question: How does alcohol effect blood sugar in people with Diabetes?
comment: I’ll let a doctor or whatever provide the science, but since I have type 1 diabetes I’ll weigh in with a practical response. Short answer: straight alcohol doesn’t affect me at all (vodka, whiskey, etc). I can drink without any noticeable effect on my blood sugar levels (and I have a continuous glucose monitor so I can literally see the effect or lack thereof). However, since most people seem to not drink just straight alcohol it will all come down to how many carbs are in the beverage. A beer prob has 3-7 g carbohydrates but a mixed drink could have upwards of 30-60 g if it’s made with juice or flavored soda (coke). Liqueurs and wines have more carbs too (sugar = carbs). In that case your blood sugar will rise, so you correct for that with insulin injections. Too much alcohol could lead to low blood sugar though because your liver is tied up processing the alcohol instead of releasing carbs into your blood stream. I’ve 36, never had this happen. However, I’m a healthy person, low body fat, good insulin sensitivity, and I have no other health issues so I don’t recommend doing what I do. Some diabetics are are more prone to low blood sugar. Anyway, like I said, this is just an anecdotal response based on my real world experience as a type 1 diabetic. Hopefully a full on scientist gives you a better answer.
passages: The intake of alcohol causes an initial surge in blood sugar, and later tends to cause levels to fall. Also, certain drugs can increase or decrease glucose levels.
  
  Section::::Units.
  
  The international standard way of measuring blood glucose levels is in terms of a molar concentration, measured in mmol/L (millimoles per litre; or millimolar, abbreviated mM). In the United States, Germany and other countries mass concentration is measured in mg/dL (milligrams per decilitre).
   Sugar alcohols are absorbed at 50% of the rate of sugars, resulting in less of an effect on blood sugar levels as measured by comparing their effect to [sucrose]] using the glycemic index. The unabsorbed sugar alcohols may cause bloating and diarrhea due to their osmotic effect, if consumed in sufficient amounts.
  
  Section::::Common sugar alcohols.
  
  BULLET::::- Ethylene glycol (2-carbon)
  
  BULLET::::- Glycerol (3-carbon)
  
  BULLET::::- Erythritol (4-carbon)
  
  BULLET::::- Threitol (4-carbon)
  
  BULLET::::- Arabitol (5-carbon)
  
  BULLET::::- Xylitol (5-carbon)
  
  BULLET::::- Ribitol (5-carbon)
  
  BULLET::::- Mannitol (6-carbon)
  
  BULLET::::- Sorbitol (6-carbon)
  
  BULLET::::- Galactitol (6-carbon)
  
  BULLET::::- Fucitol (6-carbon)
  
  BULLET::::- Iditol (6-carbon)
  
  BULLET::::- Inositol (6-carbon; a cyclic sugar alcohol)
   The glucose in the blood is called blood sugar. Blood sugar levels are regulated by glucose-binding nerve cells in the hypothalamus. In addition, glucose in the brain binds to glucose receptors of the reward system in the nucleus accumbens. The binding of glucose to the sweet receptor on the tongue induces a release of various hormones of energy metabolism, either through glucose or through other sugars, leading to an increased cellular uptake and lower blood sugar levels. Artificial sweeteners do not lower blood sugar levels.
   Section::::Alcohol and postprandial triglycerides.
  
  Alcohol taken with a meal increases and prolongs postprandial triglyceridemia. This is true despite the observation that the relationship between alcohol consumption and triglyceridemia is "J-shaped," meaning that fasting triglycerides concentration is lower in people who drink 10-20 g/alcohol a day compared to people who either abstain from alcohol or who drink more per day.
  
  Section::::Alcohol and blood pressure.
   Fehling's solution was used for many years as a diagnostic test for diabetes, a disease in which blood glucose levels are dangerously elevated by a failure to produce enough insulin (type 1 diabetes) or by an inability to respond to insulin (type 2 diabetes). By measuring the amount of oxidizing agent (in this case, Fehling's solution) reduced by glucose, determining the concentration of glucose in the blood or in the urine is possible. This then enables the right amount of insulin to be injected to bring blood glucose levels back into the normal range.
  
  Section::::Importance in food chemistry.
   Currently, the only known substance that can increase the rate of metabolism of alcohol is fructose. The effect can vary significantly from person to person, but a 100 g dose of fructose has been shown to increase alcohol metabolism by an average of 80%. Fructose also increases false positives of high BAC ratio readings in anyone with proteinuria and hematuria, due to kidney-liver metabolism.
  
