#946 Best of Juicebox: Diabetes Variables: Alcohol

July 6, 2023Scott Benner

Originally aired on Dec 17, 2021. Diabetes Variables: Alcohol

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to episode 946 of the Juicebox Podcast

I thought for the Fourth of July we would run a best of episode about alcohol. Don't ask me why just seemed like you know the right thing to do. Today's episode features Jenny Smith and I in a diabetes variables episode, Episode 596 originally aired on December 17 2021. It talks about alcohol and its impact on your type one diabetes care. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you want to check out Jenny, you can hire her at integrated diabetes.com. And if you want to check out the entire bold beginning series, it's available at juicebox podcast.com. Go to the menu at the top click on bold beginnings, you'll see all the episodes there. It's available in your podcast player, any audio app you're listening. And if you're looking for another list, but you don't want to go to the website, you can go to the feature tab in the private Facebook group Juicebox Podcast type one diabetes

this episode is ad free. But please remember to use the links if you have the need. They're in the audio app you're listening in right now in the show notes. Those links are also at juicebox podcast.com. Or you can type them into any browser. I appreciate you thinking about the podcast when you're making purchases when you support the podcast by using the links if you're keeping the podcast free and plentiful. And here's a couple of quick savings for you. If you'd like to start drinking ag one in the morning like I do drink ag one.com forward slash juice box the first time you buy at one with my link you'll get five free travel packs, and a year supply of vitamin D. And if you like comfort, comfort in your sheets, your towels and your clothing. Check out cozy earth.com If you find something you like put it in your cart. And when you're checking out use the offer code juice box to save 35% off your entire order not just one item, your entire order. Alright, check out this episode and please do not blow your fingers off. Happy Fourth. Hello friends and welcome to episode 596 of the Juicebox Podcast. Oh

so this is it. This is the last episode of the diabetes variable series with me and Jenny Smith. And today's topic is alcohol to see how I've timed that to coincide with New Year's. Hmm, that's right, I'm thinking. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before making any changes to your health care plan are becoming bold with insulin. Today I'll be speaking with Jenny Smith. Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast so come proper I really hope you've enjoyed the variable series if in the future Jenny and I think up other ones will add them but if not, they're always there for your needs and enjoyment.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. Jenny This is the last variable we're going to record. Oh, we've done it. It's very exciting.

Jennifer Smith, CDE 4:28
That is very exciting. A whole year of recordings are variable that's that's a lot of variables.

Scott Benner 4:32
I'm not kidding about it. At one point I looked at the list and I was like why did I like this is not a good idea. But it ended up being great and I really did enjoy it you obviously brought a ton to it. So last one alcohol How was alcohol a variable for for using insulin.

Jennifer Smith, CDE 4:52
but alcohol is a variable because alcohol can lower your body's ability tea to respond to the typical turnaround hormones that would raise blood sugar, you know, if you have a low, and so alcohol in and of itself, and we're talking like, several drinks, or even just one drink, depending on how your body tolerates alcohol. And many people I think are kind of confused what to do about alcohol because they feel like, well, if they're drinking, like, a hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it, and you should, you know, not not necessarily unless it's mixed with like cranberry juice or orange juice or something like that, right. But other types of alcohol such as beer, have a fair amount of alcohol to them. carbs, or sorry, yeah, the alcohol carbs. Yes, thank you. I was thinking alcohol, alcohol. Yes. So there's, you know, I mean, anywhere between 12 to maybe like 22 grams, depending on the size of the bottle or the can or whatever you're drinking, really? So do you cover the carbs? And then what happens later, right? Do you take insulin to cover the bottle of beer that you're drinking? Do you not what happens most people who don't cover the carbs initially will have a higher blood sugar.

Scott Benner 6:19
So is the concern around bolusing for carbs that are an alcohol that at some point, you become a knee braided and are not the best shepherd of your blood sugar, if it gets low?

Jennifer Smith, CDE 6:29
Those are the good questions to always be thinking about. Yes. Because in terms of low from alcohol, low from alcohol is a delayed low, it will tend to happen later on. So our typical recommendation on a normal conventional pump, it's a little more a little more, I guess, difficult if you're doing injections, but on a pump, it would usually say at the end of the night, let's say you've had several drinks over the course of the evening, it's midnight you get home at that point, you want to really decrease your Basal insulin delivery, because that's when alcohol is likely to come into the picture in terms of hitting you and causing you to go low.

Scott Benner 7:17
And is that the actual alcohol that's bringing you down? Or is that your? Or is it the Bolus that you used? Or no, if even if you didn't Bolus you would get low afterwards.

