Heavy drinking (i.e., more than 140 grams of pure alcohol, or approximately 12 standard drinks, per day) can cause alcohol-induced hypertriglyceridemia in both diabetics and nondiabetics (Chait et al. 1972). In fact, from a practical standpoint, heavy drinking should be considered as a possible contributing factor in all patients with hypertriglyceridemia. Abstinence from alcohol generally leads to normalization of the triglyceride levels, unless the person has an underlying genetic predisposition for hypertriglyceridemia. Ketoacidosis, which occurs primarily in diabetics, is a condition characterized by excessive levels of certain acids called ketone bodies (e.g., acetone, acetoacetate, and β-hydroxybutyrate) in the blood.

• Heavy drinking, particularly in diabetics, also can cause the accumulation of certain acids in the blood that may result in severe health consequences.
• Under the influence of excess glucagon, some of the free fatty acids are converted to ketone bodies and secreted into the blood, causing severe health consequences.
• Despite the high prevalence of impotence in male diabetics and the fact that many of these men consume alcohol, few studies have evaluated the relationship between alcohol intake and impotence in diabetics.
• He denies a history of diabetes mellitus, ingestion of any toxic alcohols, or recent illness.

BOX 1 PRESENTING FEATURES OF AKA

This activity illustrates the evaluation and treatment of alcoholic ketoacidosis and explains the role of the interprofessional team in managing patients with this condition. Larger studies by Fulop and Hoberman5 and Wrenn et al6 (24 and 74 patients, respectively) clarified the underlying acid base disturbance. Although many patients had a significant ketosis with high plasma BOHB levels (5.2–14.2 mmol/l), severe acidaemia was uncommon.

Metabolism of ethanol

In patients with ketoacidosis, however, the liver metabolizes the incoming free fatty acids in an additional, unusual way. Under the influence of excess glucagon, some of the free fatty acids are converted to ketone bodies and secreted into the blood, causing severe health consequences. In people with either type 1 or type 2 diabetes, single episodes of alcoholic ketoacidosis alcohol consumption (i.e., acute alcohol consumption) generally do not lead to clinically significant changes in blood sugar levels. In fact, some studies have indicated that isolated episodes of drinking with a meal may have a beneficial effect by slightly lowering blood sugar levels that tend to rise too high in diabetics (Swade and Emanuele 1997).

Diagnosis of Alcoholic Ketoacidosis

Ultimately, insulin secretion declines even further, to levels below those seen in nondiabetics (although generally still higher than those seen in type 1 diabetics). At that point, when a deficit in insulin secretion is combined with a state of insulin resistance, the person develops type 2 diabetes. Thus, whereas type 1 diabetes is characterized by a complete lack of insulin production, type 2 is characterized by reduced insulin production plus insulin resistance. The reasons underlying defective insulin secretion and insulin resistance, which are still under investigation, are complex and beyond the scope of this article (for a review, see DeFronzo 1997). Alcoholic ketoacidosis (AKA) is a condition seen commonly in patients with alcohol use disorder or after a bout of heavy drinking. It is a clinical diagnosis with patients presenting with tachycardia, tachypnea, dehydration, agitation, and abdominal pain.

Lactic acidosis

Alanine is generated during the breakdown of proteins in the muscles, whereas glycerol is formed during the metabolism of certain fat molecules (i.e., triglycerides). Alcohol metabolism in the liver, however, actually shuts down the process of gluconeogenesis and thus the second line of defense against hypoglycemia. Consequently, both of the body’s mechanisms to sustain blood sugar levels are inactivated in people who consume alcohol but do not eat, resulting in profound hypoglycemia. Generally, the physical findings relate to volume depletion and chronic alcohol abuse.

• In patients with ketoacidosis, however, the liver metabolizes the incoming free fatty acids in an additional, unusual way.
• These agents act to lower the patient’s blood sugar levels by decreasing insulin resistance rather than by increasing insulin secretion.
• Diabetes self-management education (DSME) and diabetes self-management support (DSMS) are recommended at the time of diagnosis of prediabetes or diabetes and throughout the lifetime of the patient.
• Depending on the type and cause, lactic acidosis can be mild (e.g., when caused by overexercising) or severe, requiring prompt and aggressive hospital care (e.g., when caused by a serious infection).

• Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting.
• Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol.
• He was also placed on CIWA protocol while in the ED and received 1 mg of oral lorazepam.
• Cardiovascular disease, particularly myocardial infarction (heart attack), can rarely put people with diabetes at risk for DKA.
• In general, the prognosis for a patient presenting with AKA is good as long as the condition is identified and treated early.
• If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized.

While we know that drinking alcohol doesn’t directly impact one’s development of type 2 diabetes, drinking alcohol can have serious side effects for people who have diabetes or are prone to low blood sugar issues. Drink moderately and always be sure to eat a balanced meal if you are drinking booze, as food can mitigate the effect alcohol has on your glucose levels. Check with your doctor to ensure that you shouldn’t have any adverse reactions and that your medication will not contribute to low blood sugars while drinking alcohol. Similar to illness, the body reacts to injury by releasing elevated levels of hormones, which lead to high blood sugar. Therefore, people with diabetes who have had an injury or recent surgery should look out for DKA symptoms and check their blood sugar levels often.

Management of alcoholic ketoacidosis

Alcohol’s Effects on Blood Sugar Levels of Diabetics