Thursday, May 11, 2017

A Little Bit of Knowledge is a Dangerous Thing

A couple of Sundays ago, I undertook an unassuming biochem experiment on myself, to see what would happen, if anything, to my blood sugar level if I drank alcohol without eating at the same time. Apparently, in some people, drinking alcohol in the absence of food lowers blood sugar. And yes, to address the elephant in the room, I have gone through a zillion little needles because, seriously, I'm not moderate but I am curious. (BTW, while the process isn't painful, it is irritating. One gets little bruises on the fingers pretty quickly. I feel for my diabetic friends who have no reprieve.)

So here's something that's leaving the repertoire stat, whether it's warranted or no: drinking any amount of booze on an "empty stomach". BTW, when I speak of drinking, I'm not talking about hard liquor or umbrella cocktails laden with sugar. On the distant heels of a robust breakfast* (admittedly more than an hour earlier), 4 oz of red wine lowered my blood sugar to the low end of normal** and might or might not have led to a really shitty, possible low blood sugar experience later in the aft. 

To clarify - I ate again an hour after drinking the wine (a few pieces of salami), thought I was sated, and then 30 minutes after that I felt legit hungry, so I ate more salami and some pistachios. My point is, I didn't just drink a glass of wine after more or less fasting for 16 hours. I ate protein and fat at breakfast and then again for a snack. But, while I was pleasantly sitting in a chair eating that lunch, I started to feel the feeling.

As for the feeling - here's how it goes when it's bad (note: I paid as much attention as I could to observe the fast cascade of symptoms, which usually just feels like an onslaught). First up I felt icy-strange, vaguely depersonalized. Then I got hot and cold at the same time and neither temperature would take hold. Effectively I felt feverish on the outside and freezing on the inside but that doesn't really describe it. There was a tinny sensation - like there was metal around me and I could taste or smell it. I became confused - even as I'd been concentrating on something, with no issue, moments earlier. The thing about confusion is that you know something's not right but you can't figure out what the fuck is going on. My arrhythmia kicked into gear. I was lightheaded. I could feel my body searching for some normalcy - a steady heart, the groundedness of my corporeal self. I mean, just the nausea almost had me on the ground.

I did stand, prob not wisely, because I was desperately looking for an escape. On some level, I knew I had to get some food though I couldn't figure out what. (In retrospect, it couldn't have hurt to take a swig of maple syrup, but I wasn't thinking clearly.) As I walked the few feet from the chair to the counter, I also knew I had to get down on the ground because everything was swirly. Note: That's when I got it that things were really not going well. My descent was more by collapse than intent but I was able to make it lighter than it would have been otherwise.

Scott was on the third floor of this fucking rental mansion we live in currently and he couldn't hear me calling, not to mention that I wasn't yelling very loudly. After some period of time that was probably a minute but felt like an eternity, I dragged myself to my phone and called him. No answer. I pressed the button again. He was asleep and his phone was in the other room. Finally I texted: I need help. Somehow he woke up, thought he'd heard me calling him (I wasn't at that point) and came downstairs.

Long story short, he brought me a shawl and pillow (I was on that floor for a while), some water and quickly toasted me an English muffin with a ton of butter - why did neither of us think of maple syrup or a freakin' cookie for the quick fix?? After about 10 minutes of sitting on the floor, becoming gradually less wrecked, I moved to the couch where I fell asleep for about half an hour. BTW, I knew, even as I lay there feeling crappy, that this would be a perfect time to test my blood sugar, dammit, but I could not move to get to the gizmo (or work the gizmo, who am I kidding?). I was pretty cold after all of this. Eventually I moved myself to my duvet-covered bed where I sort of slept for 2 hours. When I got up, Scott brought me some blackberries and a piece of gouda, and some more water. I was fine after that.

