Diabetes Care During Recovery

You are trying to get help for drinking or drug use without letting blood sugar become the emergency. Diabetes does not pause because someone enters treatment, and alcohol does not become harmless because a general health page mentions a drink limit. Blood sugar, diabetes medicines, and substance use are the subject. The comparison of return to drug use with the course of diabetes as a chronic illness is a different fact, explained on the success-rates guide. Here, diabetes means the disease.

What CDC calls a low

CDC says blood sugar levels change through the day. Below 70 mg/dL is low blood sugar, also called hypoglycemia, and at that level you need to bring it back up. Low blood sugar is especially common in people with type 1 diabetes. It can be dangerous if it is left untreated. Severe low blood sugar is below 54 mg/dL. CDC says blood sugar that low may make you faint, and that you will often need someone else to help.

Common symptoms CDC lists include a fast heartbeat, shaking, sweating, nervousness or anxiety, irritability or confusion, dizziness, and hunger. As a low gets worse, CDC lists feeling weak, trouble walking or seeing clearly, acting strange or feeling confused, and seizures. People do not all feel the same symptoms. Some people have no symptoms at all, which CDC calls hypoglycemia unawareness. That is more likely after more than 5 to 10 years of diabetes, after frequent lows, or with certain medicines such as beta blockers. CDC says checking matters more in that situation, including before driving or physical activity.

Drinking alcohol is on CDC's list of causes, next to too much insulin, not enough carbohydrate for the insulin, the timing of activity, and skipped meals. A low can also happen at night. CDC names an active day, activity close to bedtime, too much insulin, and drinking alcohol at night. Eating regular meals, not skipping them, and eating when you drink alcohol can help avoid a nighttime low. CDC says you may wake up, and that you should not rely on waking up. A continuous glucose monitor can alarm during sleep. CDC also says people with diabetes can have a low as often as once or twice a week even when they manage closely. That frequency is CDC's description of how common lows are. It is not a goal.

CDC points readers to its own instructions for treating a low, including how many glucose tablets to use. Follow the plan your clinician already gave you. If you do not have one, ask for one before you are alone with a meter. Call 911 for a seizure, fainting, or someone who will not wake up. Do not spend the emergency deciding whether the confusion is intoxication. For a mental health crisis, call or text 988. CDC's severe symptoms overlap with signs families sometimes blame only on alcohol or other drugs. The safe move is medical help.

What NIAAA says about alcohol and diabetes

NIAAA's core resource for clinicians says that in patients with diabetes, any alcohol intake may reduce the ability to control blood glucose adequately, and that this contributes to the progression of cardiovascular and neurologic complications tied to diabetes. It also says heavy drinking may increase the risk of developing type 2 diabetes through several mechanisms, including higher body weight, higher triglycerides, higher blood pressure, and lower insulin sensitivity. Those are risk statements. They are not a finding that any one person's diabetes was caused by drinking, and they are not a clearance to drink "a little" because the sentence said "may."

CDC's page on managing blood sugar includes a general line: limit alcoholic drinks to 2 or fewer a day for men and 1 or fewer a day for women, among other steps such as not skipping meals. That line is for a broad diabetes audience. It is not a treatment plan for alcohol use disorder. If you are trying to stop drinking, or a program has asked you to stop, do not use the CDC sentence as permission to restart. Tell the diabetes clinician that alcohol use is part of the picture so the glucose plan matches the treatment plan.

NIAAA's pamphlet on harmful interactions, published in 2003, lists diabetes medicines that can react with alcohol: chlorpropamide, glipizide, metformin, glyburide, tolbutamide, and tolazamide. The reactions it names are abnormally low blood sugar and a flushing reaction, described as nausea, vomiting, headache, rapid heartbeat, and sudden changes in blood pressure, and it says nausea and weakness may occur with metformin. The pamphlet says the list does not include every medicine, that products can contain more than one ingredient, and that alcohol and a medicine can interact even when they are not taken at the same moment. Some brand names from 2003 are not how pharmacies label the drug now. Use the generic name with your pharmacist. Do not stop insulin or a pill so that a rehab application looks simpler.

NIDA's page on co-occurring health conditions says substance use can lessen the effectiveness of medications for some conditions, and that people with a substance use disorder and another mental disorder often have a harder time staying in treatment and following treatment guidelines. It does not publish a diabetes dosing chart. Ask which of your medicines are affected. The evaluation programs may want before admission, including other medical conditions and the medicines you take, is on the medical-clearance guide. Bring the list or the bottles, and do not leave a medicine at home until a clinician has said what continues. That practical question is on the medications guide.

What a program needs to know

Say that you have diabetes, which type if you know it, and whether you use insulin, other injections, or pills. Ask who checks glucose during an overnight stay, what happens to a monitor or a pump, and what they do for a low at night. A program that cannot answer is telling you something about the level of medical care on site. Quitting a long run of heavy drinking, or stopping a benzodiazepine overnight, can be medically dangerous on its own. That warning is on the detox comparison. Diabetes does not make an unsupervised stop safer.

Meals in early recovery are the subject of the nutrition guide. CDC's diabetes page also says not to skip meals. If a program's kitchen schedule and your insulin timing conflict, that is a clinical question for the prescriber and the program nurse, not a rule you solve by skipping a dose.

A different organ complication of alcohol is on the liver guide. Do not fold it into this one. Heavy drinking can injure more than glucose control. If you are acutely ill, the emergency department comes before either guide.

Call (800) 653-9376 if you want help finding treatment and you need the program to know about diabetes before you arrive. Bring the medicine list.

Additional Resources

Sources cited on this page:

• CDC: Low blood sugar (hypoglycemia)
• CDC: Manage blood sugar
• NIAAA: Medical complications, common alcohol-related concerns
• NIAAA: Harmful interactions, mixing alcohol with medicines
• NIDA: Co-occurring disorders and health conditions
• 988 Suicide & Crisis Lifeline

Common Questions