From the Guidelines
To correct with insulin for alcohol intake while using an insulin pump, reduce your basal insulin rate by 20-50% for several hours after drinking alcohol and consider bolusing for only 50-70% of the carbohydrate content in high-carb drinks. When consuming alcohol, it is essential to be mindful of the potential impact on blood glucose levels and insulin dosing. According to the most recent and highest quality study available 1, basal insulin infusion is crucial for maintaining euglycaemia, even in the fasted state. However, alcohol consumption can lower blood glucose levels and increase the risk of hypoglycemia. To manage this risk, it is recommended to reduce the basal insulin rate by 20-50% for several hours after drinking alcohol. Additionally, before drinking, it is advisable to eat a carbohydrate-containing meal and bolus normally for those carbs. For alcoholic drinks that contain significant carbohydrates, such as beer, sweet wines, or mixed drinks with juice/soda, consider bolusing for only 50-70% of the carbohydrate content. It is also important to set a temporary basal rate reduction when starting to drink and maintain it for several hours after the last drink, potentially overnight. Regular blood glucose checks while drinking and before bed, as well as having fast-acting carbohydrates available, are also crucial for managing the risks associated with alcohol consumption and insulin pump use. This approach is necessary because alcohol inhibits gluconeogenesis in the liver, preventing it from releasing glucose when blood sugar drops, while simultaneously enhancing insulin sensitivity, creating a dangerous combination that increases hypoglycemia risk, especially during sleep. Key considerations for insulin pump users include:
- Reducing basal insulin rate by 20-50% for several hours after drinking alcohol
- Bolusing for only 50-70% of the carbohydrate content in high-carb drinks
- Eating a carbohydrate-containing meal before drinking and bolusing normally for those carbs
- Setting a temporary basal rate reduction when starting to drink and maintaining it for several hours after the last drink
- Regular blood glucose checks and having fast-acting carbohydrates available.
From the Research
Correcting Insulin for Alcohol Intake with an Insulin Pump
To correct insulin for alcohol intake with an insulin pump, several factors must be considered, including the type and amount of alcohol consumed, the individual's insulin sensitivity, and their current blood glucose level.
- The study 2 found that individuals with type 1 diabetes using insulin pumps had varying perceptions of how exercise and alcohol affected their blood glucose levels, and inconsistencies between self-reported and observed behaviors.
- Another study 3 investigated the effects of preceding ethanol intake on glucose response to low-dose glucagon in individuals with type 1 diabetes, and found that ethanol intake tended to cause lower incremental peak plasma glucose and lower incremental area under the curve.
- A study 4 examined the influence of alcohol on glucose counterregulation and recovery during acute insulin-induced hypoglycemia in type 2 diabetic subjects, and found that alcohol intake increased plasma lactate and suppressed plasma nonesterified fatty acids.
Insulin Dosing Considerations
When consuming alcohol, individuals with diabetes using insulin pumps should consider the following:
- The type and amount of alcohol consumed, as different types and amounts of alcohol can have varying effects on blood glucose levels 5.
- Their current blood glucose level, as alcohol can cause hypoglycemia in individuals with diabetes 3, 4.
- Their individual insulin sensitivity, as this can affect how much insulin is needed to correct for alcohol consumption 2.
- The timing of insulin dosing, as reducing basal insulin infusion rate before exercise or alcohol consumption may not be sufficient to reduce hypoglycemia 6.
Monitoring and Adjusting
It is essential to monitor blood glucose levels closely when consuming alcohol and adjust insulin dosing accordingly.
- Individuals with diabetes using insulin pumps should work with their healthcare provider to develop a personalized plan for managing alcohol consumption and insulin dosing 2.
- They should also be aware of the potential risks of hypoglycemia and take steps to prevent it, such as consuming carbohydrates before or during alcohol consumption 6.