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Alcohol and hypoglycaemia in type 1 diabetes (#357)

Sally Vindedzis 1 , Beryl Marsh 1 , Jill Sherriff 2 , Kim Stanton 1
  1. Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, WA, Australia
  2. School of Public Health, Curtin University, Bentley, WA, Australia

In type 1 diabetes alcohol can significantly reduce bgl 10-12h post-consumption1 with an increased risk lasting 24h.2 Hypoglycaemic risk is dose-related and can be reduced with judicious carbohydrate consumption and long-acting insulin reduction where necessary.3 We aimed to audit diabetes association guidelines as an indicator of available information on this topic and also assess knowledge of alcohol and hypoglycaemia in adults with type 1 diabetes by means of a questionnaire.

Methods: 1) Diabetes association guidelines for 6 countries were audited for key points pertinent to hypoglycaemia and alcohol. 2) Questionnaires were distributed to 50 consecutive adults with type 1 diabetes, attending routine outpatient clinics. The questionnaire was anonymous, consent was presumed by its return to a designated sealed box. Questions covered hypoglycaemic effect of alcohol, time-line for hypoglycaemia and number of standard drinks perceived to cause hypoglycaemia.

Results: 1) Association guidelines were accessed for Australia, UK, USA, Canada, New Zealand and Singapore. All guidelines provided information on alcohol and hypoglycaemia, eating with, and snacking after alcohol, and sustained hypoglycaemic effect, but the time-line given for this varied from 16h (UK) to 24h (Australia, USA, Canada). Only Australia and New Zealand provided information on insulin reduction. 2) Questionnaires were returned by 37 (74%) participants. Diabetes duration was 16.5±11.9y and treatment basal-bolus (83.8%) and CSII (16.2%). The hypoglycaemic effect of alcohol was understood by 88.2% of responders, but only 32.4% knew the time-line of 4+ hours post-consumption. Standard drink quantity perceived to lower bgl was: 1-3 (50%) and 4+ ( 41.2%).

Conclusions: General knowledge of alcohol and hypoglycaemia was fairly good in this group except in the important area of timing of alcohol-induced hypoglycaemia. This is consistent with worldwide guidelines which are variable in this area. Additionally, only 2 of the 6 guidelines provided information on reduction of long-acting insulin to minimize hypoglycaemic risk.

  1. Plougmann S, Hejlesen O, Turner B, Kerr D, Cavan D. The effect of alcohol on blood glucose in Type 1 diabetes--metabolic modelling and integration in a decision support system. Int J Med Inform. 2003 Jul;70(2-3):337-44. PubMed PMID: 12909186. Epub 2003/08/12. eng.
  2. Richardson T, Weiss M, Thomas P, Kerr D. Day After the Night Before: Influence of evening alcohol on risk of hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2005;28(7):1801-2. PubMed PMID: 223065556; 15983341. English.
  3. Choudhary P, Amiel SA. Hypoglycaemia: current management and controversies. Postgrad Med J. 2011 Apr;87(1026):298-306. PubMed PMID: 21296797. Epub 2011/02/08. eng.
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