  Section::::Metabolism and excretion.:Full stomachs.
   Various forms of transferrin exist, with differing levels of sialylation. The most common form is tetrasialotransferrin, with four sialic acid chains. In persons who consume significant quantities of alcohol (usually more than 4 or 5 alcoholic beverages a day for two weeks or more), the proportion of transferrin with zero, one, or two sialic acid chains is increased. These are referred to as "carbohydrate-deficient transferrins". These carbohydrate-deficient transferrins can be measured in the bloodstream, and are an important marker for alcohol abuse. 
  
  Section::::Test for alcohol consumption.
   Elevated blood levels of glucose—regardless of cause—lead to increased glycation of proteins with changes, only a few of which are understood in any detail, in protein function throughout the body.
   Minute quantity amounts (average 196 ppb) of endogenous ethanol and acetaldehyde were found in the exhaled breath of healthy volunteers. Auto-brewery syndrome, also known as gut fermentation syndrome, is a rare medical condition in which intoxicating quantities of ethanol are produced through endogenous fermentation within the digestive system.
  
  Section::::Production.
   Section::::Alcohol and cortisol interactions.:Recent findings.
  
  Recent research supports this strong association between high alcohol use and heightened cortisol levels. In one study, overnight urinary cortisol levels were taken from people who regularly drank a large amount of alcohol versus a small amount of alcohol. People who drank more alcohol had higher cortisol levels and lower heart rate variability (which is controlled by the autonomic nervous system, ANS), suggesting a connection between the HPA axis and the ANS. People who drank more alcohol had higher blood pressure and difficulty sleeping, indicative of heightened cortisol levels.
   Section::::Pathology.:Overweight and fatty liver.
  
  An increased intake of glucose leads to obesity and, in consequence, partly to the metabolic syndrome with non-alcoholic fatty liver disease, but not the consumption of glucose as part of a normal calorie intake.
  
  Section::::Pathology.:Hypoglycemia management.
  
  Individuals with diabetes or other conditions that result in low blood sugar often carry small amounts of sugar in various forms. One sugar commonly used is glucose, often in the form of glucose tablets (glucose pressed into a tablet shape sometimes with one or more other ingredients as a binder), hard candy, or sugar packet.
  
  Section::::Sources.
   Ethanol, alcohol increases levels of high-density lipoproteins (HDLs), which carry cholesterol through the blood. Alcohol is known to make blood less likely to clot, reducing risk of heart attack and stroke. This could be the reason that alcohol produces health benefits when consumed in moderate amounts. Also, alcohol dilates blood vessels. Consequently, a person feels warmer, and their skin may flush and appear pink.
  
  Section::::Use and effects.:Caloric content.
   There are also several other causes for an increase in blood sugar levels. Among them are the 'stress' hormones such as epinephrine (also known as adrenaline), several of the steroids, infections, trauma, and of course, the ingestion of food.
   Blood sugar levels are regulated by negative feedback in order to keep the body in balance. The levels of glucose in the blood are monitored by many tissues, but the cells in the pancreatic islets are among the most well understood and important.
  
  Section::::Mechanisms.:Glucagon.
   Section::::Glucose measurement.
  
  Section::::Glucose measurement.:Sample source.
  
  Glucose testing in a fasting individual, show comparable levels of glucose in arterial, venous, and capillary blood. But following meals, capillary and arterial blood glucose levels can be significantly higher than venous levels. Although these differences vary widely, one study found that following the consumption of 50 grams of glucose, "the mean capillary blood glucose concentration is higher than the mean venous blood glucose concentration by 35%."
  
  Section::::Glucose measurement.:Sample type.
   Since the molecular weight of glucose CHO is 180, the difference between the two units is a factor of 18, so that 1 mmol/L of glucose is equivalent to 18 mg/dL.
  
  Section::::Normal values.
  
  Section::::Normal values.:Humans.
  
  Normal value ranges may vary slightly among different laboratories. Many factors affect a person's blood sugar level. The body's homeostatic mechanism of blood sugar regulation (known as glucose homeostasis), when operating normally, restores the blood sugar level to a narrow range of about 4.4 to 6.1 mmol/L (79 to 110 mg/dL) (as measured by a fasting blood glucose test).
   BULLET::::2. In contrast to the commonly seen shallow OGTT curve, amplitude of the pointy spike in oxyhyperglycemia need not necessarily be restricted to only prediabetic range and in severe oxyhyperglycemia it may cross 250 mg/dL. In oxyhyperglycemia, by two hours, the glucose not only comes back to pre-diabetic range it may even start shooting below the fasting baseline.
   The first line of defense in preventing chronic Somogyi rebound is additional blood glucose testing. Continuous glucose monitoring is the preferred method to detect and prevent the Somogyi rebound, but this technology is far from universally used. Alternatively, testing blood sugar more often, 8 to 10 times daily with a traditional blood glucose meter, facilitates detecting the low blood sugar level before such a rebound occurs.
   The most common cause of hyperglycemia is diabetes. When diabetes is the cause, physicians typically recommend an anti-diabetic medication as treatment. From the perspective of the majority of patients, treatment with an old, well-understood diabetes drug such as metformin will be the safest, most effective, least expensive, most comfortable route to managing the condition. Diet changes and exercise implementation may also be part of a treatment plan for diabetes.
  
