1. Diabetes Edutool: Tutorial 5 The effect of alcohol on blood glucose

2. Excess glucose from the blood is stored in the liver This glucose is then gradually released during the day for energy as needed

3. When the blood glucose level tends to fall, the liver releases more glucose This helps to prevent low blood glucose, for example when we sleep

4. When we drink alcohol, it lowers our liver’s counterregulation ability

5. The risk for low blood glucose then increases, as the liver cannot prevent it

6. Let’s use the Edutool to explain how this works

7. The liver will release glucose when the blood glucose is low Maximum amount of normally available from liver

8. When alcohol is consumed, the liver’s counterregulation ability is reduced Reduced amount of available from liver in the presence of alcohol

9. Let’s use an example Arnold goes to a party, and has 2 light, low- calorie beers He goes home and sleeps While he sleeps, his body requires glucose His liver cannot make enough glucose, and he goes into a “hypo”

10. Arnold starts with a blood glucose in the normal range Normal blood glucose of 5 mmol/L

11. At the party he has 2 light beers

12. After the beers, the liver’s counterregulation ability has reduced Reduced amount of available from liver

13. The beers did not contain any His blood glucose is still normal

14. During sleep, the body uses energy to sustain life (Sleep ≈ “exercise attempted”) ≈ 1.5 /hour

15. Arnold goes to bed and sleeps for 8 hours; this requires 13

16. His liver cannot release the energy required by the body Maximum amount of available from liver

17. Arnold’s blood glucose is now dangerously low He experiences a hypo

18. This can be avoided by eating a small snack before going to bed

19. If Arnold had consumed 4 before going to sleep, his waking blood glucose would be normal Normal blood glucose of 5 mmol/L

20. Lessons: - The liver helps to counteract low blood glucose - There is a limit to the liver’s counteracting ability - Alcohol reduces the liver’s counterregulation ability - When you have consumed alcohol, eat a snack before going to bed -- End of Tutorial 5 --