Diabetes mellitus and alcohol

Abstract

Alcohol influences glucose metabolism in several ways in diabetic patients as well as in non-diabetic patients. Since alcohol inhibits both gluconeogenesis and glycogenolysis, its acute intake without food may provoke hypoglycaemia, especially in cases of depleted glycogen stores and in combination with sulphonylurea. Consumed with a meal including carbohydrates, it is the preferred fuel, which may initially lead to somewhat higher blood glucose levels and hence an insulin response in type 2 diabetic patients. Depending on the nature of the carbohydrates in the meal, this may be followed by reactive hypoglycaemia. Moderate consumption of alcohol is associated with a reduced risk of atherosclerotic disorders. Diabetic patients benefit from this favourable effect as much as non-diabetic patients. Apart from effects on lipid metabolism, haemostatic balance and blood pressure, alcohol improves insulin sensitivity. This improvement of insulin sensitivity may also be responsible for the lower incidence of type 2 diabetes mellitus reported to be associated with light-to-moderate drinking. In case of moderate and sensible use, risks of disturbances in glycaemic control, weight and blood pressure are limited. Excessive intake of alcohol, however, may not only cause loss of metabolic control, but also annihilate the favourable effects on the cardiovascular system.

The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes

“…Several of these may be of particular benefit in patients with type 2 diabetes. However, alcoholic beverages have complex, and often detrimental, effects on blood glucose levels (6). Similarly, alcohol consumption may also be associated with other behaviors, such as smoking and participation in physical activity, and social factors that influence vascular risk.…”

Mitochondrial dysfunction and oxidative stress in the pathogenesis of alcohol- and obesity-induced fatty liver diseases

“…Multiple factors have been associated with NAFLD including obesity, central adiposity, type 2 diabetes, and hyperlipidemia with insulin resistance postulated as an essential factor. Interestingly, the role of insulin resistance in alcoholdependent liver has been invoked; however, the data in support of this mechanism is equivocal [10][11][12].…”

Diabetes in chronic liver disease: from old concepts to new evidence

“…A retrospective study on diabetic patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) was carried out to determine the role of porto-systemic shunting in impaired glucose metabolism [20], and blood glucose control was found to deteriorate following TIPS, as demonstrated by the increased doses of hypoglycaemic agents required in nearly 20% of patients. Another recent study on nondiabetic cirrhotic patients who underwent TIPS showed that, while basal glucose control was not affected by the procedure, and peripheral C-peptide and proinsulin levels remained unchanged, the circulating insulin levels increased significantly compared to those prior to TIPS, suggesting that portal blood shunting implies reduced insulin clearance by the liver, marked peripheral hyperinsulinaemia and, thus, insulin resistance [21]. These observations suggest that portal hypertension affects glucose metabolism principally through the increased systemic insulin levels, and that systemic hyperinsulinaemia may contribute to the development of insulin resistance, possibly through insulin receptor down-regulation.…”

“…Although much evidence exists suggesting a protective role of moderate alcohol consumption on insulin resistance and cardiovascular risk [21], it is now clear that excessive alcohol intake impairs glucose metabolism. Indeed, prospective epidemiological studies have estimated an approximately twofold increase in the risk of type 2 diabetes in heavy drinkers, compared to that in moderate drinkers [22].…”