Jennifer Smith, CDE 7:28
It shouldn't really be the Bolus. I mean, again, bolusing has a definite like end point of action, right? Let's call it four hours, just give or take three to five hours, four hours. So if you last Bolus at 10 o'clock, you're low at 2am. Sure, it could have something to do with some of that Bolus still being left in the system. But it could also have to do with the way that the liver turns around and deals with, let's call alcohol a toxin, right. So as the liver is dealing with turning that alcohol around and getting rid of it in the body, your liver is also not putting out the typical turnaround for drop in blood sugar, right? You don't have that counterregulatory hormone production, so that your body has some glucose drip coming out of it saved stores to help you. So in that we usually say for every alcoholic beverage consumed, we really want to take the Basal rate down by a certain percent for about two hours per beverage consumed. Okay, so if you had three beverages at the end of the night, the percent that we would take it down would be by 40% of a decrease. And then the timeframe to decrease would be about two hours per beverage.

Scott Benner 8:45
Okay, so So you're basically people might not recognize that your liver is making glucose and you know and giving it is giving it off like Luca is it glucagon or glycogen or I forget the word,

Jennifer Smith, CDE 9:00
right? I mean, your body's counterregulatory hormones essentially coming from the liver or helping your body to essentially put out in the turret in terms of a low or a drop like that. It's helping your body to put out the glucose, right? I mean, that's why we have glucagon kits, right glucagon kit is a really quick turnaround of telling your body to spit out the glycogen and to turn it around into glucose to sort of bring you up from the low

Scott Benner 9:28
but if you're if you're taxing your body with enough alcohol, the liver gets focused on that. And then as your blood sugar gets low, it doesn't go through that process. In the same

Jennifer Smith, CDE 9:39
way, it doesn't go through that big process of counterregulatory. But also remember the reason that we're taking Basal insulin is to counter the production and natural drip drip of glucose into our system to begin with. So if the liver is busy taking care of alcohol, it's no longer going to help with that normal drip drip drip of glucose. Industrial Basal is going to be too heavy for you. Okay. In layman's terms, right? I mean,

Scott Benner 10:06
listen, I'm it's not a it's not a deep dive into how the liver works. But it is something I don't think people think about for certain,

Jennifer Smith, CDE 10:13
you know, and I think it's something that often isn't even brought up like I, I try really hard with a lot of the teens and those heading off to college that I work with, I try to bring up alcohol at some point, because it will come into the picture. Yeah, I mean, unless you're unless your kid has really sworn off because they just don't have any interest in that. At some point, alcohol will be something they need to think about. And it's really important that they know better how to adjust if needed, than just say, Well, I'm never going to do it.

Scott Benner 10:48
Right. Okay. Does this. Does this need a bigger episode? Or? What do you think?

Jennifer Smith, CDE 10:56
Come on. What do you have more? More questions?

Scott Benner 10:59
No, I just I don't know if it's, I don't know. I mean, it's like, you know, if you're, if it's beer, beer has carbs. If you're drinking, you know, some harder liquor, there's no carbs in them. But you have to look and see if you're going to add fruit juice just seems like maybe I could understand that when I start. But what happens when I'm like three drinks into it? Like, where do I? You know, what do I do when the when the room starts spinning? You know what I mean?

Jennifer Smith, CDE 11:22
Right? I mean, the big things with alcohol, too, that we always recommend is definitely have something to eat with it. Right? So it's not just alcohol. I mean, you probably know that. Or maybe you don't, I don't know, whether you drink or not. But if you don't, if you drink something on a pretty empty stomach, the impact of that alcohol is faster, right? You will feel the impact. Versus if you have it with a meal or at the end of the meal. Are you drinking along with the meal? It's much of a dumbed down. Impact. Yeah, which meal so then if you were expecting the impact of alcohol may lead you to drink more, because

Scott Benner 11:59
I'm also that there might be people who are wanting to get to that spot, too. It's a really difficult thing to talk about, because you're talking about it from the perspective of how do I do this responsibly? And I don't know that everybody starts an evening of drinking with that in mind to begin with, right?

Jennifer Smith, CDE 12:18
Correct. And you also have to consider like, I much feel like if, and I've only been drunk a handful of times, I'm not a drinker. I I'm, in fact, I came, I think the last time I was drunk was probably at my brother's wedding in Aruba. And that was a long time ago. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar. Okay, those tip sees types of and maybe that's not a symptom of yours, but I very much have a similar feeling with alcohol as well as with a low blood sugar. Yeah. So then comes into the equation, you're also already not really thinking very well, because you have alcohol on board. Is your symptom of being drunk? Also a symptom of a low that you're not paying attention to?

