Episode 25 — Partying with T1D: Alcohol Edition

In this episode

• 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 practical physiology combined with lived experience, because people with T1D encounter these situations whether anyone talks about them or not.

John and Dessi explore why alcohol affects blood glucose so unpredictably, why glucagon often becomes less effective after drinking, why memory consolidation is disrupted, how liver metabolism changes across multi-day events, and how people with T1D can plan, prepare and stay safer if they choose to drink.

Who is this episode for?

• People with type 1 diabetes who drink, party or attend festivals
• Parents of teenagers and young adults with T1D
• Clinicians who want pragmatic harm-reduction guidance
• Friends and partners wanting to understand what happens under the hood

Key themes explored

Alcohol and T1D: what tends to happen

Alcohol suppresses hepatic glucose output — the liver’s ability to release glucose into the bloodstream. When combined with circulating insulin, this tends to increase the risk of hypoglycaemia, particularly overnight.

• Alcohol blocks liver glucose release
• Glucagon becomes less reliable — little stored glucose remains for the liver to release
• Hypoglycaemia can appear late and more severely than expected
• Metabolic response varies widely between individuals
• Multi-day drinking changes physiology and extends hypoglycaemia risk

Why memory is disrupted

• Alcohol shuts down REM sleep
• No REM sleep means no memory consolidation
• Wearables often show near-zero REM after drinking

Why the first night tends to be the most difficult

• Alcohol-metabolising enzymes (ADH) are not yet upregulated
• Higher intoxication from the same intake
• Higher hypoglycaemia risk
• Less predictable glucose patterns

Insulin strategy — approaches people explore

• Scaled basal reductions (25–75%) based on units consumed — worth discussing with your care team to find what works for you
• Using Activity Mode on AID systems
• Switching to MDI/manual mode for festivals

• Awareness of double-basal risk when reconnecting pumps after long-acting insulin

Harm reduction principles

• CGM + hypo plan + buddy system
• Eat before drinking
• Predictability over perfection
• Pragmatic strategies over moralising

For parents and clinicians

• Silence around alcohol tends to increase risk rather than reduce it
• Young people need support, not shame
• Open, honest conversation is the antidote to secrecy and preventable harm

Alcohol and type 1 diabetes — FAQ guide

This is the structured companion guide for this episode.

About the 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 serves as a Scientific Advisor to The Glucose Never Lies.

Resources mentioned

• FAQ: Alcohol and T1D — full reference guide
• Partying with T1D — comprehensive guide
• AID systems guide
• CGM accuracy and regulation
• Alcohol and T1D Explorer — explore the hypo risk window and insulin adjustment guidance for your drinking session
• Episode 24: Skincare, Sensors and Smarter Algorithms