Do I need to be careful with alcoholic beverages if I'm hypoglycemic?

Dear Reader,

Sugar has a sneaky way of making it into many foods and beverages. Keeping track of how much of the sweet stuff you consume is a healthy habit to get into — especially if you’re also worried about hypoglycemia (low blood sugar). While you’re right that not all alcoholic drinks are created equal, it’s usually not the type of alcohol (for example, scotch, as you mentioned, versus vodka or tequila) that’s contributing to the sugar count. Mixers, on the other hand, such as fruit juices and sodas, can be loaded with sugar, and may be the real culprits behind the differences you notice. To take a pass on a hangover and keep your blood sugar in a safe range, you may want to opt for non-sugary drinks and try to eat plenty of foods with proteins, healthy fats, and complex carbohydrates — before, during, and after drinking. Why? Keep reading to find out!

So what exactly causes the spikes and dips in your blood sugar (also called blood glucose) after imbibing an alcoholic beverage? Though research is still on-going, one hypothesis is that while the liver is busy processing the alcohol, it isn’t able to store or release glucose into the bloodstream (this can last as long as 16 to 24 hours after your last drink). Imagine a temporary freeze on your body’s glucose account. This leads to acute hypoglycemia and all the uncomfortable symptoms that come with it (such as excessive hunger, headache, shakiness, dizziness, difficulty speaking, lack of coordination, or confusion). Another issue to consider is that most alcoholic beverages aren't composed of pure alcohol — beer, wine, mixed drinks, spritzers, cocktails, and frozen drinks all contain ingredients and additives that often add a decent amount of sugar to a drink. These added sugars can create dramatic spikes in blood glucose followed by a steep crash — combined with a glucose freeze, it's hard for the liver to keep everything in order. To help keep sugar levels more balanced, you could try swapping out sugary mixers (such as juice and cola) with low-sugar ones such as diet soda, plain club soda, or water. Add a spritz of lemon or lime if you prefer. If liquor isn’t your go-to libation, opt for light beers and steer clear of sweet dessert wines.

While choosing your drink wisely can help you dodge those sugar lows, one of the most effective strategies for managing hypoglycemia is to eat meals or snacks at regular intervals throughout the day. Consider the following tips to help you maintain some balance the next time you enjoy an alcoholic drink:

• If you feel any symptoms of hypoglycemia, you may want to consider passing on the booze entirely. Alcohol can cause your blood sugar level to fall even further, making you feel worse.
• Try to eat a well-balanced meal before drinking and avoid drinking on an empty stomach. It’s not recommended that any planned food be replaced with alcohol or any “carbohydrate points” be allotted to alcoholic drinks.
• Pair your drink with dinner, or sample plenty of finger foods while you sip, particularly those high in complex carbohydrates. Avoid snacks packed with simple sugars, such as candy and cookies (these give a quick boost to blood glucose, then follow it with a crash). Instead, try whole grain crackers or whole-wheat pita chips with cheese, guacamole, or hummus.
• If you're not pouring for yourself, you may want to ask your mixologist to precisely measure the amount of alcohol that goes into your drink so you can track your intake. Once the drink is in your hand, sip slowly, and alternate each alcoholic drink with a non-alcoholic one such as water, diet soda, or unsweetened iced tea. Keep in mind that drinks containing both caffeine and carbonation can alter how intoxicated you feel, and may increase how quickly alcohol is absorbed into your bloodstream.
• Continue snacking after you've finished drinking. If you're concerned about your blood sugar level dropping to uncomfortable levels while you sleep, try eating a snack before going to bed, or even wake up in the middle of the night to eat.
• It may be helpful to have a backup plan — if you plan on going out for drinks, let someone you’ll meet up with know about your hypoglycemia so that they can help you get food or medical attention if necessary. Discrete I.D.’s (in the form of bracelets or tags) are also available that can identify your condition.
• If you're diabetic, consider monitoring your blood glucose throughout the event, and keep medication (e.g., insulin or glucose tabs) with you just in case.
• Finally, think about keeping a food and drink journal — see if you start to notice if certain kinds of drinks or habits work best for you when it comes to avoiding low blood sugar or those dreaded hangovers!

You might be wondering how you or your friends can tell when your blood sugar has gotten too low when drinking. Unfortunately, the signs of intoxication — feeling dizzy, lack of coordination, and confusion — are very similar to those of low blood sugar. This can make it difficult to distinguish between the two, which can be especially dangerous if severe hypoglycemia is mistaken for intoxication and isn’t promptly treated. Extremely low blood sugar could lead to abnormal behavior, seizures, loss of consciousness, and can even be fatal. Additionally, because low blood sugar and alcohol both affect coordination, perception, and reflexes, it’s probably best to avoid driving or engaging in any other activities that require optimal alertness. Consider other modes of public transportation, perhaps a cab or subway, to get home safely.

While there are things that you can do to minimize the impact of alcohol on your hypoglycemia, it remains unclear, Reader, what may be causing your low blood sugar in the first place. Hypoglycemia is typically just a symptom, perhaps one of many others, that suggests the existence of an underlying health problem (similar to how a fever is just a symptom of the flu). While low blood sugar is often a complication of diabetes (such as accidentally taking too much insulin, or not balancing meals or exercise with the correct insulin dosage), other conditions can cause low blood sugar, too. For example, the side effects of some medications, heavy alcohol consumption, liver or kidney disorders, some types of eating disorders, having had stomach surgery, and other conditions that lead to hormonal imbalance can all cause hypoglycemia. While acute low blood sugar can be alleviated with a dose of quick-release sugar (typically from juice, soda, candy, or glucose tablets), it’s recommended that the underlying condition be treated by a medical professional. In the long-run, this can help you avoid the recurring blood sugar dips altogether. 

For any remaining concerns, consider making an appointment with your health care provider or a registered dietician to discuss your low blood sugar episodes; these professionals can help you design meal plans and discuss options that suit you and your lifestyle best.

Salut!