Diabetes type 1 (young people)

Drinking and alcohol with diabetes

Alcohol confused many young people we talked to for this project - many said they didn't know what a 'unit' of alcohol was - and several had ended up in hospital after evenings out drinking. One young woman said the 'culture of drinking' was hard to handle when she was 16 and she wanted to fit in with her friends. Most young people said that they enjoyed drinking and had learned by trial and error which drinks they could take. Some had had experimented with different drinks to see how they felt, and several had experienced hypos from drinking too much - and said that afterwards they took more care.

She got good advice from her dietician before she went to uni but still found freshers' week...

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Age at interview: 22

Sex: Female

Age at diagnosis: 9

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Tell me about you going to university because I think that's quite an important aspect for a young person with diabetes, in terms of sort of not having your parents there. Not having such a structured life?

Yeah

How do you cope?

Well initially I was quite worried. Just little things like the only time I've ever gone into a diabetic coma has been first thing in the morning. Normally if I go low during the night I'll wake up but there have been four times in my life when I haven't and I'm aware that this is a problem. So I've always, my parents will always check that I'm awake in the morning and if they've gone out before I wake up they'll just phone me. And it's just not an issue, you know. They'll phone, say 'Hi are you up' and I'll say 'Yes' and that's it. There's just, I don't think about it. So going to university was suddenly more stressful because little things like that you don't have.

And I found the drinking culture quite stressful because I just don't. I can't drink. If I drink my sugars go haywire. You know I can have a drink. I can't get drunk and obviously there's a lot of getting drunk at university. So from that aspect it was quite stressful. But, you know, by that point I'd been out with friends who had been drinking when I wouldn't drink so much and luckily I guess, I'd learnt what, how much I could drink and how much I couldn't drink before I went to university. So it wasn't like you'll get there and suddenly there's this whole new world which was really good. So you'

How did you learn before?

Well I talked to my dietician quite a lot. She was really good. I had a really nice dietician who was, perfectly willing to talk about things like drink or drugs or whatever it was that you wanted to ask which was really helpful because it meant that I could actually have proper advice rather than trial and error. So she sort of, you know, said well obviously avoid like the sort of Smirnoff Ice or bottled drinks that are lemonade basically. Anything that I wouldn't normally drink like lemonade or coke or orange juice or something I don't drink just because it's with alcohol because, you know, that was self-evident. And then I'd kind of tried different things really. I mean I used to drink with my parents, not drink with them but, you know, we'd have a glass of wine at dinner so I knew that having a glass of wine with dinner was fine.

I mean I tried out something like. There was definitely. I used to drink Archers and diet lemonade and have learnt that Archers is not good, mainly because it's syrup. So you know, you drink it. You go high and then you figure it out but just building up. You know, I tended to stick to spirits and diet whatever is there because I know that's fine. And once you've got a drink that you like and you know you have it, it's fine. And again at university once I had a group of friends it meant that I could relax and I could drink. Not, I mean I really don't get drunk because it, I don't feel well when I'm [laugh] drunk irrespective of being diabetic but it meant that, you know, if I had a drink I didn't have to worry because I knew that they'd know. But initially it was quite hard because people don't know and there's always the risk that you go low and you look like you're drunk and no ones going to, going to understand. So you, yeah it, it. Freshers' week was pretty hard because I just didn't want to get myself into a situation where that.

He drank too much once and ended up in hospital in a coma which frightened everyone including him.

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Age at interview: 19

Sex: Male

Age at diagnosis: 14

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Have your mum or your dad been anxious at some point?

There was the one time when I went to a party and I drank too much, and mum rushed me off to hospital, because from one moment I was quite fine, and then I was rejecting all food Mum was trying to put into me. My sugar was going really low, so she rushed me off to the hospital, and I went in intensive care, and I was on a sugar drip for about two hours which is - I didn't really know what was going on, because my body was going low, so I 've hardly got any memories of it at all, apart from sort of waking up. But yeah, that's the only bad time I've had, really. And then my mum, everybody, friends, were really good, because they saw what happened. Not so much my friends, but my mum did, and then it was like a wake up call, because she said to me that I caused that problem myself, whereas some people were genuinely hurt and needed attention and I was kind of wasting time, in a sense, because although I needed to be treated, it was my own doing that got me there, whereas other people, genuinely hurt in an accident or something needed attention and I was taking up their space, in a sense. So I've never had an incident like that again. So' it's always sort of - I think everybody needs a little warning like that, sometimes, because I'd got to that stage where I'd got a bit lethargic. I was sort of going along thinking that I was sort of invincible, in a sense, because everything was going so well, the control and stuff, so I sort of pushed the boundaries of alcohol a bit, and suffered the consequences.

