By Ginger Vieira — Fact checked by Maria Gifford
October 26, 2020
“Unfortunately, I see alcohol and substance abuse fairly frequently in (the type 1 diabetes) population,” says Kristine Batty, a certified diabetes care and education specialist (CDCES) in Maryland.
“Diabetes and depression are so common, so there’s a lot of self-medicating that goes on, mostly with alcohol,” explains Batty, a veteran healthcare provider who’s focused on diabetes for the last 15 years, currently at Howard County General Hospital, part of the Johns Hopkins healthcare system.
Batty was drawn to this work after growing up with a sister who has type 1 diabetes and a grandfather with type 2 diabetes.
She notes that any alcohol consumption with type 1 diabetes (T1D) comes with an extra dose of danger, especially when consumed in large amounts.
Alcohol’s impact on blood sugar
Why and how does alcohol impact blood sugar levels? While alcohol often contains some sugar, the risk of low blood sugar comes hours later when the liver is occupied with processing this toxic liquid from your system. While the liver is busy processing the alcohol, it isn’t accomplishing its normal role of storing and releasing glucose.
The result can include moderate-to-severe hypoglycemia (low blood sugar), likely while you’re still intoxicated and possibly unconscious or unaware of your blood sugar, putting you at risk of seizure and death.
People with T1D who misuse alcohol run the risk of experiencing either severe high or low blood sugar, which can both be quite dangerous.
For those consuming alcohol regularly — especially people who can function throughout the day despite a constant consumption of alcohol — the effect of their liver’s output of glucose means a constant struggle with mild-to-moderate hypoglycemia.
Problematic hypoglycemia is often a telling sign in a person suspected of living with alcohol use disorder, Batty explains. “Sometimes it’s one of their presenting symptoms that might land them in the emergency room.”
“Problematic hypoglycemia” is defined by frequent and unpredictable low blood sugar and is a common trait of alcohol use disorder in T1D.
Batty recalls working with one patient, many years ago, who was able to consume alcohol throughout his entire day as a house painter.
“A lot of people can drink alcohol all day long and still function, but his blood sugar was constantly 50 mg/dL. His liver wasn’t able to store glucose the way it should because it was constantly processing the alcohol he was consuming,” she explains.
The other impact excessive alcohol consumption has on your blood sugar levels is the way it distracts you from your essential healthcare.
“These people are more distracted, or also struggling with depression, so they aren’t taking their medications consistently. But this can lead to severe highs, too, because they think, ‘Well, I’m low so maybe I shouldn’t take my next insulin dose’ and then they’re in this vicious cycle of highs and lows.”
Batty says she’s also seen patients who are able to stay sober during the day but drink a lot of beer, for example, as soon as they go home.
“You fall asleep on the couch, haven’t eaten a full supper, and forget to take your long-acting insulin,” which increases your risk of severe high blood sugar levels and diabetic ketoacidosis by morning, she says.
Alcohol kills appetite, worsens nerve damage
Another common issue associated with alcohol misuse is its impact on your appetite for healthy foods.
“When you’re getting so many calories from alcohol, you don’t want to eat as much actual food,” which contributes to frequent low blood sugars, explains Batty.
Over time, many heavy drinkers with diabetes also develop insulin resistance through weight gain, but Batty emphasizes that the impact on their health is far more “global” than specific.
“Yes, it’s going to affect your liver function, and I’ve seen a good amount of liver failure in patients struggling with alcohol abuse — but more so, you see poor overall health, throughout their entire body.”
Neuropathy is a lesser-known but very common complication of heavy alcohol use in diabetes because of the impact alcohol has on your nerves. In a population already at high risk for nerve damage and neuropathy, alcohol can expedite and significantly worsen the damage.
Making matters worse, vitamin B deficiency is a very common side effect of heavy alcohol consumption and can contribute to further nerve damage.
When you decide to get sober
Batty says talking to your healthcare team is a must when you’re thinking about getting sober.
That’s because “diabetes has its own mind,” she says.
“If you hadn’t been taking your insulin the way you were supposed to, or you were skipping doses or forgetting doses, and then you suddenly start taking it regularly again, you may be getting more or less insulin than you currently need.”
“Don’t be afraid to call your doctor,” says Batty. “People don’t call their diabetes providers enough, and you can get yourself into trouble. Don’t be afraid to admit you’ve been drinking — we’re here to help. Reach out!”
It’s also critical to check your blood sugar frequently in those early weeks of sobriety to ensure your insulin doses are accurate and safe.
“You don’t want to hurt yourself when you’re trying to help yourself,” Batty says.
Personal stories of struggle and success
The following are three personal stories of struggle and success from three people who live with T1D. While there is no one-size-fits-all approach to thriving with diabetes, there is no one-size-fits-all in the path to sobriety either. But one thing all of these stories share is the empowering reminder that anyone struggling with addiction can achieve sobriety.
Alix Braun: ‘I could still have fun in sobriety’
“It started around the time I was diagnosed with type 1,” says Alix Braun, who developed T1D at 14 years old.
