Drinking alcohol
Alcohol tends to lower rather than raise blood sugar levels. This is largely due to the inhibition of hepatic gluconeogenesis. Thus patients should be educated about this effect, should check their blood sugar after imbibing alcohol and may even need to reduce the dose of prandial insulin taken with food before an evening in the pub.
Apart from hypoglycaemia, does alcohol consumption confer other risks on people with diabetes? 
Significant alcoholic binges are also a well recognised precipitant of DKA. In addition, all the usual complications of long term alcohol abuse are also present in people with diabetes - psychological ill health, hypertension, liver cirrhosis and osteoporosis to name but a few.
Should insulin treated patients be advised to take less or more insulin prior to ingesting alcohol?
Somewhat counter-intuitively, alcohol tends to lower rather than raise blood glucose levels. This effect is largely due to inhibition of hepatic gluconeogenesis. Patients should therefore be advised to take less insulin prior to consuming alcohol.
What other precautions should insulin treated patients take around alcohol consumption?
1. They should be advised to warn those accompanying them that they have insulin treated diabetes and may be at risk of hypoglycaemia and that strange behaviour is not necessarily a manifestation of alcohol intoxication!
2. They should be advised to keep a source of rapidly absorbable carbohydrate (e.g. jelly babies, dextrose tablets) in their pocket.
3. They should carry their glucometer with them in order to be able to check on blood glucose levels periodically while imbibing.
What are the safe recommended levels of alcohol consumption for someone with diabetes?
The recommendations are no different from those for any other person .ie. a weekly maximum of 21 units for men and 14 units for women.
In addition, people should not drink to the point of intoxication as they are then rendered less able to make sensible judgments about their glycaemic self management and indeed about general aspects of self care as for anyone else.
Do these risks also apply to people with diabetes treated with OHAs alone?
Yes. For those treated with sulphonylureas, there is also a heightened hypoglycaemia risk due to the additive effects of inhibited hepatic gluconeogenesis plus the sulphonylurea.
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