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Type II diabetes and alcohol

Discussion in 'Diabetic Foot & Wound Management' started by RobinP, Apr 11, 2011.

  1. RobinP

    RobinP Well-Known Member

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    Dear All,

    I am looking for some opinions on something of an unusual case. The patient was asking me diabetes related questions that I couldn't answer.

    This is the history - abbreviated for reasons of expediency
    73 year old male
    Type 2 diabetes diagnosed in the last 6 months
    Takes metformin
    Obese - BMI >35
    Currently not drinking at all and blood glucose level stays between 5 and 8. Diet is surprisingly healthy
    Pt has been a heavy drinker of spirits(mainly gin) for 50 years and moves in social circles where there is quite a drinking culture.

    I have, as many others have done, given the usual advice regarding drinking being bad, hypoglycaemic attacks etc. However, the patient's life without his social life is difficult as he ends up working more and cannot wind down/relax without drinking.

    Normally, in cases like this, I just tell the patient that it is their choice to drink and that they risk their health and more if that is what they choose to do. Generally, it has the desired effect of guilting them into becoming more aware of the repercussions of their habits.

    This person is unusual. He is saying that he does not intend to change. He is 73 and he wants to enjoy his remaining years and if that means that his time is shortened, so be it. He would rather have fewer years having (what he considers) a good time than having many more years living the life he lives now, which he finds boring and excluding in the extreme.

    The thing is that I believe him. He is a high acheiving person who knows his own mind so I don't think I will change him. So he started asking me questions(having explained to me his predicament) about areas that I couldn't answer other than to give the party line about alcohol being bad for management of diabetes.

    Not that I intend to share with him any slightly posistive comments as I will continue to give the party line but can anyone actually tell me

    If the patient continued to drink (for example) 1/2 of a bottle of gin per night, what would be the likely progression of his diabetes(that would differ to someone who didn't drink every night) aside from the obvious problems of low blood glucose levels/hypoglycaemic attacks.

    Does continued alcohol drinking have any effect on rapidity of onset of neuropathy(currently has none). If so, what is the timespan in which marked peripheral neuropathy will develop.(again by comparison to a regular diabetic who does not drink.

    Thanks for any input
  2. cperrin

    cperrin Active Member

    With regards the speed of onset of neuropathy im unsure of the direct correlation, but obviously with the more alcohol he drinks, the higher his levels of viceral fat resulting in increasing resistance to insulin meaning he would be more likely to develop neuropathy due to the effect of the polyol pathway.

    From treating certain ulcer patients the heavy drinkers have taken longer to heal - if this is due to a biological consequence or they are just so drunk they dont remember letting their dog lick their ulcer im unsure :D
  3. Why? This harks back to the thread on suicide and our role as a health professional and guidelines for advice. At the end of the day it's about judgment and individual choice and responsibility - yes you can give clear unequivocal clinical advice based on best practice - but at the end of the day it's your patient's choice how they conduct their lives and how they wish to manage their health - not yours.

    Also I'm not sure that a half bottle of gin per day would constitute a problem in this individual.

  4. I was thinking along the same lines

    73 healthy type 2 who drinks quite a lot.

    is very different to 73 Unhealthy type 2 with long history of Ulceration,gangrene and digit amputation who drinks quite a lot.

    Robin let him know thats it is seen as a bad combo alcohol and diabetes, but it is his life.....

    PS and maybe get a couple of invitations to a couple of the gatherings.
  5. RobinP

    RobinP Well-Known Member

    Hi Mark,

    Thanks for the reply. It was the thread on suicide that made me think a little bit more on what this particular chap was saying. The thing was that I actually agreed with him in many respects.

    As I said, I gave him the usual advice but told him that the choice was his. I'm not going to give him the positive comments unless someone can point me in the direction of a study that says continued acohol usage has a negligible effect. The opinions i am requesting are for my own insight. Like many on the suicide thread, I think that people have the right to choose their own destiny but I don't really want to push my opinions upon him.

    His exact words were, "I have half a bottle of gin before I've started(drinking)"


    Thanks to the others for their comments.


  6. DTT

    DTT Well-Known Member

    Hi Robin

    I agree with Mark, if this guy has been a heavy drinker for 50 years then I would suspect that may be keeping him going ??

    If he gave up now the body may have a problem coping with the sudden change in metabolism and yes I also agree with the sentiment of a happy few years rather than a lot of unhappy one's.

    As mike said ..get yourself an invite into the social circle !!!:drinks

    D ;)
  7. RobinP

    RobinP Well-Known Member

    I'll book him in for an extra long apppointment for next time and see if I can wangle an invite :drinks


  8. Aims

    Aims Member

    I hope he is having good good Gin to make it worth his while.

    I would recommend some good tonic water, a slice of cucumber, a dash of lime, and some cracked black pepper.

    But as for the link to neuroapathy high alcohol intake leads to reductions in Magnesium, Calcium, Phosphate, and the B vitamins - Thiamine (B1) Folate (B9) and cobalamin (B12).
    The main links to neuropathy and alcohol is a reduction in the B Vitamins principally Thiamine.
    As for the rate of sensation loss it is all about the level of vitamin loss, and the BSL control.
    I would suggest blood tests and prophylactic multi-vitamins as well as a specific B complex.

    I have witnessed this combination of diabetes and alcoholism in Australian Aboriginal patients with having an onset of total sensory neuroapathy moving to motor dysfunction and footdrop within 8 months.

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