“I was introduced to alcohol and weed and wanted to always feel high whenever I could. I did not want to think about needles and counting carbs. I felt very different from my peers and at that time, I felt a lot of shame.”
Braun, now 31, says that as a teen she sought out the “numbing” effect of alcohol and marijuana whenever she could; she smoked regularly outside of school and away from her parents. Being friends with other kids who did drugs and drank alcohol regularly encouraged the choices she was making.
But the impact on her blood sugars was inevitable.
“I would forget to take my Lantus or [accidentally] take two doses,” says Braun, and she “usually blacked out” whenever she drank. Considering her Lantus dose was supposed to be taken at night, the risk of forgetting to take it was high.
“When I was in high school, I did not care about giving insulin or checking my blood sugar so my A1C was 11 percent at one point,” added Braun, who says she did make an effort to drink low-carb sources of alcohol.
“Also, when I drank and smoked weed, I would get super hungry and would binge most nights.”
It was tough love from her father that pushed Braun to get sober.
“My dad had been sober for years, and when I went away to an expensive college and wasn’t doing well,” she explains. Having once been in the top 10 percent of her high school class, Braun was struggling to get Bs and Cs in college — and her father didn’t approve.
“He gave me an ultimatum that I could either go to community college back in Miami where I am from, or go to rehab in Arizona,” says Braun. “I talked to a lot of people about the decision and ultimately I decided to go to rehab.”
Despite not feeling ready to be there, Braun cooperated and began her path to sobriety through a rehab program at 19 years old.
“But when I learned that I could still have fun in sobriety with the people around me and with kids my age, I realized that I could do this.”
Staying sober came down to one particularly critical decision for Braun: She never wanted to move back to where she grew up — where her addiction began. She knew the emotional struggles she felt as a young teen were still present, and that she would need help wherever she lived.
The most valuable form of support came from attending regular Alcoholics Anonymous (AA) meetings for 12 years, at first going every single night, she says.
“I developed a support system that carried me through early sobriety,” explains Braun, who now works as a licensed therapist in California with a focus on eating disorders.
“What helps today is living with my amazing fiancé who rarely drinks. I have worked through all my emotional turmoil since getting sober and have become a therapist myself. Learning to regulate my emotions was probably the best way that I can stay sober.”
Today, Braun is proud to share that after maintaining an A1C of 7.0 percent for the last 12 years of her sobriety, she recently achieved a 6 percent thanks to “looping” — a homemade system that allows an insulin pump to communicate with a continuous glucose monitor (CGM).
“Never did I think I could accomplish that,” says Braun. “I am very proud of myself.”
Liz Donehue: ‘I didn’t drink today’
“My relationship with drugs and alcohol started in high school,” recalls Liz Donehue, who’s lived with T1D since she was 22 years old. “But shortly after I started, I was drinking in excess pretty much whenever I could. I chalked it up to being a high school kid and that it was just a phase, but it became clear to everyone around me I had severe addiction issues.”
Despite her diagnosis, Donehue’s battle with alcohol continued with T1D along for the ride.
“I figured as long as I was ‘taking care’ of my diabetes, I was okay,” says Donehue. “I’d make sure I’d be drinking some alcohol with sugar in it or eating along with my drinking. During my hangovers I would constantly get low and have to adjust my insulin levels over the course of the day, and because I was drinking so much, about half of my time was spent doing this.”
Both her mental and physical health crumbled, added Donehue.
“I was either drunk, or hungover and hurting — no in-between.”
Donehue recalls adjusting everything in her life to support her addiction to alcohol. And inevitably, it impacted nearly every part of her life, too.
“I was taking jobs where I’d be able to work from home so no one would see me drunk or hungover,” Donehue tells DiabetesMine. “I was lying to doctors to get on prescription medication. I would do research on upcoming events to see if I should drink beforehand or if there was booze available. During this time I admitted to myself frequently that I had a drinking problem, but I never really accepted it.”
While Donehue had attempted to sober up many times on her own, she was reluctant to ask for help.
“I was convinced I would have to go it alone,” she recalls. “I felt that admitting to needing help was an admission of failure or shame, and that kept me from asking for help much sooner than I actually did.”
It wasn’t until she woke up one morning bruised and bloody when she was ready to reclaim her life.
“I was assaulted when I was blacked out,” says Donehue of the last time she consumed alcohol.
“I woke up covered in blood and going through withdrawal, which I initially thought was my blood glucose level being low. I ended up going to the ER to get my injuries assessed. I had two black eyes, bruises in my back and chest, blood matted in my hair, and a bite in my hand. I realize me being drunk was no excuse for someone to do this to me, but if I was sober, I could have avoided being in this situation.”
During her recovery in the ER, Donehue called her mother, ready to ask for help. The next day, Donehue and her mother began looking for treatment centers.
Donehue is currently celebrating almost 6 years of sobriety at 32 years old, and working for IBM from the Czech Republic. Maintaining her sobriety is a source of pride and something she clearly devotes herself to on a daily basis.
