Alcohol and Diabetes - Mount Sinai Hospital

More documents

Recommendations

Info

Question 5: My client has type 1 diabetes. Graduation is coming up and drinking more than the recommended guidelines is a strong possibility. What do I need to discuss? Answer: An educator should remind the person to: - Wear identification indicating that the diagnosis of diabetes. - Inform friends that if the person “passes out” they need to call an ambulance. - Keep a blood glucose monitor available to check blood glucose. - Eat sources of carbohydrates to prevent hypoglycaemia. - Have the adult monitor patient’s blood glucose every 2 hours until the patient is awake enough the next day to do so him/herself - Eat a snack containing sources of carbohydrate before going to sleep - Take usual bedtime insulin but if forgotten, take it late but decrease dose by 20%. - Have a responsible person take patient to ER if he/she is vomiting, unable to keep blood glucose >4mmol/L, has a change in respirations, is showing signs of dehydration, is unconscious, or there is a concern about alcohol poisoning. The medical staff must be told that the person has been drinking. - Get up the next day as close to the usual time as possible, take insulin, eat breakfast and continue monitoring blood glucose. - Monitor blood glucose levels throughout the day after the drinking occurred and make appropriate adjustments to insulin based on blood glucose results and keeping in mind that hypoglycemia can occur up to 14 hours after alcohol consumption. Question 6: Why might Glucagon injection not work as effectively for treating hypoglycemia while alcohol is in the body? Answer: Endogenous glucagon is a pancreatic counterregulatory hormone, which is secreted in response to low blood glucose levels. Its main role is to restore low blood glucose levels by generating a ready supply of glucose. It accomplishes this in two ways. Principally, glucagon stimulates the breakdown of liver glycogen stores, converting them to glucose through a process called glycogenolysis. In addition to mobilizing liver glycogen stores, glucagon stimulates hepatic gluconeogenesis through conversion into glucose of gluconeogenic substrates such as alanine, pyruvate, lactate, and glycerol. Alcohol can interfere with the process of gluconeogenesis. This occurs during the metabolism of alcohol, in which there is depletion of the supply of pyruvate needed for gluconeogenesis. As a result, alcohol by itself may lead to hypoglycaemia or delay recovery from hypoglycaemia. It is important to realize that the behaviour-altering effects of alcohol can also complicate hypoglycaemia by clouding the recognition of hypoglycaemia by the patient and his surroundings, as well as by delaying the treatment of hypoglycemia with prompt oral glucose Updated: January 25, 2006
supplementation. Alcohol consumption may therefore have serious implications in the case of severe hypoglycaemia, in which a person is unable to self-treat. Usually persons are taught to inject exogenous glucagon s.c. or i.m. as an antidote to reverse severe hypoglycaemia. Though alcohol interferes with gluconeogenesis, it may only pose a theoretical concern in the setting of exogenously administered glucagon. This is because of the supraphysiologic blood levels of glucagon achieved following an s.c. or i.m. injection, and alcohol’s lack of effect on the glycogenolytic pathway. It is therefore unlikely that alcohol, on its own, would prevent the reversal of hypoglycaemia following the administration of glucagon. In the setting of chronic alcoholism, however, liver glycogen stores may become depleted secondary to malnutrition (or a reduced supply of substrate). The efficacy of glucagon, as a treatment for reversing severe hypoglycaemia, may therefore be significantly reduced. This is because both the glucagon-stimulated metabolic processes for generating glucose, namely glycogenolysis and gluconeogenesis, have been compromised, either indirectly or directly. In such a scenario, the preferred treatment for reversal of severe hypoglycaemia would be the administration of intravenous glucose. In patients with an absent or diminished endogenous glucagon response to low blood glucose (i.e. type 1 diabetes), reversal of severe hypoglycaemia ⎯ particularly when secondary to insulin ⎯ may be more difficult to achieve with exogenous glucagon in the presence of alcohol. In this case, treatment with intravenous glucose may be preferred. References: Glucagon product monograph, CPS 2005, Compendium of Pharmaceuticals and Specialities, The Canadian Drug Reference for Health Professionals, Canadian Pharmacists Association. Griffin, JE, Ojeda, SR., editors. Textbook of Endocrine Physiology (3 rd University Press, 1996. edition). Oxford Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003; 26: 1902- 1912. Rasmussen BM, Lotte O, Schmitz O, Hermansen K. Alcohol and glucose counterregulation during acute insulin-induced hypoglycaemia in type 2 diabetes. Metabolism 2001; 50: 451-7. Bartlett D. Confusion, somnolence, seizures, tachycardia? Question drug-induced hypoglycaemia. Journal of Emergency Nursing 2005; 31: 206-8. Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888-93. Updated: January 25, 2006
Page 1 and 2: Alcohol + Diabetes Frequency Asked
Page 3: from the triglycerides are converte

Alcohol and Diabetes - Mount Sinai Hospital

Create successful ePaper yourself

Delete template?

Save as template?