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Released 1st December 2025 (ready for the Christmas season)
Episode details
- Episode: 25 — Alcohol and Type 1 Diabetes
- Host: John Pemberton
- Guest: Dr Dessi Zaharieva
- Series: Part 1 of the “Partying with T1D” 3-part podcast series
- Focus: Alcohol physiology, hypos, nightlife, AID systems, harm reduction
Episode Summary
Alcohol is one of the most widely used psychoactive substances in the world — yet one of the most misunderstood when it comes to type 1 diabetes. In this episode, John and Dessi break the silence around drinking, nightlife, festivals and real-world harm reduction.
This is not medical advice and not an encouragement to drink. It is practical physiology + lived experience, because people with T1D face these situations whether anyone talks about them or not.
John and Dessi discuss why alcohol affects blood glucose so unpredictably, why glucagon often fails, why memory disappears, how liver metabolism changes across multi-day events, and how people with T1D can plan, prepare and stay safer if they choose to drink.
Open, honest conversation is the antidote to secrecy, shame, and preventable harm.
Who is this episode for?
- People with type 1 diabetes who drink, party or attend festivals
- Parents of teens/young adults with T1D
- Clinicians who want pragmatic harm reduction guidance
- Friends & partners wanting to understand what’s going on under the hood
Key Themes Explored in This Episode
Alcohol & T1D: What Actually Happens
Alcohol suppresses hepatic glucose output — the liver’s ability to release glucose into the bloodstream. When combined with circulating insulin, this sharply increases hypo risk.
- Alcohol blocks liver glucose release
- Glucagon becomes unreliable (little stored glucose to release)
- Hypos can appear late and severe
- Metabolic response varies widely between individuals
- Multi-day drinking changes physiology and extends hypo risk
Why Memory Disappears
- Alcohol shuts down REM sleep
- No REM = no memory consolidation
- Wearables often show “zero REM nights” after drinking
Why Night One Is the Worst
- Alcohol-metabolising enzymes (ADH) not yet upregulated
- Higher intoxication
- Higher hypo risk
- Less predictable glucose patterns
Insulin Strategy
- Scaled basal reductions (25–75%) based on units consumed
- Using Activity Mode on AID systems
- Switching to MDI/manual mode for festivals
- Avoiding double-basal when reconnecting pumps after long-acting insulin
Harm Reduction
- CGM + hypo plan + buddy system
- Eat before drinking
- Predictability beats purity
- Pragmatic strategies > moralising
For Parents & Clinicians
- Silence increases risk
- Young people need support, not shame
- Cultural and religious beliefs must be placed aside in clinical settings
Alcohol & Type 1 Diabetes — FAQ
This is the structured, printable companion guide for this episode.
📄 Download the Alcohol & Type 1 Diabetes FAQ (PDF)
About our guest — Dr Dessi Zaharieva
Dessi Zaharieva is an exercise physiologist, instructor at Stanford, and diabetes researcher. She has lived with type 1 diabetes for almost 30 years and focuses her scientific work on exercise, physiology and real-world T1D challenges. Dessi has joined the GNL as a Scientific Advisor, check out her GNL profile.
Resources Mentioned
- FAQ: Alcohol and T1D
- Partying with T1D — Guide
- AID Systems Guide
- CGM Accuracy & Regulation
- Episode 24: Skincare, Sensors & Smarter Algorithms
Closing Message
“Alcohol is part of human culture. It’s not going anywhere.
People with T1D deserve information, not silence.
Stay safe, stay informed, and remember: The Glucose Never Lies.”
Prepared by John Pemberton, supported by AI assistant (“Chad”).
Ideas, insights, and responsibility remain with John.
