Name: Laura

Age: 21

Occupation: Junior in college

Case file: Laura is 5’8’’ and 245 pounds with a family history of alcoholism and drug abuse. She was diagnosed with Type II diabetes at the age of fifteen because of complications with obesity. After her roommate found her unconscious on her dorm floor after a night of drinking, Laura was referred to Yellow Creek Treatment Center for nutrition counseling by her concerned parents.

Laura: So I went to a party, had a few beers, and danced a little. I don’t see the problem.

Nutritionist TwoShoes: Laura, your roommate found you lying on the floor after experiencing a hypoglycemic seizure.

Laura: But I don’t understand. I ate before I went out, and I snacked on some appetizers at the party. How could I have experienced low blood sugar?

Nutritionist TwoShoes: Normally, between meals and overnight, your liver releases stored glucose into your blood. Alcohol blocks this process, which can lead to hypoglycemia (low blood sugar levels) up to eight hours after the last drink. Even if you eat while you drink, the blocking effect of alcohol on the liver lasts longer than the time it takes for the food to be broken down, which can last anywhere from 8 to 12 hours.

Laura: I just thought I was tired from the dancing.

Nutritionist TwoShoes: That contributed to your state of low blood sugar as well. Physical activity lowers blood glucose and increases the risk of hypoglycemia. In addition, you may not have thought your symptoms were due to hypoglycemia, thinking that they were the effects of the alcohol.

Laura: No wonder why I felt drunk after only one drink!

Nutritionist TwoShoes: That is an extremely dangerous situation Laura, especially since hypoglycemia is frequently mistaken for intoxication. Your friends may just have thought you drank too much and passed out when you may have actually passed out due to lack of glucose going to your brain to keep it functioning. When drinking, you are also much less likely to be aware of the signs and symptoms of low blood sugar.

Laura: So does that mean I can’t ever drink alcohol again?

Nutritionist TwoShoes: Not unless it becomes a problem. A basic safety tip is to have no more than one to two drinks over a few hours while eating carbohydrates. One drink equals one beer; 4 oz of wine/ or 1.5 oz of liquor. The main concern for you, Laura, is to prevent low blood sugar. Every time you drink, be sure to check your blood glucose level every two hours for up to six to eight hours after you have your last drink. Also, eat carbohydrates if your blood glucose drops to hypoglycemic levels.

Laura: But what if it is too late and I decide to go to bed. I can’t be checking my glucose levels every couple of hours.

Nutritionist TwoShoes: That is where responsibility comes into the picture. If you think you are responsible enough to drink, then you are also responsible enough to take care of your diabetes while drinking. Have a snack before you to go bed even if your blood sugar is high at that time. Set an alarm clock if you have to so that you can check your blood sugar level midway through the night. Following a few safety guidelines can prevent a medical emergency like what happened last night.

Laura: I’ve been gaining a lot of weight lately but have not been eating more than usual. Do you have any advice?

Nutritionist TwoShoes: Remember to count alcohol as part of your diabetic exchanges since alcohol does contain 7 calories per gram and contributes as an energy source.

Laura: Well my auntie passed away last month and I notice I’ve been drinking to help me cope with her death.

Nutritionist TwoShoes: Find other ways to help you adjust to losing a loved one. I know it can be hard, but these are the times you turn to your family for comfort, not alcohol. And if you do decide to drink, just remember the key word MODERATION. Anything in moderation is okay for you, and that includes drinking. Moderate drinking may have beneficial effects on the heart, including effects on adult-onset diabetes, osteoporosis, rheumatoid arthritis, food-borne hepatitis A, and depression.

Laura: So, it can actually help my moods.

Nutritionist TwoShoes: That’s right. But it should not be taken for granted, especially for people with drinking problems. There is no vocabulary word MODERATION in their dictionary.

Laura: Something else that has been worrying me is the fact that my younger brother has started to drink. He is eighteen and drinks occasionally and minimally. He doesn’t have diabetes, but I am still concerned about him. What kind of advice do you have for me to give him about drinking?

Nutritionist TwoShoes: That’s good you admit to your problem (smiling). Before I answer your question, let me ask you a few questions. Do you have any parents who use alcohol?

Laura: Yeah, my dad had to go to treatment a few years ago.

Nutritionist TwoShoes: And how involved are your parents with your personal life?

Laura: (Puzzled) They’re not too involved I guess. They don’t seem to care too much what we do. Why?

Nutritionist TwoShoes: The question of importance here is if your brother and you have risk factors that determine who remains a casual user and who progresses to abuse. The truth is that many factors contribute to substance use and abuse. You see, substance abuse is the result of the interaction of many factors and no invariant pattern of substance abuse exists. Normally I would say as long as your brother is aware of moderation, he is fine. In fact, I would have good news for him and others his age because research has shown healthy men who have light to moderate alcohol consumption have a decreased risk of type II diabetes. However, because you have identified several of the following risk factors for adolescent use and abuse of substances with your brother, I would not advise him to drink. In fact, I would advise him to completely abstain from drinking alcohol.

Laura: And what if he decides to drink and it turns to substance abuse?

Nutritionist TwoShoes: There is an elevated risk of developing type II diabetes in non-drinkers and men with high alcohol intakes. Therefore, I would inform him on the risks he is taking for developing type II diabetes. Do you have any one else in your family with diabetes, Laura?

Laura: Yes, my maternal grandmother passed away a couple years ago because of kidney failure caused by her diabetes.

Nutritionist TwoShoes: Your brother already has two risk factors present for developing diabetes: being Native American and having a family history of diabetes. Consequentially, your brother should not drink to avoid adding another factor to his risk of becoming a diabetic.

Laura: Wow, I didn’t know the more factors you have, the more you are at risk of developing the disease.

Nutritionist TwoShoes: That is correct, Laura. So, your brother should be fighting to avoid receiving the risk factors. And you should be fighting to avoid receiving complications with your diabetes. Since you also display risk factors for possible substance abuse, you too should completely abstain from drinking.

Laura: (Proudly) And that means NO DRINKING!

Nutritionist TwoShoes: (Pleased) Yes! I think you just made a good decision in dealing with your diabetes.

GLOSSARY

Type II diabetes- a disorder of carbohydrate metabolism in which sugars in the body are not oxidized to produce energy due to lack of the pancreatic hormone insulin or the resistance of insulin in the body.

Obesity- the condition in which excess fat has accumulated in the body, mostly in the subcutaneous tissues. Obesity is usually considered to be present when a person is 20% above the recommended weight for his/her height and build. The accumulation of fat is caused by the consumption of more food than is required for producing enough energy for daily activities.

Hypoglycemic- a deficiency of glucose in the bloodstream, causing muscular weakness and incoordination, mental confusion, and sweating. If severe, it may lead to hypoglycemic coma. Hypoglycemia most commonly occurs in diabetes mellitus, as a result of insulin overdosage and insufficient intake of carbohydrates.