Alcohol- pretty long, sorry

So I will preface this by saying I know I screwed up. This is not something I normally do and not something I plan to repeat. But I would like to get people's thoughts on what happened if they wish to share. I would prefer to avoid extremely critical comments (or feel free to send them via PM, I am open to criticism I would just rather avoid a debate). I may edit this a bit in a few days.

I will go through everything that happened. I am going to be detailed just in case someone sees something I missed.

Last night I had a normal dinner consisting of grilled chicken, pesto pasta, salad, a bread stick, raspberry cheese cake and diet pepsi at 6 pm. Bolused as usual. Had a glass of wine while doing a biochem problem set at around 7 pm. I don't bolus for wine. Around 9:30 PM I had 3-4 shots of tequila. BG was 150ish at that point. Fooled around in the kitchen until around 10:30. BG was around 130 and I set a temp basal of .05 units an hour since I prefer to be around 160 while drinking. Went to a party at that point.

So this is where I think things went wrong. We were drinking these things called fishbowls. They generally have 5oz vodka, 5 oz rum, 3 oz blue cura?ao, and 32 oz sprite and swedish fish and nerds. I had probably a total of .75-1.5 of these "fishbowls" over 3 hours but I am not sure. Basically people carry around the fishbowls and you drink from straws so it is super tough to keep track of drinks. I did not bolus anything and my blood sugar stayed consistently around 150.

Got home and I was totally fine, a bit unsteady on my feet. I was around 90 when I went to sleep so I had a yogurt I didn't bolus for and I set a temp basal for 8 hours of .05 units/hour. It was around 3 AM and I set an alarm to test at 6. My boyfriend woke me up around 5 because my CGM was alarming low and I wasn't waking up. I tested and was 30. I apparently told him "no thank you I'm sleepy" when he tried to get me to drink. I don't really remember this but I guess I eventually had a tube of cake icing. I was 28 after this (numbers from the meter--I don't remember) and then had a coke (full can) and 2 zofran since I felt really sick to my stomach. I told C not to give me glucagon since I felt so sick and figured it wouldn't help anyway. I was still under 30 on the glucose meter about 1 hour in to all this. I did give myself a shot of glucagon at this point even though I figured it wasn't going to help. C (who happens to be a CC-EMT) called a friend to see if they could bring over some D50. They rightfully refused but said to call 911. Which C did. EMS came and gave me an IV push of D50. I was around 25 when they arrived and shot up to 200 about 5 minutes after the IV. Since I was totally alert the whole time they did let me sign off so I did not have to go to the hospital. I have not bolused for anything today and so far have been between 90 and 160. I spoke to the on call endo and plan to follow his advice for doing a low temp basal tomorrow and conservative bolusing.

So, I am totally aware that I made a ton of mistakes. I would like to say I have no intentions of ever drinking a significant amount again but I can't guarantee that. So if anyone has advice on avoiding a repeat of this I would love to hear it. Additionally, if anyone has any tips on what they would have done for the initial low glucose reading I would be grateful. Looking back I probably should have just called 911 much earlier.

My concerns are that I have had this much to drink before and never had a problem. I typically do go a bit low but nothing that a few carbs can't handle. I had literally 120 carbs and my bg would not go over 30. Am I missing something here? I know this makes me look really reckless but I was testing every 20 minutes while drinking and wearing a CGM. Yes, I had a lot to drink but I did not bolus for any of the carbs. I had a really low temp basal set. I just can't figure out what brought my blood sugar down that low.

Thanks for reading! I am planning on speaking to the CDE when I see the endo over spring break in 2 weeks.

 

I'm just a parent, will not be judgmental.

I do not know what to do because I do not have diabetes, nor do I have experience with treating lows/alcohol. Should I encounter someone who has such experience, I will ask them to reply. Maybe there is someone in these forums who will reply sooner, has yet to see this.

 

I don't have any specifics to offer you but the one thing I would say is that while you gave the Glucagon, you are probably right that it wouldn't do much. Alcohol suppresses the liver's function so it may not have released even with the Glucagon. That's why drinking to excess is so dangerous for diabetics - lows coupled with the liver's inability to release anything to help bring it up. That's why you kept staying low. I'd be thankful that your boyfriend got you the D50 - honestly, it probably saved your life.

