Alcohol and cigarette use among adolescents with type 1 diabetes
OBJECTIVE Alcohol is associated with acute hypoglycemia in patients with type 1 diabetes. After drinking alcohol in the evening, delayed hypoglycemia has also been described, although its cause is unknown. We performed a controlled study to investigate this phenomenon. RESEARCH DESIGN AND METHODS We admitted six men with type 1 diabetes (aged 19-51 years, HbA(1c) 7.0-10.3%) on two occasions, from 5:00 P.M. to 12:00 noon the following day. They received regular insulin injections before standardized meals, at 6:00 P.M. and 8:00 A.M., and a basal insulin infusion (0.15 mU x kg(-1) x min(-1)) from 11:00 P.M. They drank either dry white wine (0.75 g/kg alcohol) or mineral water at 9:00 P.M. over 90 min. Blood glucose, alcohol, insulin, cortisol, growth hormone, and glucagon levels were measured. RESULTS Blood ethanol reached a mean (SEM) peak of 19.1 (1.2) mmol/l and was undetectable by 8:00 A.M. There were no significant differences in evening or overnight blood glucose levels between the studies. In the morning, fasting and postprandial blood glucose levels were significantly lower after consumption of wine (postprandial peak 8.9 [1.7] vs. 15 [1.5] mmol/l, P < 0.01), and from 10:00 A.M., five subjects required treatment for hypoglycemia (nadir 1.9-2.9 mmol/l). None of the subjects had hypoglycemia after consumption of water. After consumption of wine, growth hormone secretion was significantly reduced between midnight and 4:00 A.M. (area under the curve 2.1 [1.1] vs. 6.5 [2.1] microg. l(-1) x h(-1), P = 0.04). There were no differences in insulin or other hormone levels. CONCLUSIONS In type 1 diabetes, moderate consumption of alcohol in the evening may predispose patients to hypoglycemia after breakfast the next morning. This is associated with reduced nocturnal growth hormone secretion. Patients should be informed of this risk and advised regarding appropriate preventative measures.