Dear All,
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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
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