 4 mmol/l after a binge, so it can be a surprise. My T1 guitar buddy used to drink alcohol before going on stage with the band, but he started losing the plot with very low sugars (eg <2 mmol/l)

 

[kevkevkev]

Alcohol does not sit well with Metformin. It increases the amount of lactic acid in the blood, and the kidneys reduce clearance so it is possible to pass out with acidosis buildup. Had this happen to me and now I drink in moderation.

I use whisky since this has low sugar content, but most spirits are low carb compared to beer or wines. I can drop 4 mmol/l after a binge, so it can be a surprise. My T1 guitar buddy used to drink alcohol before going on stage with the band, but he started losing the plot with very low sugars (eg <2 mmol/l)

It is highly highly unlikely that lactic acidosis will effect you as long as you don't take to much metformin. Other conditions can increase your chances minimally too but again if used correctly you would be the unluckiest person ever for this to happen to you. It is listed as a very rare side effect, this is to cover their backs but there is no cases ever recorded in patients taking it as instructed with only diabetes. Here is a quote from the BMA website "Metformin rarely, if ever, causes lactic acidosis when it is used as labeled. Metformin is associated with lactic acidosis in patients with conditions that can themselves cause lactic acidosis (heart failure, hypoxia, sepsis, etc.)."

 

[Oldvatr]

It is highly highly unlikely that lactic acidosis will effect you as long as you don't take to much metformin. Other conditions can increase your chances minimally too but again if used correctly you would be the unluckiest person ever for this to happen to you. It is listed as a very rare side effect, this is to cover their backs but there is no cases ever recorded in patients taking it as instructed with only diabetes. Here is a quote from the BMA website "Metformin rarely, if ever, causes lactic acidosis when it is used as labeled. Metformin is associated with lactic acidosis in patients with conditions that can themselves cause lactic acidosis (heart failure, hypoxia, sepsis, etc.)."

Whilst this claim is backed up by published studies such as the one I link to here, I note that there was no check if any of the monitored patients were diabetic, or using Metformin, so is not a safe correlation to assume.
https://pubmed.ncbi.nlm.nih.gov/8285968/

Here is what Healthline says about it specifically for diabetics. I point out that energetic dancing at say a rave function would also be inducive of hypoxia and dehydration and increased lactic acid beyond normal pub drinking. Taking any recreational drug such as ecstasy would not be advisable.
https://www.healthline.com/health/diabetes/metformin-alcohol#alcohol-interactions

Just be sensible and aware there is an increased effect.

 

[kevkevkev]

Whilst this claim is backed up by published studies such as the one I link to here, I note that there was no check if any of the monitored patients were diabetic, or using Metformin, so is not a safe correlation to assume.
https://pubmed.ncbi.nlm.nih.gov/8285968/

Here is what Healthline says about it specifically for diabetics. I point out that energetic dancing at say a rave function would also be inducive of hypoxia and dehydration and increased lactic acid beyond normal pub drinking. Taking any recreational drug such as ecstasy would not be advisable.
https://www.healthline.com/health/diabetes/metformin-alcohol#alcohol-interactions

Just be sensible and aware there is an increased effect.

Being sensible is always advisable diabetic or not and as for taking drugs again unadvisable. Basically your chances of suffering this taking metformin are far less than being knocked over. It's tiny at best. If ya wanna drink have a drink and always be aware of how much you drink, in summary drinking as a type 2 diabetic on 1 metformin a day is no riskier than a non diabetic drinker. These studies pretty much show that. Have some fun.... your allowed! There will always be people who want to scare you a little but facts show that you have a pretty much zero chance of lactic acidodsis because you take metformin (as instructed) and drink. I've been doing it for 10 years on 4x metformin a day.

 

[rickydoo]

Thank you guys! You’re all very helpful!