About Alcohol and Diabetes

Why people with diabetes should avoid alcohol.

• Maintaining ideal weight is a very important task for good control of diabetes for people with Type 2 diabetes. Therefore the less alcohol they consume, the better they can control their weight.

1. Alcohol increases the appetite so people with diabetes may tend to overeat and this affects their efforts to keep blood glucose under control. 
2. Alcohol can influence a person’s choice of food leading to consumption of the wrong kind of food.  

     3.  Alcohol has a high caloric content and not many other nutrients. This is not really a good thing for people counting calories. 

• Alcohol tends to lower blood glucose.  This is of  great importance to people with diabetes who are on insulin.

• Alcohol can interfere with or change the effects of medicines such as metformin and sulfonylureas which are used to treat diabetes. It can result in side effects from insulin use.
• Some of the signs of too much alcohol such as flushing, nausea, increased heart rate, slurred speech are also symptoms of hypoglycaemia. People with diabetes may not be able to recognize a hypo and take the required action in time. People around them may not recognise a hypo but instead think that a person having a hypo has had too much to drink!
• Heavy drinking can also cause a build-up of ketone bodies in people with diabetes, which can result in medical complications related to diabetes such as retinopathy and neuropathy says health psychologist Dr. Nicola Davies.
• Alcohol abuse can also cause changes in lipid metabolism, raised triglyceride levels, high blood pressure, cardiovascular disease, peripheral neuropathy, and impotence. 

The effect of alcohol on diabetes varies considerably depending on whether it is consumed by well-nourished individuals when blood glucose levels are high or in a ‘fasting’ state when blood glucose levels are low.

Alcohol affects diabetes by causing insulin resistance and also affects insulin secretion in the body. Consuming too much alcohol can result in ‘alcohol induced insulin resistance’ which may lead to hyper glycaemia in well- nourished people with diabetes.

Consuming excess alcohol and not eating can cause blood glucose levels to drop resulting in ‘alcohol induced hypoglycaemia’. This can result in permanent neurological changes or even death. 

But what if a person with diabetes is in a social situation such as a party, a wedding, a get- together or just enjoys an occasional drink?

Responsible drinking - What every person with diabetes should know:

Make sure your diabetes is well controlled, take the right precautions, know your boundaries, and most important of all … be aware of the effect of alcohol on diabetes.

• Understand the importance of moderation or self- control and know how much you are allowed to drink and do not cross that line.
• Eat before you have a drink to prevent a  ‘hypo’
• Have a non- alcoholic drink between drinks. Quench your thirst with water, not the alcohol. 
• Sip your drink. Don’t gulp it down.
• If diabetes is being treated with insulin or sulfonylureas, do not drink immediately before or after exercise or physical activity because blood glucose falls naturally during exercise and there is a risk of a ‘hypo’.
• People with Type 1 Diabetes mellitus need to calculate the carb content of both the drink and the food.
• Do not mix alcohol and fruit juice as the calorie level goes up very high. 
• Wear diabetes identification if drinking outside home.

Please consult our dietitian for further information  

(Reference : Diabetes Update Winter 2014)

Glucose intolerance recognized for the first time during pregnancy.

                                                                        Dr. Mitalee Barman

CAUSES:
Placental hormones, human placental lactogen and placental growth hormone, which are meant  to shunt nutrients to the fetus, cause worsening of insulin resistance during the late 2nd trimester

Mothers are unable to produce enough insulin to overcome the overwhelming resistance to maintain normal blood glucose levels.

DIAGNOSTIC CRITERIA

All pregnant women should undergo a 2 hour 75 gm- oral glucose tolerance test between the 24th and 28th week of pregnancy.

Fasting – 92 mg/dl 

1 hr       - 180 mg/dl

2 hr       - 153 mg/dl

Gestational diabetes mellitus is diagnosed if any 2 values are equal to, meet, or exceed the values given above.

FOLLOW UP: 

• Every 3 weeks till 28 weeks of pregnancy
• Every 2 weeks from 29 weeks to 34 weeks of pregnancy
• Every week from 35 wks to term
• Every 2 weeks from 29 weeks to term, if not on insulin. 

AFTER DELIVERY    

RISK FACTORS FOR TYPE 2 DIABETES MELLITUS FOLLOWING GESTATIONAL DIABETES MELLITUS

Unmodifiable risk factors                                                          Modifiable risk factors

Ethnicity                                                                                         Obesity

Age                                                                                                  Future weight gain 

Family history

Degree of hyperglycemia in pregnancy

SCREENING:

6-12 weeks after delivery, a follow up of 75 gm oral glucose tolerance test (GTT) should be performed to determine the women’s risk of developing diabetes and her status. If found normal , GTT should be repeated after 6 months and then after each year.

PREVENTION:

           Women who have had gestational diabetes mellitus are at a heightened risk for type 2 diabetes mellitus and so the best advice is:

• A LOW FAT DIET

• AVOIDANCE OF OBESITY   

• REGULAR EXERCISE.

A New Treatment for Diabetes?

Researchers at the Salk Institute for Biological Studies in California have shown that a single injection of a protein called Fibroblast Growth Factor (FGF1) is enough to restore blood sugar levels to a healthy range for more than two days in mice with diet -induced diabetes (the same as Type 2 Diabetes Mellitus in humans). The research is in its early stages so how this happens is still not known but scientists know that it works in a similar way to the existing diabetes drugs- glitazones by making cells more sensitive to insulin and thereby reducing blood glucose levels.

Glitazones can have side effects such as weight gain or heart problems in humans but this is not the case with FGF1. Researchers found that FGF1 did not set off these side effects or cause glucose levels to drop to very low levels, a risk factor associated with many glucose-lowering agents. Instead, the injections restored the body's own ability to naturally regulate insulin and blood sugar levels, keeping glucose amounts within a safe range.

Once perfected, it can become a very safe and effective alternative to controlling diabetes.

Diabetes Update - Autumn 2014