Written by Wil Dubois | Type ONE

Today, we bring you a special edition of our weekly advice column, Ask D’Mine. Your host, type 1 diabetes author and educator Wil Dubois has a few things to say about drinking with diabetes. {Got questions? As usual, email us at AskDMine@diabetesmine.com}

One of my type 1 patients is in jail today. Something involving a firearm and a bottle of whiskey downtown. He was so drunk he was shooting into the air.

He’s 15 years old.

Before this happened, his mother had specifically asked me not to talk to him about diabetes and alcohol. He wasn’t that kind of boy, you see. She was afraid I might put ideas in his head. Ideas that were apparently very much there already. Ideas with no facts and information to balance them.

So today, instead of our usual Q&A format, I’m writing today’s Ask D’Mine as an open letter to all my little brothers and sisters. To tell you what I should have told him.

Dear Type 1 Teens and College-types:
Today I’m going to teach you how to get wasted safely. I’m not saying you should. I’m not saying I want you to. But if you are going to, I want you to know the dangers, and I want you to know how to do it right.

Why? Because no one else will frickin’ tell you. Your parents won’t. Your grandparents won’t. Your doctors won’t. Your educators won’t. Your teachers won’t. Your priests won’t. But I will.

I call all young type 1s my little brothers or sisters, but I today I’m thinking of you as my nieces and nephews. Yep, I’m the Uncle your mother really wishes would just join the Merchant Marines and never visit until after you’re all grown up. I’m the perceived bad influence. The tattooed guy who swears, smokes, drinks, flirts with all the women in the room, and makes politically incorrect jokes.

But God puts people into families for a reason. And the black-sheep uncle has an important role to fill: the adult who cares but does not judge.

To drink safely you need to first understand how alcohol affects you and me differently than it does the sugar-normals. Do you know anything about your liver? It does all kinds of things for your body. It has more than 500 different functions, actually. But most importantly to our discussion today: It’s a blood filter. It removes toxins from your blood. Toxins like alcohol.

But the liver only does one thing at a time. Everyone and everything else just has to take a number and stand in line until it’s finished the job at hand. And on that list of 500 jobs is “remove excess insulin.” Unless, of course, alcohol is in line first. Then the insulin just builds up in your blood while your liver is dealing with the alcohol. It takes hours for the liver to “clear” a good binge, and all that time the insulin stays in your system. It’s like taking an extra shot of basal. Big-time hypos hit 8-10 hours downstream from last call, when you’re sleeping it off.

Oh, and when you’ve been drinking, your body will respond more sluggishly to the treatment of those lows. The rebound will be a lot slower than you’re used to. So don’t panic, just be prepared for a 2-3 times longer “recovery” than you’d experience with sober lows. Booze also reduces your awareness of lows overall, and sometimes even triggers a temporary state of hypoglycemia unawareness. So be aware that you may not be aware, OK?

If you want to learn more about the biology of booze, check this out. But the important message is that booze screws with your diabetic body differently than it does for all your non-D friends. And you need to plan for that fact.

So Uncle Wil, you ask, how do I get totally shit-faced drunk off my ass safely? Look, the only way to play Russian Roulette safely is with an empty gun. Oh dear. Now I’ve gone and introduced your impressionable little minds to Russian Roulette, too. Your mother is going to throw me out of the house.

The stone cold sober truth: for people with type 1 diabetes, there is no safe way to get four sheets to the wind. Hang on! Keep reading!

I know that sounds like a typical “adult” cop-out answer. But it’s true, and it’s why most adults just throw in the towel at this point and say “Just don’t drink!” But I’m a realist. I know you will still get wasted, no matter what the risks.

I don’t have any magic bullets, or secret formulas to let you binge in safety. No two young type 1s are alike, and no two binges are alike. That said, here are my tips for making this dangerous undertaking as safe as possible. Three things to consider before the first sip –

One: To bolus or not to bolus? Should you bolus for beer or mixers? Both have carbs. Sometimes a lot of carbs. Logically, you should cover those carbs. But the alcohol in the drink will supersize the insulin downstream, remember? What to do? There’s no right answer here, and the drunker you get, the worse you’ll count carbs, the worse you’ll calculate the bolus, and the less you’ll care. I suggest cutting your bolus down. Should you take half what you normally would? A third? Sorry, I don’t know. But some amount less should be in your game plan.

Two: To eat drink and be merry requires eating. If you’re not throwing up, and even if you are, I think you should eat a snack before you sleep it off. Something high in fat so that it takes a long time to work through your system. That slice of cold pizza on the floor will do the trick. Don’t cover it with insulin unless you are insanely high at bedtime. You’ll want carbs in your system to soak up the insulin that the liver isn’t filtering away.

Three: No alcohol and heavy machinery. If you’re wasted, can you drive a forklift safely? No? Then what makes you think you can drive an insulin pump safely? Or a glucometer, for that matter? If you are really out of it, can you make good treatment decisions? Smart adults choose a designated driver when they go out drinking in packs. Is there anyone in your group who can serve in that role? If so, does that person understand diabetes well enough to help? Is that person reliable? Is he or she the kind of person that’ll wipe the vomit off your hands and check your blood sugar at 3 a.m. while you’re sleeping it off? Or will they be passed out on the other side of the room?

Well, that’s it. Alcohol supersizes your insulin and sets you up for epic lows hours later when you’re likely to be asleep. It blunts your ability to feel those lows, and slows down your recovery if you do feel them and are sober enough to deal with it. But you can lower your risk of all of those scary things by thinking and planning ahead and…Oh, crap! I forgot to tell you about the Zombies.

My tattoo artist has a glass case in his studio with a faux chainsaw in it. Stenciled in bold red letters on the case is: BREAK GLASS IN CASE OF ZOMBIE ATTACK. So let’s pretend there’s been a Zombie attack. Steps behind you is a shuffling, stinking, moaning mob of the undead intent on tearing you to shreds, drinking your blood, and feasting on your flesh. You barely make it to the case in time, grab the hammer, and… Crap! The case is empty.

This doesn’t look good for the home team.

You know what? If you drink too many Tactical Nuclear Penguins, your glucagon emergency kit case might just as well be empty, too.

I bet your endo never told you, but, glucagon does not work when you are drunk.

A drunk liver won’t dump its stores of sugar on demand. I’m not saying your peers shouldn’t try giving you a shot if you have a seizure, but realistically, it won’t work. When you’re drunk, the break-glass-in-case-of-emergency cabinet is empty. The only way to save your life if you have a severe hypo when plastered is to get an IV of dextrose in the back of an ambulance or at the hospital ER. So wear your damn medic alert when you go drinking—if the paramedics smell booze on your passed out carcass, they probably won’t think to check your blood sugar.

The lesson here, my dear nieces and nephews, is don’t let your drinking get to the Zombie attack point. Plan ahead the best you can. If you drink to get drunk—or find you’re way well down that road—please get the carbs in and get the insulin out. If you’re pumping, turn down the basal or take the pump off. If you shoot up and you haven’t taken your basal yet, take less, or maybe even skip it. If you’ve already taken your basal, skip the fast-acting insulin and eat a snack.

Can you get drunk safely? No. Not really. But now you have the tools to do it as safely as possible, because I want each of you to grow up and become a black-sheep uncle or aunt for the next generation.
Much love,
Uncle Wil

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.