If you use an insulin pump there are a few particular things you need to be aware of if you’re drinking alcohol. The following frequently asked questions should cover what you need to know.
Q. How can I prevent hypos?
A. You are at risk of having a hypo both while you’re drinking alcohol and afterwards. The ‘hypo effect’ can last for up to 16 hours after you stop drinking, and so you may need to eat more carbohydrate or use a reduced temporary basal rate to counteract it. It is sensible to have a carbohydrate-based meal or snack with your normal bolus dose before you start drinking. You may want to put your pump on a reduced temporary basal rate while you’re drinking if you are active (e.g. walking home or going dancing) or if you’re having sugar-free alcoholic drinks.
To prevent overnight hypos after drinking alcohol, you can try having a bedtime snack with no additional bolus insulin. If you find that this leads to a very high blood glucose level at breakfast, then consider taking a very small bolus dose with your pre-bed snack next time you are in this situation. You should discuss your plans with your pump team, as taking too much insulin will put you at risk of a hypo. They may advise you to use a lower temporary basal rate overnight.
Many people experience delayed hypos the day after they drink alcohol. To prevent this you could try a reduced bolus dose at breakfast and/or a reduced temporary basal rate. What works best will depend on how much you had to drink and what your activity levels are during the morning. Again, it is all a matter of trial and error until you can predict how your body will react.
Q. Can anything else put me at risk of a hypo when I’m drinking alcohol?
A.Walking between bars, walking home, dancing, having sex – all these things can cause your blood glucose to drop further as they are forms of exercise. You may need to eat extra carbohydrate or use a temporary lower basal rate.
Q. What happens if I drink something sugary?
A. If you decide to drink alcohol containing sugar, such as alcopops, normal mixers, cider, some beer or lager, you may notice your blood glucose levels rise initially. If this happens you will need to take a bolus dose. If you take the full dose this may cause a hypo, so try reducing the dose and taking, for example, half your normal dose. Again, it is all a matter of trial and error until you see what works.
Q. Can I take a correction dose if my blood glucose goes too high?
A. It is very important to be cautious with correction doses as taking too much is a common cause of hypos when drinking alcohol. You may need only a half or even a quarter of the recommended correction dose to lower your blood glucose to your target level. It is safer to under-correct and gradually increase the correction dose as you become familiar with the effects of alcohol and insulin on your blood glucose. If your blood glucose is high remember to check for ketones.
Q. How can I best work out what to do?
A. The best way to work out how to adjust your insulin is by carrying out frequent blood glucose tests while you are drinking, and keeping a record of the type of alcohol you drank, the amount, what you ate and how you adjusted your insulin. This will allow you to see if it worked or if you should try something different next time by tweaking your insulin and/or carbohydrate intake.