I'm sure you'll agree that this is not the kind of thing one wants to experience on repeat. The only thing I did differently on this day, vs other days, was to drink a glass of red wine on a relatively empty stomach. Not that it's the first time I've ever done that (and I don't usually end up on the floor under that circumstance). Were the low normal reading after the wine and the subsequent horrid experience independent of one another? I hope not. I'd like to think I've identified a problem and a solution at the same time! :-) In truth, this isn't the first time I've experienced this fugue and it's been happening since long before I knew about blood sugar, not that it's a regular occurrence. Not having been able to distinguish one biochemical response from the other, I've previously assumed it was an anxiety response. It would be bizarre to determine that this kind of horridness is fueled by low blood sugar fueled by wine on an empty stomach - because that's stupidly avoidable. What the fuck else lowers blood sugar, cuz I need to know! Bring on that lancer, baby. 

What I'll also say is that I will not experiment on myself again without some sugar nearby - not that I have any proof that this was a hypoglycemic incident. In the event that I brought this on myself, I'm a total idiot. My motto: Experimenters, be prepared.

So, today's questions (for the blood sugar savvy): Does this sound like a non-diabetic hypoglycemic episode? Could a small amount of alcohol, taken in the absence of food, lead to this sort of outcome (given food timing). Have you ever experienced anything like this and, if yes, what steps have you taken to avoid recurrence? Let's talk!

PS: It has occurred to me that what allowed this to happen is more systemic than I've assumed. I've been eating no grains or beans and not so many carbs for a few months now. My blood sugar may be generally lower as a result. Furthermore, I drink about 25% of what I used to. I can't imagine this, but maybe my tolerance is lower. Plus, I weigh somewhat less. So the response I had, if blood sugar related, may have been influenced by these factors.

* Look, I don't like eating breakfast - robust was a wet cappuccino with collagen peptides (8g protein), an egg and then, an hour later, my hot chocolate (utterly equipped with fat and calories). Secretly, when I make this drink I usually replace the water with heavy cream on top of the unsweetened coconut cream... And I do eat vegetables, just not in this post.

** For reference, my fasting level was 5.2 mmol/L, after breakfast it was 6.1, after the food-free wine experience it was 4.3. Next time I could test was 30 min after dinner and it was 5.4. How I wish I'd had the wherewithal to test during the "episode".


  1. I've sent a link to my sister - she might be able to give you a Type 1 diabetic's perspective!

  2. Gillian, my sister, asked me to chime in, as her resident insulin-dependent diabetic. Yes, what you describe does sound generally like a hypo. For me, having been diabetic for nearly 20 years, I am much more attuned to them and therefore mostly catch them before they get that severe. My hypo symptoms have shifted a little over time (I remember that metallic sensation, but the first thing I notice now is a tingling on the back of my tongue and white spots in my vision). That said, it's maybe worth noting a few things?

    1) Very little of the experience of having a low is actually directly because of the low blood sugar itself. Most of the symptoms are actually part of the "fight or flight response" that characterizes most involuntary responses to threat. For me, that means that a panic attack and a hypo are pretty darned close to indistinguishable, especially at first, so my immediate response is to take a few moments to myself and eat some jelly beans or other sweets; that will allow me to assess myself and figure out if I really am low or just anxious, while also starting to treat the low if it's happening. Of course, if it's not, then I have to take more insulin to cover the candy.

    2) Other stuff also feels a lot like lows. I'm also stupidly anemic (iron and B12 absorption issues) and the dizziness I feel from that is virtually identical to the sensation of a low, except (for me) that buzziness on my tongue.

    3) If you ARE low, though, you want the simplest, purest sugars you can find, with as little fat or protein or fibre as possible, because those things slow down the digestion/absorption of the sugar.

    4) I know there are nice tidy tables that say that between 4.0-7.0 (or whatever) mmol/L is "normal" and below that is "low" but bodies aren't that simple. This morning, for instance, my glucometer reading was 5.0, but I was FEELING low; other times I've been as low as about 2.3 and have felt totally normal. This goes back to point 1 above: it's not so much that you directly experience a hypo, as that your cells start to send a message to your brain to trigger that fight or flight response, and THAT is what you experience as a low. Your blood sugar isn't the same everywhere in your body at any given moment (which is why glucometers are specifically calibrated for fingertip pricks). Your body can start sending the hypo signals well before -- or well after -- your fingerprick tests might indicate a low.

