London - Dr Martin Scurr answers health questions:
QUESTION: Though I’ve been a type 2 diabetic for more than 15 years, my blood sugar readings have gradually crept up from 4-6 to 11-12 and a recent high of 14.4.
However, I find my readings are lower after a drink - recently I drank a bottle of wine and the next morning my reading was down to 9. Is there evidence alcohol can suppress sugar levels?
C. A. Phasey, Dover.
ANSWER: You have made a rather serendipitous discovery, it seems - a drop of 5mmol/litre (millimoles per litre) in your blood sugar overnight, thanks to a heavy drinking session. Is it too good to be true?
For people who don’t have diabetes, blood sugar levels will be between about 3 and 7 mmol/litre - your levels started off relatively low for type 2 diabetes, but have gradually crept up.
There have been at least two studies confirming the sugar-lowering effects of alcohol in diabetics. One showed a daily glass of wine reduced the fasting blood sugar (the blood sugar levels after not eating or drinking any liquids other than water for eight hours) the next morning by an average of 1.1 mmol/litre.
Another study showed that diabetics who’d suffered heart attacks and drank one glass of wine a day for a year had reduced fasting insulin levels - suggesting improved insulin sensitivity and lowered levels of inflammatory markers: again implying a beneficial effect.
Exactly how alcohol lowers blood sugar levels is down to a complex metabolic process in the liver and the liver’s relationship with insulin production in the pancreas. And while I wouldn’t advocate a bottle of wine as treatment, a small amount may well be beneficial.
However, there are more important things for you to focus on with regards to your sugar- lowering regimen.
The major concern about poor blood sugar control in diabetes is the damage it causes by accelerating the build-up of cholesterol in larger arteries, and the damage to smaller arteries in the eyes, kidneys and nervous system.
The progression of complications can be slowed but not stopped, so we have to look at addressing all risk factors - not just rely on taking tablets or,indeed, having the odd ‘medicinal’ glass of wine.
Diabetics need to reduce dietary fat, take regular exercise, stop smoking, have tight blood pressure control, take low dose aspirin and cholesterol-lowering therapy such as statins and, most importantly, ensure strict control of blood sugar levels through their diet.
Blood sugar levels should be 4-7 mmol/litre before eating and under 8.5 mmol/litre two hours after. So, from what you’ve told me, I think your greatest problem is portion control, in other words the quantity you are eating.
That bottle of wine you drank on that one occasion is an example. One bottle equates, on average, to nine units of alcohol - you should have only one or two units daily.
The great difficulty I see is that type 2 diabetics treated with dietary advice and tablets never achieve the same levels of self- control as patients with type 1 diabetes, who have to inject themselves with insulin.
For some reason, the emotions associated with injections mean that type 1 diabetics take it all more seriously.
However, type 2 diabetes is just as serious - if not more so - as symptoms come on more gradually. But don’t despair.
This week one of my patients came in having lost 16kg on the Dukan diet, which involves eating only lean protein and vegetables.
There’s nothing special about that particular diet, yet despite struggling with his diabetic control for years, he’s somehow managed to embrace it: his diabetes is under control, hopefully saving him from being put on kidney dialysis, which was on the horizon.
The moral is that you, too, have to find what works for you.
So please do all you can to triumph with portion control and diet. And while alcohol does seem to reduce sugar levels, restrict yourself to just the one glass only. Good luck.
QUESTION: Recently I had blood tests for a stomach problem, which I think may be IBS, and all was fine except for a deficiency in vitamin D.
My doctor suggested I take 10,000 IUs of vitamin D daily for two months and then 1,000 to 2,000 IUs daily. When I took the prescription to my pharmacist, he expressed concern at the high dose.
I raised this with my doctor, who told me to do as she suggested and take ten tablets a day.
Just three days later I got awful stomach pains, and then another doctor advised me to stop taking the tablets. I am confused.
Name and address supplied.
ANSWER: You are right: this is all extremely confusing. I think the problem, in part, arises with the complex names for different types of vitamin D, as well as the equally confusing custom of describing the doses of supplements in milligrams and international units (IU).
What we do know is that your vitamin D level is low, and this is associated with a number of health problems including effects on bone health and immune function. So how can you go about topping up your levels in a straightforward manner?
The term vitamin D is used to describe a range of compounds: in food, we take it in as cholecalciferol, also known as vitamin D3, or ergocalciferol, vitamin D2. However, it can also be made in the body, when we are exposed to sunshine.
Vitamin D2 and D3 are converted in the liver and again in the kidneys to calcidiol: this regulates calcium levels in the bloodstream and has an effect on nerves, muscles and immune function.
One microgram of vitamin D is the same as 40 IUs and each day an adult requires 15 mcg (600 IUs). However, there’s no such thing as a plain vitamin D tablet: you can buy vitamin D2 or various other forms, such as vitamin D3, as 10mcg (400 IU) tablets.
I recommend that you take double the daily recommended dose, ie 30mcg (1,200 IUs) every day until your levels are normal.
This will be three tablets of either of the above, all available over the counter without prescription.
While on this boosting dose, make sure your GP tests your levels of calcium regularly (no less than once a month) with a blood test. When vitamin D levels rise, calcium levels can also elevate dramatically, causing nausea and other symptoms; periodically, the vitamin D level should be measured as well.
Hopefully, I’ve cleared up any confusion. -
Daily Mail