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Going out

Whether you’re out partying, travelling or away at college or uni, there’s no reason your diabetes should stop you from enjoying a full social life. Although you’ve probably read all about the dangers of alcohol and drug abuse elsewhere, there are a few extra things you need to be aware of if you have diabetes.

Drinking Alcohol

To make sure you enjoy drinking alcohol safely, it is important to know what effects it can have, what the risks are and how to avoid them.

Knowing the risks

The list below gives you an idea of some of the effects and health risks associated with drinking excessive alcohol.

What are the effects of drinking alcohol?

• it is a depressant drug – it slows down your brain. This leads to your reactions being slower, which makes it unsafe to drive.
• it can make you aggressive
• it can become addictive
• it can interact with other medications, such as flu remedies, and social drugs

What are the risks of drinking excessively?

• loss of consciousness
• compromised ability to talk
• vomiting and choking
• alcoholic poisoning
• confusion and disorientation. This can leave you vulnerable to:
  • others’ violent behaviour, e.g. sexual assaults, mugging
  • accidents
  • unwise sexual decisions, e.g. unsafe sex and risk of sexually transmitted infections
• long term health problems, such as liver, heart, stomach, mouth and breast cancer

How does alcohol affect my diabetes?

If you have diabetes, you can still enjoy a drink safely, but there are some important additional issues that you should bear in mind. Being drunk will limit your ability to:

• assess your diabetes control
• detect changes in your diabetes symptoms
• manage your condition

Drinking too much can lead to symptoms similar to those of a hypo. Alcohol can also cause your blood glucose levels to fall; this can often happen a number of hours after you stop drinking.

It is advisable not to drive if you have had anything at all to drink. Even small amounts of alcohol can increase your risk of hypos, which are particularly dangerous if you are driving and can lead to accidents and the loss of your licence. The legal alcohol limit in the UK for drivers is 80 mg of alcohol in 100 ml of blood.

If you drink excessively, you can put yourself at increased risk of developing serious hypoglycaemia and unconsciousness, which can be life-threatening if not managed appropriately.

The key is to be aware of the diabetes-related complications that exist, and drink sensibly, so that you can enjoy yourself safely.

Sensible drinking

If you drink sensibly, alcohol can be associated with positive experiences, relaxation and greater ability to socialise, especially with new people. It is excessive drinking, “getting drunk”, that can cause problems – compromising your immediate and long-term health, your thought processes and ability to function.

The keys to sensible drinking are to remember:

• quantity: everything is best in moderation. The more alcohol you consume, the greater the effect it will have on you, and the greater your risk of feeling unwell as a result.
• alcohol content: different alcoholic drinks have different amounts of alcohol in them (e.g. spirits have more alcohol in them than wine, which has more than beer and lager). The more alcoholic, or stronger, the drink, the more quickly it will get you drunk. Check the alcohol content of different drinks when you buy them, or ask the person serving you in the bar if you are unsure. This website has loads of useful information about understanding alcohol content.
• speed of drinking: if you drink quickly, you may have started your next drink before the alcohol from the previous drink has entered your bloodstream. This can cause you to drink more than you need or want to. It is not a race.
• lining your stomach: alcohol affects you more quickly if you have not eaten before you start drinking. Take a moment to think about when you last ate and, if it has been a while, take a moment to eat something before you drink any more, e.g. a sandwich.
• gender differences: men tend to be larger in stature than women and they can normally drink more alcohol before it has a noticeable effect on them.

Alcohol Allowance

Your diabetes care team can offer you information about your alcohol allowance. In general, alcohol allowances are the same for people with diabetes as they are for the general population. They should be used as a guide to the maximum amount that is thought to be safe to drink on a daily basis.

It is not recommended that you drink your entire weekly allowance in one day and then nothing for the rest of the week. This is known as “binge drinking”. Of course, having alcohol free days is fine as long as you don’t then drink to excess once or twice a week.

The maximum advisable allowances are:

• Men: 3 units / day; 21 units / week
• Women: 2 units / day; 14 units / week

A unit is a measure of alcohol normally equating to:

• Half a pint (250ml) of average strength beer.
• A small (125 ml) glass of wine 8% alcohol by volume (ABV) – remember that often a standard glass of wine is now 175 ml and that wine is usually 11–13% ABV.
• One standard pub measure of spirits (25ml).
• 25ml of fortified wine, such as sherry or port.

If you have diabetes, it is important for you to remember:

• Mixers contain sugar and, where possible, you should try to use diet mixers
• Avoid sweet wines, sherry, liqueurs and port
• Alcopops and cider contain high amounts of sugar and are best avoided

Hints and Tips:

• Eating:
  • Never drink on an empty stomach, it increases your risk of a hypo
  • If are drinking over a long period make sure you eat something every couple of hours
  • Eat some form of carbohydrate (e.g. bread) before going to bed to help prevent night-time hypos
• Alternating drinks: try drinking soft drinks between each alcoholic drink to keep you hydrated and to dilute the alcohol in your system. However, be aware that soft drinks and alcohol-free beers can be high in sugar. Water is the best option.
• Parties: whenever you have an alcoholic drink, make sure that you have a friend with you who is aware of your diabetes and who knows what to do if you become unwell.