    5) Having tested my sugar 4-12x/day for nearly 18 years... set your lancet device to the lowest setting that still allows you to draw a drop of blood. Meters require less than you think, to test. Make sure your fingers are warm when you test. Prick at the sides of your fingerpads, where there are fewer nerve endings, rather than in the middle of the fingerpad. Rotate which fingers, and which sides of which fingers, you test, so your skin has time to heal.

    6) Yes, alcohol can lower the blood sugar. Or it can raise it. It can also make you less able to judge the status of your blood sugar and make clear decisions about treatment. And, of course, many drinks do have crazy high sugar contents, which they aren't obliged to label with nutritional information. I do know diabetics who drink, but I'm by and large not one of them, so I can't really speak to your initial thesis about alcohol.

    1. Anne: Thank you SO much for this incredible comment. I was hoping that Gillian would reach out to you! There's so much to take in here that I'm going to keep re-reading. The thing about blood sugar being person-specific is so interesting. The idea that you can have a hypoglycemic response when your readings show that you're in the normal range is also fascinating. When next I do 2 days of finger testing, I'm going to pay attention to how I FEEL and observe whether the reading is "normal". Also, the idea that an anxiety attack can actually be motivated by low blood sugar (something I've been considering for a while) just blows my mind. The only times I have an "anxiety attack"(always very physical for me i.e. arrhythmia, blurred vision etc.) are when I'm completely relaxed - and, often, having a glass of wine (something I associate with relaxation). I've always wondered how it is that I deal with an extremely stressful job/life that never causes me anxiety and sitting on the couch, watching TV, can bring on hideous physical symptoms - that are so terrifying that I feel panic.

      I may reach out to you with more questions, if you don't mind!

    2. Okay, a few points of clarification:

      — Different people feel lows differently, BUT it's not that one person is always "low" at 5.0 and another is never "low" until 3.0. My point is that it varies within the same person. The sugar reaching your brain, say, might be higher or lower than the sugar you can test in your finger at any given moment, which is why the "emergency!!" signal isn't always triggered at exactly the same number. If your brain cells aren't getting enough sugar (i.e., energy) then they'll send that signal to your nervous system regardless of what the cells in your fingertips are experiencing — and vice versa. The cells that trigger the response could be in your heart, your toe, anywhere that isn't getting enough energy at that particular moment.

      — I also didn't exactly mean that a hypo directly causes a panic attack. Anxiety AND low BG AND lots of other issues (like my anemia) can all trigger the SAME "fight or flight" reaction, which is why the symptoms are so similar (cold sweats, dizziness, vision issues, rapid heart rate, etc.)... If your symptoms are fixed by eating sugar, then there's a good chance that it's a low, but many people also find that a snack of comforting food helps calm them in a panic attack, for instance, so it's not a definite diagnosis. The point is that there are a lot of different issues that can lead to more or less the same set of symptoms.

      — As someone who also deals with a high-stress job (I'm a conference planner and deal with heads of state, diplomats, high-level executives, etc.) and an anxiety disorder, I can also tell you that panic attacks don't necessarily happen in the moment of crisis. In the moment, I can handle things coming at me from all sides and respond with grace, tact, and efficiency, because I have my "game face" on and I've worked myself up to a state of readiness. It's when I'm at home, asleep or relaxed, that the real anxiety punches through, because I've let my guard down. That has a lot less to do with my blood sugar (though stress, via adrenaline, does raise blood sugar somewhat), and a LOT more to do with my emotional state.

      Hope that's helpful. By all means, we can continue the conversation, but my point is that bodies are complicated, yo, and blood sugar is only one piece of the puzzle.

  3. The title of this post lead me to believe that this was going to be about the President of the United States.

  4. Chiming in as an uneducated hypoglycemic person here - that is, nothing like the experiemce someone with diabetes would have and I've never officially tested my blood sugar - but based on experience - yes - alchohol triggers low blood sugar for me - and different types of wine are different. Sweeter wines are disasters - and liquid in general is a really bad way for me to ingest sugar - it generally has a bad effect.

    1. Sarah - seriously, get yourself a monitor. It will be so illuminating! And I completely agree, the ONLY liquid sugar I drink is in wine (I don't have juice or pop). But whenever I drink sugar I get super messed up.