Thursday, December 17, 2015

The Beer and Blood Sugar Effect

Yes, I have type 1 diabetes and I can drink beer.

In fact, I'm a craft beer lover who's pretty passionate about trying new brews and supporting my local beer makers (who invent awesomeness in a mug). The fact that I'm pancreatically-challenged changes nothing about that.

Over the years, I've lost count of the times I've heard folks wonder whether PWDs (people with diabetes) are able to drink anything, particularly beer. And I've been amazed to meet medical professionals who take the lazy way out and just tell patients that any drop of alcohol is off-limits. This very directive came my way early in the year, from a general practitioner who clearly didn't make the cut when I was searching for a new family physician.

Obviously, I'm not a doctor. But in my 16 years of legally drinking countless beers, I would like to think I've learned a thing or two -- particularly that YES, you can and should be able to enjoy beer with diabetes if you want to, of course doing so responsibly in the context of society and your health.

Until this past summer, I never thought too deeply about the specifics of beer influencing my diabetes management. Sure, I knew it raises my blood sugar in the short-term, and can increase my hypo risk over the ensuing hours and next day. But that's about it.

The general information available online isn't particularly helpful, either. Try searching for "beer and diabetes," or toss "blood sugar" into the Google mix, and you'll find boring, cautious bits of information that are certainly not practical. You might find general info that a light beer or "regular" 12-ounce beer has a certain number of carbs, but it's quickly followed by "don't drink more than X servings and to talk to your doctor." Of course, beer affects different people in different ways, so it's all a matter of individual trial-and-error, but isn't that true for pretty much everything in the world of diabetes?

So, I decided to investigate this on my own, much like I've done on the coffee front in the past.

Let's refer to this experiment as: The Beer and Blood Sugar Effect.

Disclaimer: By no means am I encouraging drinking of any kind. Like everyone with a working pancreas, we PWDs have to weigh the risks of alcohol consumption and take care in drinking responsibly. For us, that means knowing how much sugar is in a particular beverage and calculating that while also being aware of how alcohol in general affects our blood sugar.

Beer Base of Operations



My curiosity on beer and diabetes piqued in early August, when a conversation with a friend in the D-Community coincided with International Beer Day. That conversation evolved into talk of "best beer states," and I of course mentioned my homestate of Michigan that's ranked one of the top in the country. This friend was from a state not in those rankings.

In mid-September I began what would become a three-month, non-scientific analysis of my beer and BG effect. The home base of operations: local microbrewery Baffin Brewing Company, in my hometown of St. Clair Shores, Michigan. The brewery theme and logo are centered on a Burmese mountain dog named Baffin that the head brewer used to own, which I find awesome (those who know me and my Riley Dog can attest to my canine affection).

What's even more cool is that this brewery focuses on reuse, sustainability and being eco-friendly, and it's housed in a historic brick building that's one of the oldest in the city. The taproom walls are made from reclaimed bricks from Detroit buildings in the 1920s era and the bar itself is made from 100+ year old reclaimed lumber.

This place is way-cool as it relates to diabetes, too. Take this example from late November, when I came in wanting to try out a new microbrew pitched as a "maple syrup infused" beer:

And did I mention that they've just recently tapped a new brew, called DOC? It may be pronounced "dock," but I like to order this one by spelling out the letters, and thinking that it stands for Diabetes Online Community. Yep, this is a great place -- and it's only a half-mile from my house, so you can imagine how often I frequent Baffin. :)

Needless to say, this brewery was my home-base, so to speak, for my Fall experiment. 
Microbrews, with Diabetes On Tap

Between mid-September and mid-December, I examined four different types of beer and the effect they had on my BGs: a Belgian pale ale named Pope John Pale, an Irish red ale called The Walking Red, their dark imperial coffee stout named Bob Barley., and an IPA (whether it was the Don't Hop, Mosiac Moproblems, or Hopstepper double IPA brews).



I also sampled a few others during this whole process, from the outstanding "Holland Oats" oatmeal stout to the very sweet "Kane and Maple" holiday beer has gallons of maple syrup added, such that I could feel my BGs rising just by looking at it! But the four varieties mentioned above were my mainstay.

For each brew, I established a baseline -- no food, no Insulin On Board, no intense exercise or BG swings. I wanted to begin with as steady a flatline in the 80-160 range as possible.

Testing each beer had three parts:
  1. A single beer without any insulin dosing. Repeat a second day for confirmation to establish a baseline.
  2. One beer with insulin. Repeat, possibly adjusting dosing slightly if needed.
  3. Two or three beers with insulin, using the baseline and carb-counting info. Repeat to confirm.
Overall, this experiment meant 8 beers of each style -- a total of 32 beers consumed over the course of a few months. That's just over 10 beers a month, or 2 or 3 per week.

Needless to say, this took some time and effort.

