Alcohol and diabetes can be a fatal combination Tom was nine years old when he was diagnosed with diabetes, 10 when he began drinking alcohol, and 34 when he died from diabetes complications aggravated by the daily abuse of alcohol. Growing up with a chronic illness such as diabetes is tough, but as Tom's family found out, the addition of a second chronic condition was fatal. Tom had so much anger over his diabetes. "He couldn't hold a job because of his drinking, and he'd spend the money for his medical needs (insulin injections) on booze," said Tom's sister. "He tried to regulate his insulin with how much alcohol he was going to drink." Tom's case is a vivid example of what can happen when the two diseases are not managed. Alcoholism and diabetes are frequently compared. Both are chronic illnesses, which means they can be controlled and treated but they have no known cure. Diabetes is a disorder of food metabolism in which the pancreas doesn't produce enough insulin or the body doesn't respond to the insulin that is produced. Alcoholism is the excessive use of alcohol and the individual's inability to stop drinking despite adverse consequences. The causes of these two diseases are still unknown. An estimated 14 million people in the United States have diabetes, and about the same number show symptoms of alcoholism. Both diabetes and alcoholism touch the lives of all persons regardless of race, sex, national origin or social position. Early diagnosis and treatment is critical in the management of both diseases, and treatment for both is lifelong. Education is crucial in the acceptance and recovery of both illnesses. Self-care is critical, and the mutual-help support groups for each disease can play key roles in living with the diseases. If left untreated, both conditions can cause severe complications. "Anyone--even the person without diabetes--who depends on alcohol as a major source of calories will see a depletion in their health," said Nancy Cooper, a registered dietitian and coordinator of Nutrition Education at the International Diabetes Center in St. Louis Park. This is especially true for the person with diabetes, who relies heavily on proper diet to control blood-sugar levels. Alcohol has virtually no nutritious value and is considered a "fat" in the food-exchange diet of people with diabetes. The effects of alcohol vary from individual to individual, but small amounts of alcohol (one or two drinks) consumed close to or with a meal generally produce little change in the blood-sugar levels of an individual with diabetes whose disease is under control. On the other hand, alcohol use can cause many problems, especially if the person with diabetes hasn't eaten for several hours. "The overall effect of alcohol is to lower blood-sugar levels," said Cooper. "And this can put a person with diabetes at risk for hypoglycemia (low blood sugar) if he or she hasn't eaten for a while. The liver can assist in controlling blood-sugar levels by releasing glucose (sugar) into the blood stream, but this doesn't happen normally when alcohol is in the system because the liver is busy trying to get rid of the alcohol." Because the symptoms of hypoglycemia (slurred speech, loss of balance, disorientation, headaches, combativeness) are similar to those of intoxication, hypoglycemia may be mistaken for drunkenness, and treatment (ingesting sugar) may be delayed. Alcohol use, especially excessive use, can also disrupt dietary control for the person with diabetes, said Cooper. Alcohol use may stimulate the appetite and lead to excessive food intake, which may cause a transient rise in blood sugar that is usually followed by a fall in blood-glucose levels. People with diabetes should consult with their physician or diabetes educator on how to include alcohol safely into their diet. The chronic alcohol user who has diabetes may face a number of problems, such as circulatory disorders, liver damage, high blood pressure, pancreatitis, atherosclerosis (fat-clogged arteries), heart problems, gastritis, kidney disease and/or renal failure. Tom was treated for alcoholism several times and was frequently hospitalized for his poorly managed diabetes. His sister believes he never accepted his diabetes--never got past denial--and used alcohol to help him forget his problems. "You never knew if he was intoxicated from alcohol or having a low blood sugar because of his diabetes," she said. Patient self-care is critical for managing diabetes and alcoholism. People with diabetes can learn to accept their disease and live healthier lives--much like recovering alcoholics. Alcoholics Anonymous helps achieve a happy, healthy lifestyle for alcoholics, and similar mutual-help support groups for people with diabetes are available through the American Diabetes Association of Minnesota (1-800-232-4044). The effects of alcohol consumption on diabetes are addressed in "Learning to Live Well With Diabetes," a general diabetes manual written by authors from the International Diabetes Center. The manual costs $24.95 and is available by calling 1-800-444-5951. The Hazelden Report is a chemical health column that addresses the prevention and treatment of chemical dependency and other related addictive behaviors. This Report was originally published Jan. 28, 1992 in the Star Tribune newspaper.