Public health

Diabetes and alcohol: “I’m here for a good time, not a long time”

Young adults with type 1 diabetes like to drink as much as other young people and this puts them at risk of “close call” hypoglycaemic events, a Victorian study shows.

Almost 80% of young people with T1D aged 18-29 engage in occasional binge drinking (more than four standard drinks in one session) but they are reluctant to disclose their risk-taking behaviour to their doctor because of stigma, according to a survey carried out by doctors at St Vincent’s Hospital, Melbourne.

Presenting the results at ADC 2018, addiction medicine specialist Dr Adam Pastor said many of the young people already took some ‘staying safe’  measures such as bringing lollies with them when drinking, but it was important for health professional to raise this issue in a non-judgemental way and provide clear messages about harm minimisation measures.

His survey of 91 young adults found that most did not let their diabetes deter them from consuming alcohol, and there was wide variation in their understanding of the effect of alcohol on blood glucose levels.

About 60% said they would only go drinking if accompanied by a friend who knew about their diabetes, about half said they would carry carbohydrates and make sure to eat according to their regular pattern when drinking.

“I definitely know that I test my sugars a lot,” said one participant. “I feel like you don’t really switch off from that and I’m still very aware of what’s happening, even if I’m in the middle of the dance floor,” she said.

However, only 10% said they would talk to a health professional for advice on what to do.

The study also found that some young people had difficulty telling the difference between symptoms of hypoglycaemia and being drunk or having a hangover.

And worryingly, when 20 of the participants used flash glucose monitoring for 6 weeks to assess the effect of social drinking, this revealed hazardous episodes of nocturnal hypoglycaemia after drinking in some. In two cases the young people had blood glucose levels persistently below 5.6mmol/L while they slept off the effects of alcohol, with levels going as low as 2 mmol/L for extended periods.

“I know when I wake up the next day and I’ll do a blood test, it’s like that explains things. I’m not just hungover, I’m like really hypo,” commented one participant after drinking on Melbourne Cup Day.

Dr Pastor said the findings showed that young people with diabetes were using alcohol in much the same way as their peers, and there was a need for health professionals to be aware of this and raise the issue in a non-threatening manner so as to provide counselling on harm minimisation methods.

The survey responses showed that young people with diabetes felt that drinking was a taboo subject and would elicit disapproval and strong warnings from their doctor.

“I’ve learnt to just acknowledge the drinking and be quite agnostic about this,” he said. “One interesting question I use it to ask the patient what close calls they’ve had while drinking and almost all have some story to tell,” he said.

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