Drugs and diabetes

If you choose to take social drugs, you must be aware of the all the risks involved – those that affect the general population, and also those specific to your diabetes. Confide in your diabetes care team if you choose to experiment with social drugs and they will suggest ways of managing the risks.

Use of drugs can never be classed as safe.

Groups of drugs

Depressants: act on the central nervous system and slow down the activity of the brain, e.g. alcohol, tranquillisers, glue, aerosols

Stimulants: act on the central nervous system and increase brain activity, e.g. tobacco, speed, ecstasy, cocaine

Anabolic steroids: increase body mass, promoting growth in skeletal muscle

Hallucinogens: act on the brain distorting the senses (how you hear, feel and see things). They can produce a feeling of extreme relaxation e.g. cannabis, detamine, LSD, magic mushrooms Analgesics: control pain and provide a feeling of well being, e.g. pethidine, morphine, heroin.

You need to be aware that experimenting with any drugs will impair your senses and you run the risk of not recognising potential problems with your diabetes.

Failure to identify early warnings of a problem with your diabetes can prove potentially dangerous or even fatal.

Drugs in Common use

Name	Other common names	Form	Effects	Side Effects
LSD	Acid, dots, trips, microdots	A small square of paper with a picture on one side, small tablets or a liquid	Senses become hyper-sensitive (everything appears slowed down or speeded up), sounds are distorted, colours are heightened; the effects (the “trip”) can last for around 10 hours	mental health problems inability to stop a trip once it has started flashbacks of the trip after it has finished
Ketamine	Special k, vitamin k, green k	A small white tablet or powder or even a liquid. Often passed off as Ecstasy	Similar in action to LSD; trip lasts for approximately 1 hour	gastrointestinal side effects – sickness, abdominal cramps, diarrhoea mental health problems
Magic Mushrooms	Mushies	Small brown mushrooms that can be eaten raw, cooked or dried	Similar effects to LSD, but the trip usually only 4 hours	gastrointestinal side effects – sickness, abdominal cramps, diarrhoea mental health problems
Cannabis	Grass, weed, hash, marijuana, blow, puff, or skunk	Leaves, seeds or stalk of the plant that are rolled, mixed with tobacco and smoked in a spiff or joint; resin (solid lump) that is usually shaved into pieces and smoked in a pipe. Potency varies greatly dependent on manner of presentation.	reduced ability to concentrate food cravings (‘the munchies’) addiction – cannabis is an addictive substance anxiety and paranoia mental illness – research has indicated that there is a link between cannabis use and mental illness reduced sperm count (in men) can stop ovulation (in women) lung cancer it’s also illegal to grow
Speed	Amphetamines, uppers	Whitish powder or tablets. May be smoked, snorted, dissolved or injected	Feeling of confidence, highly alert, excited	listlessness for days after taking loss of appetite continuous use causes strain on the heart mental health problems
Ecstasy	Es, disco burgers, little ones	More common in a tablet white tablet (various shapes), powder (dissolved or injected)	Everything seems more intense, feel alert and full of energy, feel as though you love everyone; trip lasts 4-6 hours	causes dependence little is known of the long-term side effects, but it has been shown to affect brain chemistry in animals tiredness and depression for days after taking affects liver, kidneys and heart dehydration and overheating tablets often cut with impurities – unknown risk long-term brain damage sudden death
Cocaine	Coke, c, snow, charlie	Usually sold as a white powder which may be snorted up the nose or injected	Powerful stimulant, creating a feeling of well being and confidence; short-lived for approx 30–45 minutes	tiredness / depression / craving for more restlessness and confusion heart problems or chest pains permanent damage to nasal septum highly addictive

 

How do drugs affect my diabetes?

Mental state

All drugs can compromise your diabetes control. Taking any social drugs affects your state of mind and perception of reality, which can affect your diabetes in a number of ways. You may:

• become paranoid and overly anxious about your condition
• feel depressed and de-motivated, which could affect your willingness to maintain good control of your condition (e.g. correct diet, exercise as well as remembering insulin)
• lose your ability to detect symptoms of a change in your condition, which will affect your ability to respond correctly – potentially putting yourself at risk
• disturbed sleep patterns, making you excessively tired

Appetite

Drugs can also affect your appetite. Some can suppress it (e.g. LSD and cocaine), while some can give you cravings (e.g. cannabis). Remember that changes in your eating, both increases and decreases, will affect your blood glucose levels.

Ketoacidosis

Taking drugs often goes hand-in-hand with omission of insulin. This can be particularly dangerous if taking a stimulant (e.g. ecstasy), which are often taken before partaking in intense physical exercise like dancing or raving. This can lead to severe dehydration, exhaustion and, ultimately, ketoacidosis.

Remember, more advice can be found from websites like Talk to Frank or from your diabetes care team.

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