  Section::::Abnormalities.:Low blood sugar.
   BULLET::::- Regular dancing has been shown to lead to significant decreases in salivary cortisol concentrations.
  
  BULLET::::- "Withania somnifera" (ashwagandha) root extract
  
  BULLET::::- High-dosage treatment with ascorbic acid (vitamin C) has been shown to decrease circulating cortisol levels during and shortly after the treatment period.
  
  Section::::Regulation.:Factors increasing cortisol levels.
  
  BULLET::::- Viral infections increase cortisol levels through activation of the HPA axis by cytokines.
  
  BULLET::::- Caffeine may increase cortisol levels.
  
  BULLET::::- Sleep deprivation
   Section::::Mechanisms.:Insulin.
   Section::::Lipids.:Cholesterol.
  
  While cholesterol is essential for membranes and steroid hormones, excess cholesterol affects blood flow impairing cognitive function in vascular dementia.
  
  Section::::Carbohydrates.
   Blood glucose levels are maintained at a steady state concentration by balancing the rate of entry of glucose into the blood stream (i.e. by ingestion or released from cells) and the rate of glucose uptake by body tissues. Changes in the rate of input will be met with a change in consumption, and vice versa, so that blood glucose concentration is held at about 5 mM in humans. A change in blood glucose levels triggers the release of insulin or glucagon, which stimulates the liver to release glucose into the bloodstream or take up glucose from the bloodstream in order to return glucose levels to steady state. Pancreatic beta cells, for example, increase oxidative metabolism as a result of a rise in blood glucose concentration, triggering secretion of insulin. Glucose levels in the brain are also maintained at steady state, and glucose delivery to the brain relies on the balance between the flux of the blood brain barrier and uptake by brain cells. In teleosts, a drop of blood glucose levels below that of steady state decreases the intracellular-extracellular gradient in the bloodstream, limiting glucose metabolism in red blood cells.
   The blood sugar content of a healthy person in the short-time fasting state, e.g. after overnight fasting, is about 70 to 100 mg/dl of blood (4 to 5.5 mM). In blood plasma, the measured values are about 10-15 % higher. In addition, the values in the arterial blood are higher than the concentrations in the venous blood since glucose is absorbed into the tissue during the passage of the capillary bed. Also in the capillary blood, which is often used for blood sugar determination, the values are sometimes higher than in the venous blood. The glucose content of the blood is regulated by the hormones insulin, incretin and glucagon. Insulin lowers the glucose level, glucagon increases it. Furthermore, the hormones adrenaline, thyroxine, glucocorticoids, somatotropin and adrenocorticotropin lead to an increase in the glucose level. In addition, there is also a hormone-independent regulation, which is referred to as glucose autoregulation. After food intake the blood sugar concentration increases. Values over 180 mg/dl in venous whole blood are pathological and are termed hyperglycemia, values below 40 mg/dl are termed hypoglycaemia. When needed, glucose is released into the bloodstream by glucose-6-phosphatase from glucose-6-phosphate originating from liver and kidney glycogen, thereby regulating the homeostasis of blood glucose concentration. In ruminants, the blood glucose concentration is lower (60 mg/dL in cattle and 40 mg/dL in sheep), because the carbohydrates are converted more by their gut flora into short-chain fatty acids.
   BULLET::::- Folate: Folate helps to create and maintain new cells. Alcohol interferes with the intake, absorption, transport, storage, and release of folate.
  
  BULLET::::- Vitamin B: Vitamin B is required to make DNA and maintain healthy nerve and red blood cells. Alcohol has been shown to decrease the levels of B.
  
  BULLET::::- Vitamin A: Vitamin A is needed for vision, regulation of the immune system, bone growth, reproduction, cell division, and differentiation. Alcohol decreases the levels of this vitamin and increases toxicity when alcohol is consumed in large amounts.
  
presuppositions: Straight alcohol affects blood sugar.
corrections: Straight alcohol doesn't affect blood sugar.
raw_presuppositions: Alcohol affects diabetics to a certain extent.  Alcohol affects diabetics to a certain extent.  Straight alcohol affects blood sugar.
raw_corrections: The affect of alcohol on a diabetic varies per person and does not effect every diabetic universally.  The affect of alcohol on a diabetic varies per person and does not effect every diabetic universally.  Straight alcohol doesn't affect blood sugar.