Inhaled Insulin has been withdrawn from the world market, due its side effects.

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Hoping for a beer at the ball game, or a glass of wine with dinner?

If you have type 2 diabetes, that’s probably OK as long as your blood sugar is under control, you don’t have any complications that are affected by alcohol (such as high blood pressure), and you know how the drink will affect your blood sugar, according to the American Diabetes Association.

An alcohol-containing drink a day might even help your heart (though if you don’t already drink, most experts say that’s not a reason to start).

In moderation, alcohol may cut heart disease risk
According to a study by researchers at the Harvard School of Public Health, women with type 2 diabetes who drank relatively small amounts of alcohol had a lower heart-disease risk than those who abstained. A second study found that men with diabetes had the same reduction in heart risk with a moderate alcohol intake as non-diabetic men.

In general, the recommendations for alcohol consumption for someone with type 2 diabetes are the same as anyone else: no more than two drinks per day for men and no more than one drink per day for women. (Make sure to measure: A drink serving is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor such as scotch, gin, tequila, or vodka.)

People with diabetes who choose to drink need to take extra care keeping food, medications, alcohol, and blood sugars in balance.

Janis Roszler, RD, a certified diabetes educator in Miami, Fla., recommends:

• Mixing alcoholic drinks with water or calorie-free diet sodas instead of sugary (and calorie- and carbohydrate-laden) sodas and other mixers.
• Once you have had your drink, switch to a non-alcoholic drink, such as sparkling water, for the rest of the evening.
• Make sure you have an eating strategy and plan in place to avoid overeating and overdrinking in social situations. Alcohol can make you more relaxed, and may lead you to make poor food or drinking decisions.
• Don’t drink on an empty stomach because alcohol can have a very rapid blood glucose lowering effect, which is slowed if there is food in your stomach.
• If you’re going to have a drink, wear your diabetes identification bracelet or necklace.

“If you become hypoglycemic and there is alcohol on your breath, police or paramedics may mistake your condition for being drunk and may not get the care you need,” says Roszler.

Alcohol may also worsen nerve damage
Some people with diabetes, though, should not consume alcoholic beverages.

Drinking can worsen nerve damage from diabetes and increase the pain, burning, tingling, and numbness that people with nerve damage often experience.

If you have complications related to your diabetes, you should be more careful about your alcohol intake. More than three drinks a day can worsen diabetic retinopathy. And even if you have fewer than two drinks per week, you can increase your risk of nerve damage (alcohol abuse can cause nerve damage, even in people without diabetes). Alcohol can also raise levels of fat called triglycerides in the blood.

Here’s something else to consider: Researchers at Kaiser Permanente in California wanted to see whether there is a relationship between drinking and diabetes self-care behaviors. The team examined survey data for 65,996 adults with diabetes to determine their levels of alcohol consumption and adherence to good health habits, such as testing their blood sugar, getting their A1C levels checked, and taking their medicines.

People who drink alcohol, the study found, are less likely to follow recommended practices than those who don’t drink, and the more they imbibe, the less likely they are to stick with recommended health practices.

Although the study doesn’t prove that drinking causes poor health behaviors, it does suggest that drinking is a marker for poor self-care.

You’ll need to test your blood sugar to gauge alcohol’s effect
If you do choose to drink, there are no specific recommendations for one type of alcoholic beverage as better than another. However, the American Diabetes Association notes that light beer and dry wines tend to have less alcohol, carbohydrates, and calories.

It’s important to test before and after having a drink to see the impact on your blood sugar, especially when you’ve first been diagnosed with diabetes or if you’re taking insulin or other medicines that can cause hypoglycemia. Treat abnormal blood sugar levels as directed by your health care team.

Alcohol usually causes blood sugar to drop (while the liver is processing alcohol, it takes a break from its other role of releasing stored glucose as needed). However, alcohol can sometimes raise blood sugar.

“I do drink alcohol in very moderate amounts,” says Donna Kay, 40, of Prairie Village, Kan., who was diagnosed with type 2 diabetes in 2003. She always checks her blood sugar before and after consuming alcohol. “If I’m at a dinner party, I’ll duck into a bathroom,” she says.

“For me,” says Kay, “beer will raise my blood glucose, while a martini will cause it to fall a little. I avoid drinks with fruit juice or a lot of sugar, such as a cosmopolitan or a piña colada. “They are not worth the blood sugar spike or the calories. Also, some alcohol, such as Baileys Irish Cream, has lots and lots of added sugar—I skip the sugary stuff so I can save those carbs for something else,” Kay says.