Everyone said they had been told they must eat before they had a drink and that it was very important to eat something starchy (like bread or cereals) after they had been out drinking and before they went to bed. They understood that they risked having a hypo if they didn't eat before going to sleep.

He's learnt from bitter experience that he has to watch how much he eats before he goes out and...

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He's learnt from bitter experience that he has to watch how much he eats before he goes out and...

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Age at interview: 26

Sex: Male

Age at diagnosis: 18

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And do you drink alcohol?

Yes, probably more than I should. It's a, it's not really, it's not been a particularly big problem. I mean obviously a student at university, everyone drinks kind of a fair bit from time to time, but as long as you don't go and make a complete mess of yourself it's not normally been too much of a problem. So kind of drink and have fun, but don't go and wake up in the gutter somewhere. That's pretty much the same advice you'd give to anyone, but you have to kind of be a bit more strict with yourself about following it really.

Which kind of safety guidelines do you follow? Do you eat before you, if you know that you're going to drink, do you eat beforehand?

Yes, definitely. There was one time when I started drinking without eating and it played all kinds of havoc. It was quite interesting the way that different drinks affect my blood sugar as well. So if I drink wine it will tend to take them down. But if I drank say something with some kind of a sugary mix in it would go up instead. And this one particular time I drank the best part of a bottle of wine without having anything to eat and ended up just for the rest of the evening with blood sugars going all over the place. So since then I've avoided doing that. So it's one of those things that you kind of learn by experience, but probably you don't want to have too much of an experience xx that kind of thing.

So what happened? Your sugar levels went down?

Yes. And I ended up eating a huge amount. Because one of the, yes, one of the things that happens when they seem to drop down quite a lot is you get incredibly hungry. So then I ate a huge amount and then they went straight back up again, and then they went down again. And it was kind of all over the place for most of the evening. But, yes, which kind of, I ended up having to keep disappearing to find something to eat and this kind of thing. It made a bit of a mess of the evening. So, yes, not really the best, cleverest thing I've ever done.

Young people wanted to know more details about which drinks they should avoid and how each sort of drink would affect their blood glucose levels. They know that alcohol tends to lower blood glucose levels and can cause hypos but at the same time some were puzzled about sugary drinks. Most thought that alco pops were worse for them than wine because of the high sugar content; others said they couldn't cope with wine. They knew that they should think about what they had to drink, when they drank and who they went drinking with but many found initially that they didn't feel like being so responsible.

Drinking a glass of wine with your family over dinner in a controlled environment was seen as being safer than drinking at a club or pub - though most people we talked to did both. People said that drinking too much alcohol at the same time as clubbing was potentially dangerous because dancing uses up energy and could make blood glucose levels dip even lower.

When she was sixteen she felt confused about what she could and couldn't drink but now she finds...

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Age at interview: 21

Sex: Female

Age at diagnosis: 15

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And what about drinking alcohol? Do you?

To start with I was told I couldn't have more than one unit a night and I was a bit worried about that and lots of my friends went, 'Oh, what are you going to do?' because I sixteen so I hadn't really been out and drunk much before. And I was like, 'Oh, I'm going to be missing out forever,' but I, and, I find it's all right. I go out and I may have quite a few drinks. I just have to be really careful and check my blood tests all the time. Because when you're drunk the symptoms of being really drunk for other people appear to be the same as having hypo. Like if I'm having a hypo when I'm drunk I might say, if it got really bad, I've never done it, but could pass out, people would think, 'Oh, she's just really drunk.' And also the more drunk you get, the more careless you get so you might forget to eat or you might forget to do your blood test and see what's going on. And alcohol itself, I have to be careful what I drink because a lot of drinks are really sugary so I couldn't have Alco pops or beer, I can't drink. Or a sweet wine or anything. So I can't have a lot of drinks and the alcohol itself, it's really confusing, but alcohol is meant to bring your sugar level down, I think, in a different time span though to the sugar in the drink making it go up so if you had a sugary drink it would rise and then the alcohol would kick in and it would fall and then, I think, might make it rise again. I don't know. It goes up and down which is really bad. So, when you have drunk you have to be careful that you make, you make sure you eat before you go to bed because the alcohol can make your sugar level dip in the night. I always make sure friends, friends I'm with know, know what to do and know what's going on and I generally feel quite safe.

