The GNL Podcast
Episode 25, Partying with T1D: Alcohol Edition
The physiology of alcohol in type 1 diabetes, hypo risk, liver metabolism, AID strategies, and practical harm reduction from someone who lives it and studies it.
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Released 1 December 2025, Part 1 of the Partying with T1D 3-part series
In this episode
- Episode: 25, Alcohol and Type 1 Diabetes
- Host: John Pemberton
- Guest: Professor 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, Professor 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
This content is for educational exploration only. It describes average responses and general principles. It is not medical advice and cannot replace individual clinical guidance from your diabetes care team.