Red and white wine both have about 100 calories per five-ounce glass; sweeter red wines will have a higher calorie count because of the extra sugar from the grapes. A screwdriver (vodka and orange juice) made up of 1.5 ounces of vodka and eight ounces of orange juice would have 208 calories and 25 carbohydrate grams (all the carbohydrate is from the orange juice.)

You may have to adjust other food choices during the day to accommodate the extra calories and carbohydrates from alcoholic drinks. As a general rule, it is better not to “drink” your calories; healthy food choices should come first.

Source:Health.com

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An alcoholic drink during a meal may help reduce the subsequent rise in blood sugar levels.

Moderate drinking reduces heart disease and diabetes risk. This could be due to the fact that alcohol consumption reduces sugar formation in the body, scientifically known as gluconeogenesis, while increasing sensitivity to insulin.

Researchers from the University of Sydney investigated whether a drink with a meal helped in reducing the increase in blood glucose levels that occurs after eating. The study involved young adult volunteers without diabetes, and was conducted in three stages. Firstly, the effect of drinking an alcoholic beverage, beer, white wine or gin, was compared with eating the equivalent amount of calories in carbohydrate. Each of the alcoholic beverages produced a smaller rise in blood sugar than bread, while insulin response to the drinks was also lower than to bread. Secondly, it was found that blood sugar levels rose less when any of the alcoholic drinks were consumed with bread than eating bread with water. Wine had the strongest effect, while the effect of beer was the weakest. Thirdly, the participants were made to drink before a meal— specifically, the equivalent of about two drinks of beer, wine or gin an hour before eating a meal of instant mashed potatoes. The post-meal blood glucose increase was lower with drinks than when they drank water. However, there was no difference in the effect on insulin levels when an alcoholic beverage was consumed instead of water with or before a meal.

The findings suggest that moderate quantities of beer, wine, and gin reduce post-meal blood sugar by up to 37% in lean, healthy participants. This could be because alcohol reduced gluconeogenesis as well as release of glucose by the liver. The results also showed that alcoholic beverages consumed alone, with or before a carbohydrate-containing meal, are capable of reducing peak blood glucose concentrations or the overall postprandial glucose response in young, lean, healthy participants. Therefore, there is an unrecognised benefit of moderate alcohol consumption.
American Journal of Clinical Nutrition,
June 2007

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Objectives

• To maintain adequate nutrition
• To achieve and maintain desirable body weight
• To maintain normal blood sugar levels
• To prevent, delay or minimize the onset of chronic degenerative complications

Diet plays an important role in the treatment of diabetes. The diet may be used alone or in combination with insulin injections or oral hypoglycaemic drugs.

The diet plan of an individual is based on height, weight, age, sex, physical activity and nature of diabetes. One should consider the following points while planning a diabetic diet:

• Determining energy requirements
• Determining the type of carbohydrates, fibre and food preparations
• Presence of any other complication such as high blood pressure, high cholesterol levels etc.

In case of insulin dependent diabetes mellitus, the energy intake is based on needs for normal growth and development, physical activity and maintenance of desirable body weight.

In case of non insulin dependant diabetes mellitus, the majority of patients are overweight or obese. Therefore, calorie restriction is required to achieve a desired weight.

Type of carbohydrate and amount of fibre: More of carbohydrate must be given as complex starches rather than simple sugars as they breakdown more slowly to release glucose in blood. The presence of fibre in complex carbohydrate like grains, vegetables and other starches slows the glucose absorption. One should emphasise more on the high fibre foods instead of high fibre supplements available in the market.

Sample diet plan (for NIDDM)

Sample diet plan (for IDDM)

To remember

• It is important to control the amount and time of food intake.
• Meals should not be missed.
• Consider the likes and dislikes of the patient.
• Try to substitute the craving for sweet by taking some fruit.

Foods to be avoided

Glucose, sugar, honey, all sweets, chocolates and candies.

Foods to be restricted

Potatoes, yam, arbi, sweet potatoes, mangoes, grapes, bananas, alcoholic beverages, fried foods, paranthas, poories, pakoras, mathris, deep fried foods, dry fruits, salad oils, cakes and pastries.

Foods to be used freely

Green leafy vegetables, tomatoes, cucumber. radish, soups, buttermilk, tea and coffee without sugar.

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