by Pops » Wed 19 Aug 2015, 09:47:47
TLDR unless you are really interested, LoL
Alcohol is a funny thing.
The biggest hassle with T1 is manually managing blood sugar within a good range. BS too high, too long causes your toes to fall off and other unfortunate things to happen. T1 & T2 are similar in that respect but for T1s, the short run, day to day, hour to hour bigger task is preventing and treating low blood sugar rather than high. Low blood sugar can kill you at worst, it can cause you to have seizures that are very unpleasant for the folks around you to witness, and even a mild case can be debilitating as it affects personality, cognitive ability, coordination, blah, blah. I've learned that if I am wrenching for example, and I just can't get a nut to start no matter how hard I try, I need to check my BS. 9 of 10 times I'll be low, not dangerously but enough to affect my already limited brain waves.
Blood sugar is reduced by insulin and exercise and increased by food carbs but also by the liver creating glucose from fat and protein. The liver can produce somewhere around 125g a day IIRC which is why carbs aren't necessarily a daily requirement. One reason you can't treat T1 simply by eliminating carbs from your diet is the liver will produce glucose anytime there is no insulin in the bloodstream. The pancreas is the glucose monitor, when it senses sugar, it produces insulin, which, among other things, indicates to the liver to stop gluconeogenesis. It is a great adaptation that keeps us alive between trips to the snack drawer; eat carbs/fat/protein, store as fat, convert fat to glucose as needed.
Just as soon as you think you are going to eat, that same "mouth watering" signal causes the pancreas to squirt out a big dose of insulin into the bile duct and straight into the liver. Liver goes, "ah, food coming" and stops gluconeogenesis.
In addition to the Beta cells in the pancreas producing insulin in response to "mouth water" signal, they respond to blood sugar levels above a set point. The Alpha cells in the pancreas produce another hormone below a set point, glucagon. It is the "gimme sugar" indicator. It causes the liver to squirt out stored up sugar kept there in reserve.
I use a long acting insulin, kind of a 24 hour timed release deal. I take one shot a day to maintain a constant low insulin level that keeps my liver from overproducing sugar. It really is the great deal but the flip side of that constant level of insulin is when my BS gets too low (because I haven't eaten enough carbs or I exercise too much) my liver is not going to increase production of glucose as readily, sort of a Sweeeet Power-Stand; mashing the brake and throttle at the same time. So I get low.
So now back to alcohol. Alcohol is a carb, and I think the pancreas just ignores it but when the liver sees alcohol it says "hey, don't need to make any glucose, we'll just use that" and goes to work metabolizing the alcohol and forgets about making glucose. That is where the problems start because remember, I have a time release load of insulin on board that is also telling the liver to reduce gluconeogenesis and at the same time busy locking away glucose in tissue elsewhere.
So, when you drink, your blood sugar can rise on the calories. But it can also fall. The liver takes a break from it's regular program and concentrates on the alcohol, and depending on how much insulin you have on, what you've eaten, how much breakdancing you do, your BS can crash. Like everything else, it is pretty hard to predict exactly what will happen because so many factors are involved. And it is even worse if you are really trying to keep you BS low to begin with since there is not a lot of wiggle room
But the worst thing is, low blood sugar mimics the effects of alcohol in some ways so it can be hard to tell whether you have a buzz on and are on the floor breakdancing or your blood sugar is low and you are flopping around in a seizure.
I haven't had a drink since I got out of the hospital in '09. Which kinda sucks because I like me some beers! But I know how scary hypoglycemia can be to bystanders, my stepdaughter developed T1 when she was around 4 and I don't want to put my wife through that.
The legitimate object of government, is to do for a community of people, whatever they need to have done, but can not do, at all, or can not, so well do, for themselves -- in their separate, and individual capacities.
-- Abraham Lincoln, Fragment on Government (July 1, 1854)