So you tell them in advance?

Yeah. But I've never got drunk enough that I'd be sick or pass out. I'm lucky. Some people, some of my friends are sick but after a couple of drinks, but luckily I never have been sick and if I was sick then it would get complicated because obviously you're throwing up your food but you've given yourself insulin for and it's not good. I've been told that if I'm sick just from illness or anything more than twice in one day then I have to hospital and be on a drip. That's happened to me once before, I had flu. Yeah, I was sick twice and I was on a drip for three days or something.

They've been told to drink a lot of water when they go out, to keep checking their levels and to...

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Age at interview: 18

Sex: Male

Age at diagnosis: 9

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Interviewee 2' We've thrown a lot of parties at our time at, at secondary school. And so obviously we've got a lot of experience with drunk people you know, just, we know what to do. And we know that drinking, for a diabetic, we know what it does. It makes you go high and always, always, always you've got to watch out for your blood sugar, when you go out drinking.

Interviewee 1' Yeah. Because if you get drunk you can go high and it, you're not going to watch your insulin. You're not going to'

Interviewee 2' It dehydrates you.

Interviewee 1' It dehydrates you. And you drink more.

Interviewee 2' And there are always some sort of drinks that make you go higher than others. Alcopops, WKD, Bacardi breezer'

Interviewee 1' Because they contain a lot of sugar, to mask the flavour of the alcohol and stuff.

What has the doctor told you about'?

Interviewee 2' They've always said, 'Watch your blood sugar,' 'Drink a lot before you go out, as you're out and when you get back drink a lot of water.'

Interviewee 1' Eat, eat '

Interviewee 2' Eat a lot.

Interviewee 1' Before you go out.

Interviewee 2' Eat before you go out. Eat when you come back. Have a lot of bread. Some cereal maybe. And that will help to stop the effects.

And how many units can you have?

Interviewee 2' Good question.

Interviewee 1' I've no idea. It's more down to personal tolerance.

Interviewee 2' Probably, but always, always watch yourself because a diabetic has a lower alcohol tolerance than a non-diabetic.

She went into a coma one night after she'd had four glasses of wine with a meal and thinks it was...

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Age at interview: 19

Sex: Female

Age at diagnosis: 3

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I know I think it was New Year before last. I had a really serious hypo actually on New Year's Day when I was in France. I was with my family at the time and my boyfriend was there as well so it was all a bit difficult and we had to get emergency doctor out. I went unconscious and had a diabetic coma. That was really quite scary and just directly after that I my whole family got very scared. And I got very scared myself and I was thinking about at that point kind of, why me, why have I got diabetes, its a hassle I could do without. But then 's always someone else in a worse situation than you, I mean 'some many worse things than'

Why, what happened, what did you do different?

It's always hard to say because obviously you never plan for anything like that to happen, but I think it was a combination of a lot of factors. I find having wine tends to affect my diabetes, more so than any other form of alcohol. It will make me drop a lot more the next morning rather than making me drop at all that evening, whereas different forms of alcohol have different affects. And I think I'd had four glasses of wine actually that evening which is probably maybe more than I should have had. But I wasn't quite aware of it because it was all at the stage. I mean I hadn't really had that much wine in the past I probably only had one or two glasses at a time. And also we danced a lot into the night [laughs] So I was using up a lot of energy there and combined with the fact that I'd had the much wine which was making my sugar levels drop come the early morning. I stayed up later as well. And we had eaten quite a big meal, I think kind of mid evening. But I think I forgot to have a snack before bed that night. I don't quite remember to be honest because it was New Year, big celebrations I think it slipped slightly to the back of my mind and I should've been thinking about it more obviously come the next morning. But it was just because I'd had the wine and I didn't have the response in myself to wake up in the middle of the night when I had the hypo. So I never actually wake up in the morning I my family were just aware of me kind of kicking around' making a bit of a noise on the bed whilst in my sleep and then they came out' I just slipped straight into the coma from sleep. So I think that's was why it was so dangerous, really that I wasn't awake so didn't have any of those warning signs before it happened.