Scott Benner 13:15
Yeah. And how are you going to be able to handle that, um, so I'm just thinking of a person I met recently, whose son was away at college and was not a drinker, not a drinker, and then all of a sudden, one night just dove headfirst into it. And then this person had to, like, drive to a place to like, rescue the kid and take them to a hospital. Yes, you know, because then the next problem is, is that you're now around a bunch of drunk people, no one's going to be able to help you. Like, you know, you. It's not like you have a designated, what if my blood sugar gets low person here? You know, right,

Jennifer Smith, CDE 13:49
right. I mean, it's a reason in college that I 98% of the time, I offered to be the driver, when we would go out. And I might have knowing that we were going to be out for a fair number of hours, I might have like, half a beer when we got there. And then I had nothing else the rest of the night giving it a good like four hours of clearance time to be able to be like the driver hole.

Scott Benner 14:16
I can say with confidence that in my life, I haven't had the equivalent of a case of beer. Like I just don't drink for no reason that I can particularly point out to you other than it's not interesting to me. It's just not a preference. Yeah, it's not for me, I just I don't know, like I don't even know how you like consume that much. Like I have a bottle of like, flavored like peppy water here. And if I tried to drink this whole bottle, I'd be like, oh, like it can't really be too much. happens when you start putting like hops and barley into it. I'd be like, Oh, I'm so full. But yeah, but anyway, all right. I appreciate this. I know it's it's not an easy. It's not an easy conversation, because there's a lot of perspectives that that need to be taken into account. But I think in general, I mean, at least you could Try to follow what Jenny was saying about decreasing your basil. And, and, you know, I would add, you know, you gotta have I would want to have somebody there that understood my diabetes a little bit who wasn't drinking, but

Jennifer Smith, CDE 15:12
correct? Absolutely. And I mean even people ask even about wine, you know, a glass of wine, typical table wine is somewhere between three to five grams of carb, per you know, glass, should you cover that? I think a lot of it is also experience, right? What do you know about what has happened and along with what you said, make sure somebody is there who knows, you knows you have diabetes knows how to help you if you don't seem to be acting, the way that you normally would be acting. Because all of those things very much like all of the things with diabetes in general, take a little bit of experimentation. And you have to figure out what works the best for you.

Scott Benner 15:54
Let me let you I know you have to go. But let me ask you this, because I think I remember that this is true. When I'm drinking my glucagon won't work as well, right? That is right. Yeah. Okay. So if you're thinking doesn't matter, if I pass out, I'll just use my glucagon, it might not help. It will. I

Jennifer Smith, CDE 16:13
mean, will it turn things around versus nothing at all? Yeah, but it's not going to be the the same impact from what I recall. And I would I mean, it certainly would look it back up, but I'm quite certain nothing has changed about the recommendations and what we know about your glucagon kit and alcohol in the mix together.

Scott Benner 16:33
Yes. So read the label on your glucagon if you're expecting it to save you when you're, you're drunk, because it might not be as impactful as you're hoping. Okay. That somehow we made drinking sad, and I'm sure everybody oh

Jennifer Smith, CDE 16:51
well, people don't see us so they can't tell whether we're smiling or

Scott Benner 16:55
having a great time talking about I'm like, I just started thinking like we're taking the thing or people like oh, my, my Saturday night happy place. These guys are bumming me out. All right, well, thank you so much. G voc hypo pan has no visible needle, and is the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. And the diabetes variable series began I guess technically at episode 231 with the pro tip called diabetes pro tip variables but then the variables proper began at 491 with trampoline followed by temperature travel exercise hydration, food quality leaky sites and tunneling video games stress masturbation school bedsides, growth hormone sleep pump site placement, a full moon diabetes tech weight change Walmart, the final episode sort of the last episode menopause and today's episode, alcohol. Check them out. They're all available in your podcast player. We're at juicebox podcast.com. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And now I will sing the simple version of your Grand Old Flag for the Fourth of July. You're right Grand Old Flag Euro Hi Fi in flag you're forever in peace may you weigh in. You are the emblem of the lion that I love the home of the free and the brave. Every part beach true neath the red, white and blue where there's never a boast or brag. Sure Should old acquaintance be forgot. Keep your eye on the Grand Old Flag. Never had a lesson one take for those of you who don't live in America or hate us. I'm sorry about that. Actually, for those of you with ears, I'm sorry about that. Please don't unsubscribe. I'll be back very soon with another episode of The Juicebox Podcast.