Alcohol management for hybrid close loop system users

Download and print as a PDF (304kB pdf)

Alcohol management for hybrid close loop system users

• Your liver keeps extra glucose and releases it when your glucose levels drop. But alcohol makes it tough for your liver to do this well.
• A lot of alcohol can make your glucose levels drop, leading to hypos while you are drinking or even the next day.
• How much alcohol you are drinking depends on:

Alcohol content > Size of the drink > Number of drinks

• High carb containing drinks may raise your glucose levels initially, but the alcohol content of your drinks can cause your levels to drop later.
• It is important to note that no one is the same, and it’s a trial and error when drinking alcohol. The same drink could cause a hypo to a HCL user and a hyper to another user. Learn how your body responds to alcohol and adopt strategies that works for you.
• You can learn more about more general alcohol information at www.drinkaware.co.uk.

Checklist BEFORE drinking alcohol

Considerations DURING the event

Medtronic 780G:

Apply ‘Temp Target’ prior to drinking alcohol, set duration to cover the entire drinking session and 8-12 hours after the event.

What happens when ‘Temp Target’ is applied: Glucose target is at 8.3mmol/L, autocorrections inactivated.

CamAPS Fx:

Apply ‘Ease Off’ prior to drinking, set duration to cover the entire drinking session and 8-12 hours after the event. You can pre-set ‘Ease off’ to start later.

What happens when ‘Ease Off’ is applied: Glucose target is increased, algorithms calculations are softened and insulin stops earlier.

Omnipod 5:

Apply ‘Activity mode’ prior to drinking alcohol, set duration to cover entire drinking session and 8-12 hours after the event.

What happens when ‘Activity mode’ is applied: Glucose target is at 8.3mmol/L, automated insulin delivery is reduced by 50% and microbolus corrections are limited.

Tandem T-Slim:

Apply the ‘Exercise Function’ prior to drinking alcohol, Max duration is 8 hours. Re-new your ‘Exercise Function’ at bedtime for another 8 hours.

What happens when ‘Exercise Function’ is applied: Glucose target is between 7.8mmol/L to 8.9mmol/L and insulin is stopped earlier. Autocorrections can occur once per hour.

• DO NOT turn Automated Mode/SmartGuard/Control IQ/Auto Mode off.
• Pace yourself by alternating between alcoholic drinks and water.
• Dancing and walking can be exercise which can lead to lower glucose levels.

Carbs from food:

If you are able to, consider reducing the amount of carbs you enter into the pump for food or when you have a bedtime snack. Start with decreasing by 25% and if you go hypo, consider decreasing by 50% next time.

Carbs from drinks:

Choose low carb options as much as possible (refer to page 4), monitor glucose levels, your automated insulin delivery will increase accordingly. (Make sure you have set up Temp target/Ease Off/Activity Mode/Exercise Function on your HCL system to prevent too much insulin from being delivered)

AFTER the event, it is important to:

Alcohol consumption guidelines

14 units of alcohol per week per person, it is not recommended to drink all your weekly units in one day. Here is what makes one unit:

• Half a pint of beer, lager, or cider            4% alcohol.
• Standard pub measure (25ml) of spirit    40% alcohol.
• 125 glass of wine                                       13% alcohol.
• Cocktails                                                 Similar to spirits.

Carbohydrate content of drinks

• 330ml Beers: 9-14 grams of carbs e.g. Beck’s, Budweiser, Fosters, Stella Artois, Corona.
• 330ml Alcopops and Ciders: 10-40 grams of carbs e.g Bacardi Breezers, WKD, VK, Thatches, Strongbow.
• 330ml Low carb beers: 0-5 grams of carbs e.g. Beck’s Premier Light, Coors Light, Bud Light, Miller Light.
• Spirits with sugar free mixers: Zero Carbs (but high alcohol content! 35-60% alcohol).
• 125ml Champagne and wine: 1-5 grams of carbs.
• 25ml Cocktails: approximately 15 grams of carbs (cocktails containing juices, syrups, liquers). Low carb cocktail options: extra dry martini, Gin Rickey, Gin or vodka and diet tonic water.

Glucagon and alcohol

• Glucagon might not work as effectively if you have been drinking alcohol.
• Make sure your friends know the signs of a severe hypo and get help right away.
• Call 999 when you have a severe hypo.

Information for your friends on how to spot and treat a hypo when you are unable to:

1. Hypo is when glucose level is low (less than 4mmol/L), the diabetes technology should alarm when glucose levels are low.
2. Symptoms of hypos are very similar to symptoms of being drunk.
3. Symptoms to watch out for:
   • confusion
   • anxious
   • irritable
   • hunger
   • sweating
   • tearful
   • going pale
   • tiredness
4. If your friend with Type 1 Diabetes is having a hypo and cooperative:
   • Technology should be alarming and showing low glucose.
   • Give your friend one of the below hypo treatments shown on the next page.
   • Check glucose level after 10-15 minutes, repeat if glucose level remains below 4mmol/L.
   • If glucose level remains low after two rounds of hypo treatment, call an ambulance. Stay with your friend.
5. If your friend is uncooperative or unconscious – call an ambulance immediately. Stay with your friend until help arrives!

Information compiled from the following sources:

1. ACDC Omnipod 5 HCL training booklet
2. ACDC T Slim Control IQ HCL training booklet
3. ACDC CamAPS FX HCL training booklet
4. ACDC Medtronic Minimed 780G HCL training booklet
5. Cambridge insulin pump training course 2023 run by Cambridge University Hospitals NHS Foundation Trust. It was presented by Emma Musgrave
6. Eng-SEREN-Connect-3-Drinking-alcohol-with-Type-1-diabetes-.pdf (cypdiabetesnetwork.nhs.uk)
7. Alcohol and diabetes | Managing your diabetes | Diabetes UK
8. Diabetes UK Young Adults Guide to Alcohol
9. Birmingham Children’s Hospital Study Day March 2024, Alcohol Presentation by John Pemberton.
10. National Children & Young People’s Diabetes Network Close loop comparison Guide 2021