Does Ethanol Cause Hypoglycaemia in Overnight Fasted Patients with Type 1 Diabetes?

Abstract

Drinking ethanol is widely believed to predispose to hypoglycaemia in patients with Type 1 diabetes, the suggested mechanism being suppression of hepatic gluconeogenesis. The hypoglycaemic effect of ethanol was investigated by measuring steady-state glucose infusion rate during a hypoinsulinaemic (mean plasma insulin 14 +/- 1.3 (SEM) mU l-1), euglycaemic (blood glucose 5 mmol l-1) clamp. Nine patients with Type 1 diabetes fasted overnight and then had, in single-blind fashion, ethanol 0.5 g kg-1 by intravenous bolus followed by 0.25 g kg-1 h-1 or matched volumes of saline. After 1 h of ethanol or saline, all infusions were stopped and blood glucose monitored for a further 90 min. A 60-min ethanol infusion leading to a steady-state blood concentration of 26.2 +/- 1.4 mmol l-1 (120.7 mg %) did not alter the glucose infusion rate needed to maintain euglycaemia (1.22 +/- 0.12 mg kg-1 min-1 before and 1.23 +/- 0.12 during ethanol infusion), the initial rate of fall of blood glucose (ethanol 0.039 mmol l-1 min-1 vs control (0.033), the lowest blood glucose (4.43 mmol l-1 vs 4.31), or the rate of blood glucose recovery (ethanol 0.050 mmol l-1 min-1 vs control 0.054). We conclude that a moderate amount of ethanol, administered intravenously under controlled conditions, does not lead to hypoglycaemia in patients with Type 1 diabetes who have fasted overnight.

The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes

“…In type 1 diabetes, gluconeogenesis is responsible for a signifi- cant proportion of increased basal hepatic glucose output, and patients may therefore be more sensitive to ethanol. However, in a study of fasted type 1 diabetes controlled by hypoinsulinemic clamp, there was no difference in glucose response to a 1-h infusion of ethanol (peak level 26.2 mmol/l) or saline (11). In nondiabetic subjects, reduced glucose production seems to be matched by inhibition of glucose utilization (probably by acetate) at low and moderate ethanol concentrations (4 -14 mmol/l) (18).…”

“…Studies of diabetic patients have failed to show any short-term effect of moderate alcohol intake with a meal (9,10) or alcohol administered intravenously after an overnight fast (11). However, some authors report an increased risk of hypoglycemia in the morning, 12-16 h after consumption of an alcoholic beverage in the evening (12,13).…”

Ethanol Stimulates Glycogenolysis and Inhibits both Glycogenesis via Gluconeogenesis and from Exogenous Glucose in Perfused Rat Liver

“…It is commonly recognized that ethanol intake inhibits gluconeogenesis and decreases glycogen content to induce hypoglycemia [13,14]. The incidence of ethanol-induced hypoglycemia, however, is unexpectedly rare in patients with insulindependent diabetes mellitus [15]. The hepatic glucose metabolism is very complex, i.e.…”

Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: A neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry

“…Compared to the European average, the number of German 15 to 16‐year‐old adolescents who drink alcohol is higher (89% vs 79% within the past 12 months, 73% vs 57% within the past 30 days), and slightly more alcohol is consumed during each drinking day (44 vs 40 g) . Besides the general risks of high alcohol consumption, some small studies suggested an increased risk of hypoglycemia and ketoacidosis after consuming alcohol in patients with type 1 diabetes mellitus, while others found no change in blood glucose or occurrence of hypoglycemia after moderate alcohol use in the evening . One study in an uncontrolled social context observed increased glycemic variation, but no low glucose levels after moderate alcohol consumption …”