“Alcohol is the most widely used psychoactive drug on earth. In type 1 diabetes, understanding how it interacts with physiology can prevent serious harm.”
Authors:
John Pemberton, RD — T1D since 2007, Founder of The Glucose Never Lies®
Dr Dessi Zaharieva, PhD —T1D for 20+ years, Scientific Director of The Glucose Never Lies®, T1D researcher, educator & advocate
Q1. Why talk openly about alcohol and T1D?
People with type 1 diabetes drink alcohol at similar rates to everyone else. Nights out, festivals and celebrations are normal parts of life. Yet most official guidance stops at “don’t drink.” That silence creates risk.
Open, evidence-aware conversation helps people understand:
- Why alcohol increases hypoglycaemia risk
- How insulin and liver metabolism interact
- Why glucagon often fails after drinking
- How to plan, prepare and stay safe
- How to rebuild confidence after a bad experience
Q2. Why is lived experience essential here?
There are no randomised controlled trials on alcohol or nightlife in T1D. Everything we know comes from lived experience, physiology, CGM patterns, clinical expertise and stories from real people. This FAQ blends scientific understanding (Dessi) with lived experience (John).
Q3. How does alcohol affect glucose and the liver?
Alcohol is treated as a toxin. The liver prioritises clearing it, suppressing:
- Glycogen release
- Gluconeogenesis
- The body’s ability to prevent or correct hypos
Glucagon becomes far less effective. Overnight risk increases.
Rule of thumb: 1 unit of alcohol ≈ 1 hour of impaired liver glucose output.
Q4. Why does memory fail after drinking?
Alcohol disrupts REM sleep, which is required for memory formation. If REM collapses, memories do not consolidate. Wearables like Oura often show near-zero REM after heavy drinking — explaining blackouts without extreme intoxication.
Q5. Why do people drink more easily on days 2–4 of a festival?
Alcohol dehydrogenase ramps up with repeated exposure, meaning:
- Faster clearance
- Reduced intoxication from the same intake
- Higher doses needed to feel anything
Long-term intake drains B-vitamins, especially thiamine — a key reason tapering matters.
Q6. Why is alcohol uniquely dangerous in T1D?
Three high-risk mechanisms align:
- Basal insulin continues lowering glucose
- The liver stops releasing glucose
- Glucagon becomes ineffective
This can cause late hypos, overnight unawareness, coma and (rarely) death. Harm-reduction is essential.
Q7. What practical strategies reduce risk?
Core safety pillars:
- CGM
- Hypo plan
- Buddy system
Additional strategies:
- Eat before drinking
- Hydrate
- Monitor glucose frequently
- Expect next-morning lows
- Use medical ID / CGM sharing
Q8. How do insulin needs change when drinking?
MDI
- Reduce long-acting by ~25–75%
- Carb drinks → 0–50% bolus
Pumps
- Temp basal reduction 25–75%
- Continue overnight
AID systems
- Turn on Activity Mode
- Leave it on overnight
- Beware auto-corrections
Q9. What about switching from pumps to injections for festivals?
Some people switch temporarily to MDI for long events.
Benefits:
- Stable basal
- No cannula/pump risks while dancing
- Fewer alarms/corrections
Practical notes:
- Use ~50% of usual basal as long-acting
- Carry rapid-acting pen
- When reconnecting pump: run reduced temp basal for until the previous basal ijnection wears off
Q10. How should parents support young people?
Support must replace silence. Parents can practise strategies, provide safe learning environments, discuss risks openly and ensure communication plans are in place.
Q11. What should clinicians know?
- Ask about nightlife without judgement
- Avoid projecting personal beliefs
- Silence increases harm
- Harm-reduction is clinically essential
Q12. Does a bad night mean failure?
No. T1D is trial, error, pattern recognition and growth. Confidence returns with experience and planning.
Q13. What are the practical take-homes?
- Alcohol suppresses liver glucose output
- CGM + Hypo plan + Buddy system
- Insulin often needs reducing
- Glucagon may not work
- REM disruption explains memory issues
- Practise strategies first
Q14. Related The Glucose Never Lies® resources
- Partying with T1D — Introduction
- Alcohol section
- Festival Safety Checklist
- AID Systems Guide
- CGM Guide
- Episode 25 recording (forthcoming)
Prepared by John Pemberton, supported by AI assistant (“Chad”). Ideas, insights, and responsibility remain with John.