So it was a frightening experience?

It was really scary. But I think what I was particularly worried as well but the fact that my boyfriend was there staying with us at the time and we'd been together about three or four months, so it quite a scary experience to put him up against when he's never really had any real experience of diabetes before that because I'd always said, 'Oh well you know, I'm diabetes it's no big deal. I'm absolutely the same as anyone else, just have to have the hassle of doing the odd injections and things here and there'. But I mean generally it is no big deal.

Young people felt that they were also affected by the attitude of the friends they went drinking with. Several said they felt comfortable drinking with good friends who knew about diabetes and who didn't put them under pressure to drink. It was important for people's friends to know that they were diabetic and to know the difference between a hypo and being drunk. A few people chose not to drink any alcohol when they went out with their friends and said they could relax without drinking, but several others said they wanted to be free to enjoy themselves without worrying all the time.

He knows he's been lucky so far not to get ill and doesn't want to start worrying while he's...

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Age at interview: 20

Sex: Male

Age at diagnosis: 10

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Well, whether, because alcohol lowers your blood sugar level doesn't it anyway so and, and I, and I've just said yes I know that it does and that's why I will always, you know, eat a substantial meal before going out. And I'll always eat on, or after a night out so you know have, I'll always wake up and have breakfast and things. You know I, yeah I just do it because I want to do it and as I said nothing happens so.

And what about the long-term consequences?

Yeah. You know I know, that is, you know, that is a valid point. I obviously don't, I don't know how it will affect me in the future. And I do sometimes think about that but it's not, you know it's not something I want to get bogged down in. I'd rather. You know, I want to have a good time now in the time of your life when, you know, compared to when I'm going to have a job and things. I'm not going to be able to have as much fun as I'm having now so. I guess I just look at it, this is going to sound really corny but, you, you know, if I, if you should have a good time when you can and I can now so that, that's what I want to do.

You have never-

I probably sound really irresponsible [laugh].

You have never had a hypo or?

No not for many, many years. I, when I, you know when I first got diabetes I had sort of a couple but I've never had very many at all. No I've been, you know, been quite lucky.

She used to drink a lot but then she ended up in hospital. She still goes out but tries with the...

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Age at interview: 18

Sex: Female

Age at diagnosis: 6

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So every little thing I do, god I think if I do that, is that going to affect my diabetes? And I think a lot more about it, it's made me more aware of everything I do rather than just' it's like I still get on with things. It's like things when I go out down the pub and that I think a lot more of my drinking and that because I know it can affect it. Whereas before I'd think, 'Oh, it will be OK'. So I didn't know really' I knew what could happen but I didn't know what it felt like for it to happen. So now I know what it feels like and have complications and that and I'm much more aware of it.

So it has changed that experience, that experience has changed your behaviour?

Yeah it has very much changed it. I look I look at things a lot differently now than I used to. Just life in general makes you think differently.

And regarding alcohol for instance?

It's like yeah before it's like I still have the odd one or two now, but I haven't touched a drink quite a few months. Whereas before I was going down the pub have five or six Bacardi breezers and that and not think too much about it. And that very next day I'd get up and my blood sugars would be sky high and I'd have to deal with the affect of a stinking hangover and trying to sort my diabetes out. And think, god having that much alcohol it could and my blood sugars go that high, it just go that bit too high I'd end up back in hospital. So it's that I have the odd one or two now that's literally it, the odd one or two, and that's because I know that having a couple more could then put me back in hospital again and that's so.

