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Practice 10-Minute Consultation

Hypoglycaemia

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d567 (Published 16 February 2011) Cite this as: BMJ 2011;342:d567

Alcohol and hypoglycaemia

The patient described in this case may require special attention
regarding the alcohol consumption during lunch time. It has been already
reported that in type 2 diabetic patients treated with commonly used
hypoglycemic sulfonyl ureas, alcohol intake may result in sustained
hypoglycaemia1. The problem may also be attributed to the long biological
half life of sulfonyl ureas.The chronic use of alcohol may lead to
pancreatitis which in turn result in the impairment of beta cell
function2.

Ethanol is a known inhibitor to the counter regulatory hormonal response
to hypoglycaemia 3 thus it may delay the recovery from hypoglycaemia. In a
study conducted by Zhen Huang and Ake sjoholm on the effect ethanol on
pancreatic circulation they concluded that ethanol exerts substantial
influence on pancreatic microcirculation by evoking a massive
redistribution of blood flow with in the pancreatic gland redirecting it
in to the endocrine part evoking sustained insulin secretion and
hypoglycaemia 4.

The treatment strategy has give special attention to alcohol
intake during lunch time, the dosing of sulfonyl urea, and routine
monitoring of Liver and renal function.

References

1. Asplund K, Wiholm BE, Lithner F. Glibenclamide-associated
hypoglycaemia:
A report on 57 cases. Diabetologia 1983; 24:412-417

2. Nealon WH, Townsend Jr CM, Thompson JC The time course of cell
dysfunction in chronic ethanol-induced pancreatitis: a prospective
analysis.
Surgery 1988;104:1074-1079

3. Kolaczynski JW, Ylikahri R, Harkonen M, Koivisto VA The acute
effect
of ethanol on counterregulatory response and recovery from insulin-induced
hypoglycemia. J Clin Endocrinol Metab 1988; 67:384-388

4. Zhen Huang, Ake sjoholm Ethanol Acutely Stimulates Islet Blood
Flow, Amplifies Insulin Secretion, and Induces Hypoglycemia via Nitric
Oxide and Vagally Mediated Mechanisms Endocrinology 2008;149:232-236

Competing interests: No competing interests

21 February 2011
Madhavan Nampoothiri
Lecturer
Dr.K.B. Koteshwara and Anup Naha
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India-576104