I honestly would say, and I'm sure you don't want to hear it, is the only thing you can do differently is NEVER, EVER drink like that again. I was 19 once and I do understand the pressures and I can tell you that I often drank like that when I was in college, but I will honestly tell you that drinking like that with diabetes can literally kill you because it numbs the "last line of defense" for a diabetic, which is your liver.

 

Was there food involved in any of this? How about water? Did your food/water intake vary from prior times? I know you had a yogurt before bed but I mean more food involved during the drinking.

No judgment here. This sounds very scary. I commend you for wanting to understand things better.

It's already been said, but understand that glucagon is useless during events like this.

 

From this scary experience, I would say that from now on there is no reliable way to second guess what will happen when you drink a lot. Eating some good fatty carbs with the party drink might have been a good idea. No bolus of course. However, you might have just vomited it all up later if you were feeling sick to your stomach in the middle of the night. Also, the 90 at bed was probably way too low to just have a yogurt. As far as not getting the low up, I have no idea! That's just terrifying! Thank goodness for 911 call!

 

Thanks. No I am willing to hear it. I know I really messed up. I don't think the glucagon did anything. I figured it wouldn't since I know the liver was tied up with the alcohol. I don't plan on ever doing this again. Yes, I am very thankful C called 911. At the time I was pretty furious but there really was no other choice.

 

Thanks for the reply.

I had a few muffins in between the tequila and the vodka/rum mix. I did not bolus for them. There was no water whatsoever involved. There was really no food involved during the heavy drinking except for a few handfuls of chips. I have actually only ever had this many drinks maybe 3 or 4 times and there was food involved there but I hadn't had such a big dinner before either. Generally, there are wings, pasta, and fries at these things which I nibble on but this time there was no food out that I had saw. I am guessing the lack of eating while drinking may have been the problem.

 

Please run yourself high for a while.

Even though you had supper, you were drinking for so many hours after ward, the food would have been long gone and you were actually drinking on an almost empty stomach. A lot of late night pizza may have helped, but I doubt you could have kept it down with that booze combination.

For the initial low I would have used several liquid or gel Dex. It works so much faster than anything else. "The quickest way to raise your blood glucose and treat hypoglycemia is with d-glucose. Dex4? glucose tablets, Dex4? glucose gel and Dex4? Liquiblast produce the ideal glycemic response by providing the exact sugar (d-glucose) your cells need for energy and quick relief from symptoms of hypoglycemia." "Please note that candy, cola and juice may contain carbohydrates, but take longer for your body to digest as they contain extra ingredients that need to be broken down before your body gets the exact d-glucose it needs." www.dex.ca

I am so glad you are safe and that your boyfriend was there for you. Thank you for posting your experience. I will be showing it to DD and praying she remembers it when she is tempted.

I cannot imagine how lousy you must feel after those lows and the hangover.

Extra thanks to your Guardian Angels from all of us.

 

I would guess lack of food and water were what made it worse. And would for anyone but diabetes adds an extra component.

I'm glad you were ok and had someone to help. Maybe in the future bring a large bottled water along with you and try to keep drinking it all evening. Also keep track of your own drink, if you're sipping here and there after a while it's impossible to keep track. Plus as a Mom I have to throw in the possibility of people spiking your drink and if you keep track of your own it's less likely to happen.

Kudos for owning up to your mistake. I hope you feel better soon.

 

Wow, that is truly scary and your boyfriend's actions saved your life. All the advice I have heard about drinking is to limit it to 2 drinks and to eat. You experience seems to show that the premise that more drinking, plus more food does not work as well as eating and drinking a moderate amount.

You were able to dodge the bullet this time.

Many of us as we gain experience recognize our limitations. Try to internalize that your body is simply not equipped to handle that much alcohol.

At 19, I too drank like that. One day, I stopped as I hated getting sick. It wasn't worth the trade off.

This could be your turning point.

Considering not going to parties like this where so much drinking is occurring.

