There are several studies done to investigate on the effect of alcohol on the regulation of blood sugar levels in the diabetic patients. The influence of alcohol on the blood sugar levels varies depending on the time at which the person has consumed alcohol. If the alcohol is taken just after having the meals, then the blood sugar levels will enhance the already higher levels due to the Fed state.
Another time at which alcohol effect is substantial in the diabetics is that when the alcohol is consumed at fasting state where the person has not eaten anything since few hours.
The Effect of Alcohol on Diabetics in the Fed State
Acute Alcohol Consumption
Irrespective of the person whether he/she is suffering from type 1diabetes or type 2diabetes, acute alcohol consumption might not bring any clinically important changes in the blood sugar levels. Some studies done in the year 1997 have revealed that single episode alcohol taken along with the meals might show beneficial effect by reducing the blood sugar levels slightly as the diabetics will have comparatively higher blood glucose levels.
This positive effect was observed to be present in both men and women irrespective of their ages. These research studies allowed the study participants to consume alcohol in 0.5grams per kg of body weight and 1gram per kg of body weight. The alcohol levels in the blood due to the above intake have risen to 0.03 and 0.1 percent2. The dosages that were used in those studies represent nearly 2.5 to 5 standard drinks.There were a few studies also done to investigate the effect of alcohol consumption on the non-diabetics. The results of these studies were variable leading to increase or decrease or no changes in the blood sugar levels.
Chronic Alcohol Consumption
The research studies have revealed that chronic alcohol consumption in the diabetics who are highly nourished led to their increased blood sugar levels. There was a research study conducted by Ben and his colleagues in the year 1991 on type 2diabetics who are habitual drinkers, non-drinking diabetics and nondrinking & non-diabetic (control) subjects.
The habitual drinkers used to have 3 to 4 standard drinks per day. All of them were hospitalized for seven days and provided with the standard hospital diet. A few biochemical markers like blood sugar levels in the fasting state, C-peptide levels and hemoglobin A1c were used for measuring the effect of alcohol consumption on the blood sugar levels.
1. The blood sugar levels in the fasting state were found to be higher for the drinking type 2 diabetics than the non-drinking diabetics in the first few days of their stay in the hospital. Thereafter, not much difference in the blood sugar levels between the two groups was observed.
2. The HbA1c levels were observed to be significantly higher in the drinking type 2 diabetic patients than the non-drinking diabetic patients. The non-drinking type 2diabetics were having comparatively higher HbA1c values than the non-drinking & non-diabetics. Whether the blood sugar level elevation was due to the alcohol consumption or due to something else was unknown.
3. The C-peptide levels and in turn the insulin synthesis were observed to be lower in the type 2 diabetics who are drinking as well as non-drinking compared to the non-diabetics. However, no alteration in the C-peptide levels was observed between the drinking and non-drinking diabetics. This result observed indicates that the insulin production is not influenced by chronic alcohol consumption.
The actual mechanism that is involved in elevation of blood sugar levels in diabetics who are chronic consumers of alcohol is not clear. The type 2 diabetes is related to the insulin resistance or inadequate insulin production and hence the influence of alcohol on the rise in blood sugar levels was found to be due to its adverse effects on the above mentioned variables.
The Effect of Alcohol on Diabetics in the Fasting State
The consumption of alcohol in fasting state might reduce the blood sugar levels tremendously. According to a study done by Arky and Freinkel in 1964, the influence was observed on the type 1 diabetics and type 2 diabetics and also on non-diabetics. The low blood sugar or hypoglycemia might be more devastating as low blood sugar levels might hamper the functioning of the brain.
The hypoglycemia is induced mostly in both diabetics and non-diabetics who had been drinking alcohol since few days without any break and had stopped eating. In the fasting state, the body has few mechanisms to regulate the sugar levels in the blood. They are production of glucose and breakdown of glycogen.
1. Glycogenolysis is considered as the primary line of defense against hypoglycemia that occurs in the liver. To regulate the blood sugar levels, glycogen in the liver will be broken down into glucose molecules and supplied to the blood. If the person is in fasting state for one or two days, the glycogen storage will be depleted. Therefore, the drinker who has not been eating for few days and have been drinking only will exhaust the stored glycogen.
2. Gluconeogenesis is a mechanism of glucose regulation which again occurs in the liver. This process results in the formation of glucose molecules from alanine and glycerol. The liver that is engaged in alcohol metabolism cannot carry out the process of gluconeogenesis. Therefore, the person loses the advantage of secondary defensive mechanism against hypoglycemia.
The Effect of Alcohol on the Complications of Diabetes
Ketoacidosis is found to occur in people suffering from type 1diabetes as they lack insulin production completely. Rarely, it might also be seen in people with type 2diabetes.
Ketoacidosis might also result due to intense fasting. According to a study that was conducted in the year 1991 by Wrenn and his colleagues, it is reported that consuming more than 200 grams of alcohol per day can lead to ketoacidosis in diabetic people as well as in non-diabetic people.
Changes in Lipid Metabolism
There are several mechanisms by which the influence of alcohol enhances the triglyceride levels. Alcohol might trigger the production of VLDL particles that are filled with triglycerides, in the liver. The breakdown of the VLDL particles is also likely to be blocked by alcohol. The usual increase in the triglyceride levels in the blood after the meal is further enhanced by alcohol consumption.
Reduction in LDL-Cholesterol
A research work done in 1977 said that LDL-C levels were found to be lower in alcoholics than in non-alcoholics. Another study done in 1997 by Lin et. al., has revealed that LDL-C will bring changes in the biological functions and might be responsible for causing cardiovascular disease. The researchers have reported that vitamin E helps in reducing the free availability of LDL-C by binding to it. This binding will reduce the risk of cardiovascular disease. Vitamin E is found to be present in lower levels in alcoholics than in non-alcoholics.
Elevation of HDL-cholesterol
The data that is obtained epidemiologically has revealed that alcohol consumption in moderate levels (three drinks in a day) was observed to cause decreased risk of heart strokes. This result was due to the alcohol triggered elevation of HDL3 and HDL2 levels.