It's easier because I'm driving because so I say to my friends to stop me drinking, 'I'll do all the driving, buy me three or four diet cokes between you down at the pub and I'll drive you around for the night', so that stops me drinking. Whereas I think if I didn't have a car and I was out and about, I'd be more tempted to have more than a couple. But I haven't had a drink in ages and like that's so I can have a good time without it. So It's like I want a bit of extra energy I just have an extra bit of chocolate so instead and it's better for your system.

But it must be difficult to get used to, I mean because if you were socialising and everybody was drinking alcohol, around or now it's part of your every day life now?

Yeah it's like before it like with the new friendship group I'm in, they're not they're not a lot older but they're in their twenties and that most of them, so when I first stopped drinking I found I didn't know them that well. So I used to drink to socialise with them to get in with them. But now it's like I know them and I just let myself go and half the time they say to me, 'Have you been drinking?' I say, 'No, I've just been on the diet coke', because, and that. But I go around, and I'm in high spirits anyway so I join in and they don't look any different on me. It's like most the time if I do go to get the odd sneaky drink, they're the ones that taking it off me, telling me not to and putting a diet coke in my hand, because they're supportive like that with me saying, 'No you're not drinking'. And then I get annoyed with them so'

And so they have helped?

Yeah, oh they're, they're very it's like the few times I been down the pub and that they're like, 'Oh stay over the night' and my boyfriend's like, 'No, she's not staying. She hasn't got her injections on her' and so then the whole pub are kicking me out saying, 'Go home'. So they do really support me down there and that they're really good.

Several of the young people we talked to point out that they have not received any specific advice from their diabetic clinics about drinking. In other cases, information and advice about drinking is given too late, after the young person has already started drinking. Several young people said that they felt too shy to asked for advice.

She had to ask her diabetes nurse for practical advice about drinking.

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Age at interview: 27

Sex: Female

Age at diagnosis: 7

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But through my teenage years it was very much a case of just the politics of it, the mechanics of it. 'We'll check your HbA1c, we'll check your sugar levels, we'll adjust your insulin and then you're on own'. And I don't ever ever remember having one conversation about the kind of problems that I encountered. Maybe one about alcohol, which is what I asked about, you know, 'What, what am I allowed to drink? What happens if you drink?' And then somebody basically just said to me, 'Just make sure you, you, make sure you eat when you come in'. I think that was the advice I got, 'Make sure you eat something after you've drunk, because it, alcohol lowers your sugar level'. It was myself that, trial and error. Which is quite a dangerous thing to do. Which it was a dangerous thing to do, because I didn't know what I was allowed to drink and what I wasn't. And everybody else was doing it, so, 'Why shouldn't I?' Now I know that I can drink dry white wine and very low sugar things. Back then I was drin-, you know, doing the same as everyone else did. Just drinking alcopops and sugary this and sugary that and didn't have the first clue. But, you know, I sort of had to do it all myself by, by trial and error and testing my sugars after certain things. When I was, when I cared more about my diabetes as I grew older, that's more or less what I had to do myself.

As a teenager, she found it difficult to ask for advice about drinking alcohol and says that she...

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Age at interview: 16

Sex: Female

Age at diagnosis: 5

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And what about drinking alcohol? Do you, do you ever drink alcohol?

Yes. If I do, I have to make sure that I take my insulin. I tend to take it a bit before I have my tea. And then after I have my tea, check it before I sort of, you know, start drinking. And make sure I'm eating as well whilst I'm drinking. And then I tend to have, like if, I don't know, if I'm out then I'd have like one Coke and vodka and then the rest Diet Cokes and vodka. So that I've got the sugar there, but it's not going to be a sugar overload. But I mean I need to make sure I've taken my insulin before I start drinking. Because otherwise that's when, you know, if I take it when I come in, it's going to be late on when I come back. So it's too late. And that's when I'll have a low.

You sound really certain about that. Did anybody sort of sit you down and say to you, 'Now this is something you've got to be really''?

No, I just, I, from past experiences I've, seem to have managed. There was a phase, well, that happened quite a bit. So we, and it was because sometimes I wouldn't have, not have taken my insulin straight as I had. I had, took it at like sort of five minutes after I'd eaten. So now I take it sort of half an hour before I eat instead of twenty minutes before I eat.

I mean do you think this is something that young people ought to be -

Yes, I -

- told more about?