 

When you get low enough for long enough, you don't digest well. That would probably be the reason for the 120 carbs not doing much. I find hypos get really stubborn often if they get down that low.

 

Here's a resource that might be helpful:

http://www.drinkingwithdiabetes.com/

 

First of all, I am really glad you are ok.

Second of all, I'm no where near a point where this has even crossed my radar. My son is only 10 years old, but it's good to know the challenges I will face in the future. Teens are teens, there is no way to avoid these issues.

My Ex BIL was diagnosed when he was 23 yrs old. He was a heavy binge drinker. His dx seemed to do little to change that and honestly, I don't know how he did it.

I am blown away by the mechanism of alcohol in diabetics. I always thought that alcohol would increase your BS. I had no idea there was a risk of lows.

I obviously have some learning to do. The only thing I can suggest is eating a high protein, moderate fat snack as you drink. Obviously, drink less. Socially, I know you can't avoid going to these kinds of parties. I used to blame antibiotics when I didn't want to drink (pregnant but didn't want to tell anyone yet) to avoid the conversation about why I wasn't drinking more.

The other key point about alcohol is that it affects your perceptions and judgements. Combined with the normal confusion that can accompany a significant low, you inadvertently put yourself at risk. I recall being so intoxicated that lying on the bathroom floor under a sink in s bar bathroom seemed like a good idea. As did suddenly getting up without telling anyone and climbing into the back seat of my car and falling asleep. They looked for me for over an hour thinking I had been kidnapped. Not cool.

Best of luck to you and I hope you are on the road to feeling better. Hangovers of all kinds suck!

 

Glad you're ok, I am Type 1, and have had a few drinks over the years, when I was a teen we had NPH and Regular, didn't seem to affect me that much, and I always took injections for the sugar in the mixes.

My only advice is if it affect you that way, to disconnect from the pump, the CGM is still working and will alert your b/f to any highs, then just connect and do a half bolus until you're sure the alcohol isn't affecting your liver!
Just MHO

 

In my experience I have never seen any proof this is a good thing to do or makes any difference.

To the OP, no advice except I am glad you are OK and have learned from this.

 

Thanks for the replies and lack of judgement!

I am actually feeling a lot better then I deserve. Other then a bad headache yesterday I have been fine. On the blood sugar front things are still really wacky. I have had about 100 carbs today without bolusing and my blood sugar has not been above 130. I have spoken to my endo though and I have a low temp basal set and I am not bolusing for anything until I start to go over 200.

It was a really terrifying experience though. I think my body flat out can't handle that amount of alcohol. I don't foresee myself drinking more then 2 or 3 drinks in the future (and no alcohol at all for awhile).

I plan on uploading my pump so I can send cgm graph to my endo. I will try to post it here. It is scary to see just how low I was for so long. I am actually pretty shocked that I am fine now considering I spent 2 hours in the 15-30 range.

 

So glad you are ok.

 

The important thing is that you are ok.

I have to agree that since it had been more than a few hours since you had eaten that it didn't help for you to drink on an almost empty stomach.

 

I drink < 5x/year.

Probably not recommended, but if I drink heavily (> 2-3 drinks), I don't take any insulin at bedtime (or take my pump off). I deal with the consequences in the morning.

Your friends need to know that it is unacceptable to leave somebody unconscious/incoherent for any reason, even for being intoxicated. With diabetes, it is always a serious concern, whether drinking or not.

I actually did get my drink spiked in college (it was with water-no alcohol or drugs involved) but nothing happened except me being under the influence of a drug and being messed up all day after my drink was spiked (in the morning). A guy (at his house) gave me a glass of water (because my blood sugar was high) that was spiked while we were studying. Nothing else serious happened, but I was super p*****.

Anyways, I would stay away from liquor outside of your own residence OR a decent (relatively safe) bar. I would stick to (sealed) bottles of beer. Never, ever leave a drink unattended. Spiking can happen within a matter of seconds

 

Great article about drinking and T1:


http://www.diabetesmine.com/2012/11/d-teens-and-alcohol-no-bull-from-uncle-wil.html


I'm glad your better!