Alcohol can provide calories, or energy, without directly raisingblood sugar, but if you'rean insulin-dependent diabetic, you need to be cau tious about drinking.
Ethyl alcohol, which is the active ingredient in hard liquor, beer, and wine, has no direct effect on blood sugar be causethe body does not convert it into glucose.
In the caseof distilled spirits and very dry wine, the alcohol generally isn't accompanied by enough carbohydrate to affect yourblood sugar verymuch.
For exam ple, 100 proof gin has 83 calories per ounce.These extra calories can increase your weight slightly, but not your blood sugar.
Different beers — ales, stouts, and lagers — can have varying amounts of car bohydrate, which is slowenough in its actionthat if you figure it into your meal plan,it may not raise your blood sugar.
Mixed drinks and dessert wines can be loaded with sugar, so they're best avoided.
Excep tions would be a dry martini or mixed drinks that canbe made with a sugar-free mixer, suchassugar-free tonic water.
Ethyl alcohol, however, can indirectly lower the blood sugars of some diabetics if consumed at the time of a meal.
It does this by par tially paralyzing the liver and thereby inhibiting gluconeogenesis so that it can't convert enough protein from the meal into glucose.
For the average adult, this appears to be a significant effect with doses greater than 1.5 ounces of distilled spirits, or one standard shot glass.
If you havetwo 1.5-ounce servings of gin with a meal,your liver's abil-
The Basic Food Groups 137
ity to convertproteininto glucose may be impaired.
If you're insulin- dependent and yourcalculation of how much insulin you'll require to cover your meal is based on, say, two hot dogs, and those hot dogs don't get 7.5 percent converted to glucose, the insulin you've injected will take your blood sugar too low.
You'll have hypoglycemia, or low blood sugar.
The problem of hypoglycemia itself is a relatively simple matter to correct — you just eat some glucose and your blood sugar will rise.
But this gets you into the kind of messy jerking up anddown of your blood sugar that can cause problems.
It's best if you can avoid hypo- andhyperglycemia (high bloodsugar) entirely.
Anotherproblem with alcohol andhypoglycemia isthat if you con sume much alcohol, you'll have symptoms typical of both alcohol intoxication and hypoglycemia — light-headedness, confusion, and slurring of speech.
The onlyway you'll know the cause of your symp toms is if you've been monitoring your blood sugar throughout your meal.
This is unlikely.
So youcould find yourself thinking you've con sumed too much alcohol when in fact your problem is dangerously lowblood sugar.
In such a situation, it wouldn't even occur to you to check your blood sugar.
Remember, that early blood sugar-measuring device I gotwas developed in order to help emergency room staffs tell the difference between unconscious alcoholics and unconscious dia betics.
Don't make yourself an unconscious diabetic.
A simple over sight could turn fatal.
Many of the symptoms of alcohol intoxication mimic those of ke toacidosis, or the extreme highbloodsugar andketone buildupin the body that can result in diabetic coma.
The great buildup of ketones causes a diabetic's breath to have an aroma rather like that of someone who's been drinking.
If youdon't die of severe hypoglycemia, thenyou mighteasily dieof embarrassment when youcome to andyourfriends are aghast and terrified that the emergency squad had to be called to bring you around.
In small amounts, alcohol is relatively harmless — one glass of dry wine or beer with dinner — but if you're the type who can't limit drinking, it's best to avoid it entirely.
For thereasons already discussed, and contrary to the guidelines of the ADA, alcohol can be more be nign between meals than it is at meals.
One benevolent effect of alco hol is that it can enable some diabetics to consume one beer or one small bloody Mary (tomato juice mixed with an ounce and a half of vodka) without raising blood sugar.
10 Diet Guidelines Essential to the Treatment of All Diabetics
Research into creatingreplacement ceUs for burned-out insulin- producing pancreatic beta ceUs is so promising that it's temptingto think of a "cure" not in terms of if but when.The reaUty is,however, less rosy.
There may one daybe a cure, but to put off normalizing your blood sugars until then is simply to ignore the reaUty of your situation.
If you're going to controlyour diabetes and get on with a normal life, youwiU have to change your diet, and the when is now.
No matter how mild or severe your diabetes, the key as pect of aU our treatment plans for normalizing blood sugars and pre ventingor reversing complications of diabetes is diet.
In the terms of the Laws of SmaU Numbers, the singlelargest"input" you can control is what you eat.
THE FUNDAMENTAL IMPORTANCE OF A RESTRICTED-CARBOHYDRATE DIET The next several pages may weU be the most difficult pages of this book for you to accept — as weU as some of the most important.
They're fuU of the foods you're going to have to restrict or eliminate from your diet if you're going to normalize your blood sugars.
You may see some ofyourfavorite foods on our No-No Ust, but before you stop reading, keep in mind a few important things.
First, toward the end of this chapter we discuss the foods you can safely eat.
Second, whUe you wiU have to eliminate certain foods, there are some gen uinely sugar-free and low-carbohydrate alternatives.
One purpose of blood glucose self-monitoring is to learn through
Diet Guidelines Essential to the Treatment ofAllDiabetics 139
your blood sugar profiles how particular foods affectyou.
Blood sugar self-monitoring is the ultimate measure of the effect foods have on your blood sugar.
If you don't beUeve what you're reading here, check your blood sugars every 2 hours after consuming food you are certain must be benign.
Over yearsof examining profileslike the ones you wiU create, I've observed that some people are more tolerant of certain foods than other people.
For example, bread makes my own blood sugar risevery rapidly.
Yet one or two of my patientswith mUd type 2 diabetes eat a sandwichof thin breadevery daywith only minor prob lems.