from the ADA

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THRIVING WITH DIABETES

Just a Drop of Common Sense

From the April 2008 issue of Diabetes Forecast, C2008 American Diabetes

Association.

By Marrero, PhD

After you are diagnosed with diabetes, you might find yourself learning

quite a bit about your diet. Much of this involves making decisions

about how best

to eat and drink to achieve good outcomes and avoid problems with your

therapy. While some rules are fairly obvious and based on solid science,

for others,

far less evidence is available. One such example is drinking alcohol.

Thriving with Diabetes -- Marrero, PhD

Let's face it: Alcohol is a potent drug that can have a profound, and

often negative, impact on users. Still, more than 120 million people in

the United

States drink alcohol on a regular basis, and many of them have diabetes.

When I was diagnosed with type 1 diabetes 30 years ago, many doctors,

including

my own physician, believed that people with diabetes should not drink

alcohol. The prevailing wisdom was that alcohol could impair your

judgment, make

it difficult to sense the onset of hypoglycemia, and inhibit

self-management. While there wasn't much experimental evidence

supporting these assertions,

it was the party line of the time.

Today, however, increasing evidence suggests that moderate consumption

has many beneficial effects for people with diabetes. In a comprehensive

review of

several studies on the effect of alcohol use by people with diabetes,

the data show that both not drinking at all and drinking heavily (i.e.,

more than

three drinks per day) have more deleterious effects on health status

than does moderate consumption. Indeed, moderate alcohol intake (i.e.,

one to three

drinks per day) is associated with decreased incidence of coronary heart

disease, a major killer of people with type 2 diabetes; improved lipids;

and,

potentially, reduction of inflammatory response, which is increasingly

linked to the risk of cardiovascular disease events.

Limited research also suggests that alcohol is not associated with

adverse outcomes when using sulfonylureas or thiazolidinediones.

Moderate consumption

was found to have no acute effects on glycemic control in type 2

diabetes. In type 1, it may in fact cause hypoglycemia the following

morning, and the

usual symptoms of hypoglycemia may be masked and impair the

counter-regulatory responses to insulin-induced hypoglycemia.

This suggests that people with type 1 need to consider diet regulation

when they drink and make sure they are monitoring their blood glucose.

While moderate consumption of alcohol may have some positive benefits

for those who already drink, the science does not support adding alcohol

to your diet

if you don't currently do so. But if you have diabetes and you do drink,

it's important to discuss this with your health team. Make them aware

that drinking

alcohol is part of your lifestyle and that you want to continue to do so

in a responsible fashion. A dietitian can show you how to enjoy a glass

of wine

or beer with your meals without adding excessive calories.

Optimal control of diabetes is not only about attaining good metabolic

numbers, but achieving a lifestyle that is comfortable and rewarding

while you do

so. You can, with a little thought, drink a glass of fine wine with your

meal and by doing so benefit your health- and your enjoyment of life.