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Alcohol in diabetes
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Tea and diabetes

Alcohol in diabetes: educational and psychological aspects

INTERNATIONAL JOURNAL OF METABOLISM (Vol. VI No 9)

Alcohol consumption

In Western countries, 80% to 85% of people drink alcohol. The majority of these have no alcohol-related problems(1). Some people drink above the WHO recommended limits (2 to 3 glasses/day, Figure 1) with consequent problems, such as insomnia, excess weight, pancreatitis, cirrhosis, and high blood pressure(2). The situation chages when the person in alcohol-dependent, because of an inability to control alcohol intake. Alcohol was previously prohibited for diabetics, especially type 1 diabetic patients, because doctors were worried about interaction between alcohol and glucose metabolisms. Now however, they may drink alcohol, provided they follow some general principles(3).

Moderate alcohol consumption

Numerous studies have demonstrated a beneficial effect of alcohol intake on cardiovascular mortality(4). What should we tell diabetics about this ? Diabetes increases the risk of cardiovascular morbidity and mortality, and so, although patients should not be encouraged to drink in order to reduce the those risks, those who have a moderate consumption should not suffer any undue effects. The American Diabetes Association recommends not more than 1 to 2 glasses/day.

Influence of alcohol on hypoglycaemia and hyperglycemia


Patients should be taught never to drink without eating some carbohydrate because of the threat of hypoglycaemia, and told that if they do, they are putting themselves at risk. Moreover, when they eat normally, but drink too much, their blood sugar will have a strong tendency to rise. Blood sugar must be measured about 1 hour after alcohol consumption in order to evaluate the hypo/hyper effect and the patient should take the appropriate preventive steps(5).

Excessive alcohol consumption

The effects of excessive consumption are well known, eg, glucose intolerance(6). Diabetics who consume excessive alcohol have a higher mortality rate than those who drink moderately. Excessive alcohol intake is also associated with poor adherence to diabetes treatment (insulin and/or diet). Because these patients have no or very little alcohol dependence, they should be advised to reduce their consumption to a maximum of 2 glasses/day(7).

Doctors should regularly assess alcohol intake, particularly when glycemic levels increase, or diabetics fail to reduce weight without an obvious reason. In the latter case, doctors should reevaluate the reasons why alcohol intake remains high or consider the possibility of alcohol dependence. Sometimes alcohol-dependent patients become diabetic, either because they drink heavy amounts of alcohol, provoking glucose intolerance or insulin resistance, or due to chronic pancreatitis-provoked type 1 diabetes. Weight reduction becomes more problematic to sustain and so abstinence is highly recommended : (a) because abstinence will improve glucose metabolism and insulin resistance, and reduce the risks of hypoglycaemia; and (b) because of the patient’s definitive inability to control consumption.

Relapses frequently occur because patients drink after a period of abstinence, believing they can once again control their consumption. Doctors should be aware of this phenomenon. Therefore continued abstinence is the only way of recovering from alcohol dependence(8). Positive effects on adherence to antidiabetic treatment will accur quickly. Patients feel encouraged to maintain this new behavior, despite its high level of difficulty.

Alcohol consumption can be managed well by diabetics. This may decrease cardiovascular risks in those with low to moderate consumption. Excessive drinkers should be identified and advised to reduce their intake. Alcohol-dependent patients have high risks of worsening their diabetes and any complications. Abstinence is recommended. Diabetics with advanced complications such as neuropathy must stop drinking.

P. GACHE, J.P. ASSAL - Geneva, Switzerland


References
1. Edwards G. BMJ. 1996;312:1 2. O’Connor P, Schottenfeld RS. N Engl J Med. 1998; 338:592-601. 3. Connor H, Marks V. Diabet Med. 1985 2:413-416. 4. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. BMJ 1999;319:1523-1528 5. Bell DS. Diabetes Care. 1996;5:509-513. 6. Shanley BC, Robertson EJ, Joubert SM, North-Coombes JD. Lancet. 1972;1232. 7. Moyer A et al. Addiction. 2002;97:279-292. 8. Weiss F, Porrino LJ. J Neurosci. 2002:22:3332-3337.

Figure 1

One standard drink = 10g pure alcohol
               
7 cl 2,5 cl 10 cl 25 cl 2,5 cl 2,5 cl 25 cl 10 cl
               
Aperitif Brandy Champa-gne Dry Cider Whisky Aniseed Aperitif Beer Red/white wine
               
18° 45° 12° 45° 45° 12°
 

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