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The body treats alcohol as a poison.  (No moralizing here, just stating the 
physiological fact.)  One of the many roles of the liver is to deal with 
poisons, rendering them as harmless as possible.  While it's busy doing 
that with alcohol, it's not able to respond to low blood sugar by releasing 
stored glucose or making new glucose, which are other liver 
functions.  Thus lows while drinking may be sudden and profound, with no 
natural rebound response.

Another consideration re: drinking is that the symptoms of lows often mimic 
those of drunkenness, so victim and bystanders may not recognize the 
problem and give appropriate treatment.  Of course, if those others are 
also inebriated, their thought processes are impaired too.

Pure alcohol alone does not raise blood glucose level and should not be 
covered with insulin.  Sweet wines, mixed drinks with syrups and/or juices 
may have carb that needs to be covered but at a lesser ratio of insulin to 
carb. Again, impaired thinking may lead to errors in insulin 
dosing.  Alcohol should never be taken on an empty stomach. Extra blood 
glucose testing - especially before sleep - is necessary when alcohol has 
been consumed.

Judith C. Renwick RN MSN CPNP BC-ADM CPT

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