DD is now in a situation where virtually all of her friends and classmates will have a few drinks on a Saturday night. She held off for a long time, but is now experimenting with having a couple of drinks when out with friends. I want her safe, so we've agreed on a no-penalties for disclosure rule for evenings when she's had alcohol. I need to know if she's consumed alcohol because I need to step up my night-time testing on those nights. When alcohol is consumed by someone with Type 1 D, the liver will stop putting out its usual level of basal glucose to keep the body's cells sustained. What that means is that all of the basal insulin that is acting suddenly becomes a slow-motion bolus. In DD's case, she is getting 36 units Lantus daily and the Lantus keeps blood sugars steady on a normal night. Those 36 units of Lantus are covering her liver's basal glucose output. On nights when she's had alcohol the liver stops putting out glucose, the Lantus (which works out to 1.5 units an hour) is simply pulling down blood sugars. It will keep doing so until all of the alcohol has been processed.. I've seen her go to bed with a blood sugar of 250+ and no correction on such nights, and if I hadn't been checking overnight she'd have been low before morning. Night-time testing for teens on weekends is probably even more critical than when they're younger.. :cwds:
Yes, Maddie mentioned that some of her friends are beginning to drink at parties as well. Sigh... Did you see this blog post? It was posted by a few people here and on FB. Interesting, and in sync with what you are noting. http://forums.childrenwithdiabetes.com/showthread.php?t=71882
Similar situation and rule here. No judgment when he asks for a 3am check. What I see most is his usual peaks and valleys while sleeping don't happen, cgm shows a strangely flat flat line. I've seen lows up to 8 hours later, which is exactly what the articles all say. So my main advice is to keep a close watch not just overnight but for an extended time, allowing all to metabolize. I don't encourage it but living in a reality world. We do have the ability to lower or suspend basal which helps. Scary times for sure.
Ha ha - that's a beauty of an article. To date DD's drinking is more social, but if she starts to get serious about it I'll consider strewing this..
I know! Let's hope it never comes to that for the girls, but it was a fresh take on a topic that gets less attention than it should. Nonetheless, I''ll probably leave out literature on the medicinal benefits of smoking pot
Case in point: saw a 225 point blood sugar drop overnight last night, simply due to the aftereffects of a few drinks with friends on a night out..
I'm glad you posted this. I had asked my endo what I should do about bolusing for alcohol. She told me to bolus for the drinks, as there is a lot of sugar in most drinks. It didn't seem right to me, and so on my 21st birthday, my gut instinct said don't listen to her. I don't believe I bolused for anything, went to bed at 350 or so, and woke up at around 60. I'm so glad that I trusted myself, and didn't take my endo's advice. Alcohol really has a huge effect on my blood sugar, and I am scared to think of how that night would have turned out if I had listened. Good job parents for the no judgement rules that you have with your teens. :cwds:
I would not be forthcoming with this information to your DD?s D team. Since Mac became a children?s hospital and even before that they started beating the drum of duty to report, duty to report, duty to report. If you reveal that information to them, it will be charted in EMR. It will then be uploaded to Clinical Connect, which is available to all hospitals in the area i.e. there will be widespread and indelible access. A nervous / overzealous / prudish clinician may report to CAS justifying it in their mind that you are contributing to the delinquency of a minor. Especially at a teaching hospital. Learners that are in contact with the pediatric population constantly have duty to report shoved down their throat, and some clinicians may take personal issue with the behavior and view you as enabling her. . I am just cautioning you of the possibility. This does not reflect my personal judgment. I?m sure you know this, but I feel it has to be said. Drinking at a young age tends to go hand in hand with being sexually precocious. When you?re 16 you tend to believe that everyone is having sex, but statistically it is really not the case. Maybe the cat?s out of the bag a bit, but it is kind makes me sad when kids feel the need to grow up so fast, and a lot of it relates to peer pressure.
While I am always glad to collect information, I would not be as casual if my almost 17 year old was "having a few drinks with friends".... We have a no tolerance policy in our school district, and even if things are posted on facebook or emailed and the school finds out, they get a code of conduct violation. It could mean being being kicked off any team or school activity. and just curious? who'd driving your kids when they're drinking? or are they at someone's house? in the US, If parents let other kids drink at their homes, it's against the law....
Seriously, when I was 16 animals followed me around like I was snow white. I had no idea Ancaster kids were so badass Wilf. There's something sort of ironic about returning home after a night of drinks all tuckered out, only to have daddy test your blood sugar while you visions sugar plums dance in your head.
I'm not casual, I'm concerned. I've talked at length with her about alcohol and the problems with it. On the other hand I live in the real world and don't want my daughter to end up in a diabetic coma.. Up here in Canada there's none of the prohibitions you're talking about, not that they make a whit of difference overall. Myself or another parent pick up our daughters at the end of the evening. :cwds:
This is really frightening. It is such common knowledge that BS drops with alcohol I honestly would question your doctors knowledge on this. The idea than an endocrinologist would tell you this is really upsetting to me. It definitely teaches you one thing, always trust your gut.
I'll let Wilf speak to this, but the culture of alcohol use is much different in Canada and Europe compared the the US. There is typically more of an emphasis on moderation as opposed to the secretive binge drinking that US teens engage in. It is also not against the law for teens to drink in much of the rest of the world.
I remember being in Belgium many years ago visiting a friend and her 15 or 16 yr. old brother came in and grabbed a beer. It was so funny. No drinking laws there like in the USA for sure - a refreshing approach. So a question then for Wilf - if the basal insulin turns into a slow motion bolus - is it different for pumpers vs. those on MDI who use lantus? If so - how would handle it with a pump out of curiosity.
The thing with Lantus, is that once you've given the injection you're committed for the next 24 hours. You can't turn it off.. If DD was pumping I'd experiment with reducing the basal (by 50% the first few hours after some drinks, then by 75%, and then down to the minimum after 8 hours) - my sense from watching blood sugars is that the biggest effect is actually many hours after the drinks have been consumed.
I've tried doing a temp basal, but typically if I've had a few drinks I feel more comfortable eating something with fat and carbs (pizza is perfect) and going to bed well above 200 rather than trying to do a temp basal.
I think the culture surrounding drinking is similar in Canada to what it is in the US. The difference is that alcohol costs substantially more here because it is heavily taxed by the government and is only sold at government-operated stores. The stores have limited hours. Whereas in the US you can buy alcohol 24 hours a day, 7 days a week at a grocery store or convince store. Therefore, if anything I would say that alcohol consumption is more tightly regulated in Canada than in the US. We also have a publicly funded health care system. Drinking related illness and injury cost that system millions if not billions of dollars.
You could definitely be sanctioned at the university level for underage drinking in residence, on campus, at a school sanctioned event, or while representing yourself as a student. Your individual faculty could also discipline you if you are enrolled in a faculty that leads to entry into a specific profession governed by ethics. Your mentality, that apparently all the 16 year olds at her HS drink is distorted. I highly doubt that even the majority of 16 year olds at her school drink. An HS is unlikely to intervene, unless someone showed up inebriated at Prom or a dance. Or made an ass of themselves on social networking relating to drinking.
The drinking age in Canada is 18 or 19 (with parental presence, younger), depending on province. In the United States, it's 21, except on military bases, Puerto Rico, and the Virgin Islands. That is significant because that means that in Canada, just about everybody at college or University is legal to drink, whereas at my freshman orientation we got a long lecture on what would happen if we got caught drinking underage, or using a fake ID, including permanently being barred from getting various professional licenses. Depending on which state in the United States you are in, it may or may not be legal for people under 21 to drink alcohol in various circumstances, such as with parental presence and consent.