“Today, I don’t necessarily have a strict regimen I follow, but I avoid certain places and people if I can help it,” explains Donehue on what helps her maintain her sobriety. She now also gets support from an online community in Reddit of others who have chosen sobriety.
“The Czech Republic is notorious for its cheap beer and I made sure I was in a solid place in my sobriety when I moved here three years ago. I have a good circle of sober people I stay in consistent contact with. And I look forward to saying ‘I didn’t drink today’ at the end of the day.”
Victoria Burns: ‘I am finally letting go of shame’
“Alcoholism runs deep on both sides of my family,” Victoria Burns tells DiabetesMine. “From my first drink in junior high school, I knew I drank differently than my peers. I had several near-death experiences, all related to drinking. That knowledge didn’t stop me. I loved the effect of alcohol. I dedicated 15 years of my life trying to figure out how to safely control and enjoy my drug of choice.”
Diagnosed with T1D at 30 years old, Burns explains that her relationship with alcohol really became a problem around the age of 18, escalating when she began college.
“Binge drinking is not only normalized but glorified on college campuses,” says Burns. I won a scholarship to study abroad in France. That year in France, my drinking and romanticization of the bottle really took off.”
Despite drinking heavily on a regular basis, Burns says she was able to hide it well, never missing work or other responsibilities during the more sober or hungover hours of the day.
“But as soon as I picked up a drink, I didn’t know how the night was going to end,” says Burns. “I got my first ultimatum to stop drinking from a boyfriend when I was 19. I ignored it. Dropped the boyfriend and continued drinking.”
With her T1D diagnosis in 2011, Burns says she hoped it would be the “antidote” to her alcoholism, motivating her to stop drinking.
“After all, I was told by my endocrinologist that my body could no longer tolerate my usual amounts of alcohol, that it would kill me,” she recalls from those early appointments. “Unfortunately, addiction doesn’t work that way. It defies all logic. I tried everything to control my drinking, and nothing worked.”
Complicating her relationship with alcohol further, Burns was sexually assaulted by a stranger just 3 months before her diabetes diagnosis. The trauma of her assault inevitably fueled her drinking further, using alcohol in an effort to treat her emotional pain.
The impact of both alcohol and an addiction to cigarettes made her blood sugars far from manageable. As she watched her body change rapidly from the combination of her trauma and starting insulin, Burns began to omit her insulinTrusted Source in a life threatening and ineffective effort to lose weight.
Diabulimia, officially referred to as ED-DMT1, is an eating disorder in people with T1D characterized by intentionally withholding insulin, resulting in severely high blood sugar levels and tremendous risk of coma and death.
Burns says she also used the blood sugar-lowering effect of alcohol to her advantage.
“I started using wine as insulin. The black-outs and recovery time between binges got worse.”
By 32 years old, Burns says she was living a double-life in an effort to hide her addiction.
“By day, I was a wife, a PhD student at a top university, a responsible homeowner, dog mom, a writer and instructor. By night, I was a raging, out-of-control drunk.”
Burns recalled a birthday outing, intended to be a simple night of a few beers with her husband and friends. Instead, it turned into a 16-hour blackout and a trip to the emergency room.
“I couldn’t understand how this happened again,” says Burns. “Full of shame, remorse, and self-loathing, I knew I could no longer live this way. I was emotionally, physically, and spiritually bankrupt. A hollow shell. I knew in that moment I was completely powerless over alcohol and that something had to change, or I would die.”
Today, at 38 years old, Burns has maintained her sobriety for nearly 7 years. She completed her PhD and moved across the country for a full-time tenure track as a professor in social work.
“When I figured out that alcohol was the solution to my pain, not my problem, my recovery truly began. By healing my underlying trauma, I am finally letting go of shame… which allows me to honestly say that I am grateful to be sober.”
After a nearly decade-long battle with diabulimia, Burns sought help in 2019 by reaching out to her endocrinologist and taking an entire year off from work in order to focus on recovering.
Since then, living with the demands of T1D has become less oppressive, she says.
“Overall, taking booze and smoking out of the equation has made things much more manageable. I’m just very grateful to be coming up on 7 years sober from alcohol, 6 years cigarette-free, and one year in recovery from diabulimia. A year ago my A1C was in the double digits, and my last A1C was 7.3 percent. Freaking miracle.”
Burns also gives tremendous credit for helping her maintain her sobriety to her husband — who she says has been a constant source of support.
“He is my rock. I also work a rigorous program of Alcoholics Anonymous, where I attend meetings, and have a sponsor.” Burns says she is now a sponsor to others striving to achieve and maintain their own sobriety. “Peer support is key. I also have a trauma therapist that I see regularly.”
She added that daily exercise, intuitive eating, and meditation all play important roles in her daily health and ongoing sobriety.
“There is a lot of stigma around addiction,” she concludes. “That needs to change. If you are struggling, know that you are not alone.”