I don't know, I don't really understand, I mean it's known to everyone people everywhere are drinking under, underage, and I didn't think there wasn't as much help as there could have been I don't think with it. I wasn't really told what I should be drinking, what I shouldn't be drinking. And I just sort of had to learn myself. Which I think is hard. Because, you know, with the alcopops, they're so sugary and I feel really sick when I have them. Because obviously when you drink alcohol your sugars go completely up and then they tend to sort of decrease. So I mean I found it really hard to deal with at first. But, and I don't think there was the amount of help, and I guess it was probably because I was a bit cautious about asking. But I mean I know, I mean I know the help is there if I need it, but it's just, you know, sometimes it's nice for it sort of be given, it, for it to be given to you rather than for you have to ask for it.

And what, I mean what sort of age do you think it would be sensible to start talking to young people about it?

I'd say when they were about 15', about 15, 15'.

I just think that with the way time is moving, I mean 15' is, -' is about the age that people start to drink. Usually at that age it's when people are being more rebellious about it and maybe their parents don't know. But at least by the age of 16 their parents know about it, and they're going out to meals and having a glass of wine. And I don't think the awareness of what can happen is there. Because I had to learn through trial and error. So I think that needs to be raised.

Most people who had been given specific practical advice about drinking appreciated the help. They valued dieticians who had detailed knowledge of drinks and so could direct them towards/away from different kinds of beer or alco pops (e.g. should they drink lager or beer, Smirnoff Ice or Archers?). Most thought alco pops were riskier than wine because of the high sugar content; but others pointed out that different kinds of wine had different levels of sugar and wondered if drinks diluted with mixers were safe. Some people said they had been told to avoid diet drinks; others said they assumed diet drinks were better because they had no sugar.

He's been advised not to drink diet drinks when he goes out clubbing.

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Age at interview: 20

Sex: Male

Age at diagnosis: 10

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On average how many units would you say you drink when you go out?

I don't know what, I don't know what and what an average unit is.

Well I don't know a pint of beer, two pints. Which type of drink do you tend to have?

Normally drink vodka, and or beer.

You don't sort of drink the sugary drinks?

Some, sometimes. I mean it, it depends really what's on offer on, in, you know where, where we are so. But I mean I've been told in the past by a doctor that it's actually. I mean he said that if you're going to go, you know, double vodka coke or something. He's actually said sometimes get the, the proper coke. Don't get diet coke because the alcohol lowers your blood sugar anyway and if you're going to be dancing or anything it's actually, she said it's sometimes good to get sugar to stop you, your blood sugar going too low so I do that as well.

Her nurse suggested that she should try different kinds of alcohol to see what effect they had on...

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Age at interview: 19

Sex: Female

Age at diagnosis: 3

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I find generally with my diabetes while I'm careful what I'm drinking, with wine it affects me a lot more but diabetes wise but generally if I have about four normal drinks that's fine I've found. But it all depends on individual situations. I'm not a big drinker but it's good just to be aware [laughs]. You can't really keep testing it too much.

Something that was quite useful was that my nurse suggested to me that a couple of times when I go out say for one evening if I just had maybe vodka based drinks or with mixers or that sort of thing, or another evening just wine, just to try and work out the exact reaction that I have with my diabetes, to the different types of alcohol, because they will have a completely different affect on how they influence your blood sugar levels. So it's useful working that out because I mean, like I found wine influences my diabetes a lot more, makes me drop more than others.

Supposedly I think before you start drinking you should be at least eight or nine, a high' not really high level, but not be low anyway because it will probably make you drop a lot during the evening whilst your out. So make sure you're a descent enough level before you start drinking.

If you're going to have the really sugary alcopops sort of drinks, like I don't know Reef or something, even though there's the alcohol in there that will make your levels drop, then it you may even need to do some extra insulin, Or if you had a cocktail or something because there's so many sweet substances that go into there, I found they tend to still go a bit high and then won't have the affect of making my level drop so much afterwards. But it's all individual, so you need to work that out for yourself. And make sure you have a snack and do a test before going to bed because you want to make sure you're not going to drop to a dangerous level in the morning probably.

Last reviewed December 2017.
Last updated November 2014.