It was interesting to see at times the additional effects of using the fast-acting inhaled insulin Afrezza, trying out two different CGMs, playing with my insulin doses and different food factors like lower-carb, higher-fat options. I realize that these variables make my experiment decidedly convoluted, but I still felt it had value for me as an "N of 1" trial-and-error effort.

There were a number of times when I got de-railed by a lack of willpower in resisting a meal or exercise a few hours post-beer and therefore forfeited those BG results. And yes, the free popcorn at Baffin certainly didn't help and was very tough to resist!




Ingredients & Resources


This whole process also made me look more closely at the beer-brewing process, trying to understanding how the making of different brews might play into their "diabetes effect."

Four key resources I found the most helpful came from the Diabetes Daily Grind, and a carb-calorie count list over at Beer100.com.
  • Podcast on Beer & Diabetes: D-peeps Ryan Fightmaster and Amber Clour over at Diabetes Daily Grind (a new site kicked off last year) recorded an outstanding podcast in April on this topic, interviewing some local Oklahoma craft brewers and talking about the nitty-gritty of brewing and how beer affects diabetes management. This was very educational and fun, and I learned specifically that the amount of sugar put into a beer during the initial brewing process isn't necessarily transformed into carbs; much of it's burned out as the substance turns to alcohol. But some does carry over, especially in higher alcohol mixes, and brewers can make a beer sweeter if they choose. I was also intrigued to hear them discuss how difficult it could actually be to require brewers to list the carb count on their wares. Fascinating stuff!
  • Online Beer Info: Despite the note above, the all-in-one brew hub Beer100.com does offer a calorie info sheet with estimated carb counts on a huge number of domestic and imported beers. I've used this list and found it pretty spot-on for me in carb-counting and insulin dosing for beer.
  • Six Beer Questions: Meanwhile, I also very much enjoyed the personal post that Ryan from DDG published in October, outlining the 6 questions he thinks about when deciding to drink beer. These echo my thoughts in many ways, and it's just a handy go-to list to keep bookmarked. I had already started this Beer and BG Effect effort by the time he wrote this, but I certainly had this checklist in mind when going about my "research."
  • DOC Gems: Of course, for personal anecdotes and stories from other PWDs, I've found myself re-reading what our friend and colleague Wil Dubois has written on this topic at Ask D'Mine over at DiabetesMine  Also read some of the testimonials shared over at the Drinking With Diabetes site.

All helpful stuff, if I do say so myself, and a lot of this factored into my experiment.

So, what did I find?

My Beer and BG Takeaways


These four types of Michigan microbrewed beer boosted my blood sugar an average of 75 to 115 points for each beer, without any insulin. You can figure out where that leaves you.


Stout raises me up the most; I can just watch my CGM line make a steep upward climb. Without insulin, my BG jumped about 100 points for just a single stout.

No matter the beer, it took about 30 minutes to start raising my blood sugar, but my levels began to smooth out within a couple of hours post-consumption. Sometimes they even started dropping.


A typical beer takes about 1.5 units of insulin for me (matched well with most carb counts of 17g or so). If I go out and have a couple beers and take 3 units stretched out over the course of an hour, I find I can stay in range, nice and steady on the CGM graph. With a 25-minute pre-bolus, too:


Overnight after drinking I do see the "alcohol liver effect," which is caused by your liver being too busy processing the residual alcohol in your system to naturally make the necessary glucose needed when your BG starts to drop. As a result, you can get hypoglycemic even though the initial beer (or cocktail) may have raised your BG level. I found that my blood sugar usually starts dropping within 6 hours after drinking two or three brews. But it's not a dramatic drop, so nothing I worry too much about personally.

But this phenom was especially interesting to watch in September, when we attended a brew festival at the Detroit Zoo and I had the chance to try about 16 small samples of various Michigan microbrews -- the equivalent of roughly 4 or 5 full-size beers. That's more than I usually have in one night (!), and I saw those higher BGs immediately post-beer, but then a drop several hours later and into the following day. I'm sure the earlier low-carb dinner, all the extra walking around the Detroit Zoo played a part in that, too.

Moral of the story: advance planning is key to being able to go out and enjoy a few brews. As a PWD, you have to think hard about the type of drink you'll be imbibing, and the food and physical activity that will likely accompany it.

So what's next for me in using this Beer and BG info?

I really did learn a lot about the actual effect my favorite types of beer can have on my D-management, and I'm excited to be sharing that with the community via the Diabetes Daily Grind podcast soon, where I'll be interviewed next week about all of this. I understand this podcast will air in January.

Please be sure to tune in to listen to our chat once that goes live (we'll probably be enjoying some beer live as well).

Now, armed with this new information, the only challenge left is to... find a microbrewery that's actually operated by a PWD. That would certainly be a taproom worth visiting!\

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This post originally appeared on DiabetesMine in December 2015, written by Michael Hoskins based on his own personal diabetes experiences and at his own personal expense.

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