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Re: [IP] Alcohol, your liver and BGs
Long, but not too long...
Bob Burnett wrote: (a while back)
> To those in the crowd who imbibe:
> Can any of the medical professionals on the list clarify this at all? I'd
> really like to understand the process a bit better and I'm in over my head ;-)
Sorry to be slow responding to this lovely question. (I've been in
Freiburg for a few days flat hunting with my girlfriend, sorry, fiancée
(!) We've found our dream home and it was only a little over our limit
:) Move in August.)
Anyhow, for what it's worth, this is my undertanding of the liver and
bg's: (If anyone can correct or add to what I'm saying, I'd be very
What is critical is the concentration of insulin actually in circulation
at any time. When the insulin level is above a certain amount, it
"pushes" glucose into the liver. It modifies the glucose and stores it
as glycogen. When the insulin level drops below a certain much lower
level, this glycogen is converted back into glucose and released back
into the blood stream.
For the normal non-diabetic person this works very nicely: when your bg
is high (after a meal), insulin is made, which stimulates the liver to
remove glucose from the blood, bringing the bg down. When the bg is low
(during the night or during exercise), the body stops making insulin,
the insulin level drops, and so the the liver releases glucose into the
blood stream, raising the bg level. It's a nice self-correcting system.
So it is the insulin level, and not the glucose level, that triggers the
correct response from the liver. This is crucial to understand.
For the diabetic, this is unfortunate: when your insulin level is low,
the liver dumps glucose into the blood. But the insulin level still
remains low, so it dumps even more, since it only responds to the
insulin level, not the glucose level. That's why when you infusion set
falls out, the bg rises very quickly.
Similarly, when you have had too much insulin, and your bg is low, the
liver responds to the high insulin level, and removes even more glucose
from the blood, which is precisely what you didn't want.
This is why we have so much trouble sometimes!
OK, this is a slight simplification, and the body has a lot more
defenses against high and low bg's - but that's the contribution of the
insulin and liver partnership. The muscles also do a lot of the
glucose-glycogen swapping as well.
Whilst the absence of insulin is the primary trigger for the liver to
release glucose, there are other hormones which will cause it to do so.
Andrenylin is one of these. The anxiety, nervousness, palpitations etc
which many get with a hypo are caused partly by the release of
adrenyline, which in turn causes the liver to release glucose, which is
what you want. But at the same time, the insulin is pushing it back in
again, so it's not quite as effective as it could be.
Alcohol complicates things, since, as you say Bob, the liver cannot
release glucose into the blood stream when it is also filtering out
alcohol. It can't do both at once, and alcohol has priority.
I'm convinced that alcohol can move your bg through other mechanisms as
well, but I'm not sure what they are. It's possible that it can release
adrenyline, which then releases glycogen from your muscles, pushing up
the bg. But I'm a bit fuzzy there. Since I've been pumping, I've had
less trouble with alcohol causing my bg to move, so it's possible that
in modest quantities it affects absorbtion rates...
If you have diabetes, and drink alcohol, it is certainly your
responsibility to learn how it affects your bg. Some find alcohol causes
the bg to fall rapidly. Others find it has no effect.
I know Barbara feels strongly about this. I suspect she's seen diabetics
die in the Emergency Room, due to massive hypoglycemia compounded by
heavy drinking. Such things are possible. We all have our own attitudes
and responses to alcohol. Many wisely don't drink. Others find alcohol a
very pleasant recreational drug. I do. Julia and I enjoy a bottle of
wine with our evening meal several times a week, and I like my beer. So
there we are.
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