Day: 01/02/2023

Diabetes and Hangovers: What You Need to Know

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Diabetes and Hangovers: What You Need to Know

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By Christine Fallabel

December 26th, 2022

Anyone who lives with diabetes knows that a hangover can mess with your blood sugars, leaving them unpredictable for hours (and even days). When you’ve had too much to drink and you’re feeling hungover, what can you do?

This article will touch upon what you can expect after a night of heavy drinking, the best course of action to take to help your diabetes management when you are hungover, the best food and beverages to help treat a hangover, and how you can help prevent a hangover in the future.

Alcohol and Blood Sugar

If you’re planning on drinking, it’s important to know how your blood sugar is likely to react.

Alcohol itself is known to cause low blood sugars. This is because alcohol use can both improve insulin sensitivity and inhibit glucose production in the liver, each of which leads to increased risk of hypoglycemia. While moderate alcohol use is not likely to be dangerous, heavy drinking is another story and can be a real risk, especially given the fact that the effects of drunkenness make it so much more difficult to assess and treat one’s own glucose control issues.

Everyone with type 1 diabetes is at risk of this glucose-dropping effect, as are patients with type 2 that use insulin, sulfonylureas, and any other medications with a known risk of hypoglycemia.

People at risk of hypos should always carry glucose tabs, gel, juice, or candies with them in case of an emergency low, and should check their blood sugar regularly both during and after drinking. That might mean putting a juicebox or a bowl of candy on your bedside table.

Some people with diabetes ask a sober and capable friend to act as a kind of designated driver to make diabetes decisions for them when they get drunk. It should go without saying, of course, that it’s much easier and safer simply to drink less alcohol intake in the first place.

Hangovers and Blood Sugar

Alcohol does not typically lower your blood sugar immediately, or even when you’re at your tipsiest. In fact, the glucose-lowering effect usually peaks hours later, the morning after.

In a fun 2001 study published in Diabetes Care, scientists got six men with type 1 diabetes drunk on about one bottle of white wine each. Then they watched what happened.

The brave volunteers drank their fill between 9:00 pm and 10:30 pm, a few hours after eating dinner. Surprisingly, it look a very long time for their blood sugar levels to drop. Five of the six men experienced symptomatic hypoglycemia, and they all did between 10:00 am and noon the next morning, about 12 hours after drinking.

That means that you’re just as likely to have blood sugar issues the morning after drinking. And the more you drink, the greater the likelihood of low blood sugar, and the less capable you will be of dealing with it.

The Symptoms of a Hangover

A hangover, quite simply, is the accumulation of disagreeable symptoms that develop several hours after drinking too much alcohol. Common symptoms include:

  • Headache
  • Nausea, vomiting, or stomach pain
  • Light and sound sensitivity
  • Fatigue
  • Thirst
  • Dizziness
  • Poor sleep quality
  • Decreased ability to concentrate

These side effects are more likely to be unpleasant than dangerous. You might also notice that there is some overlap between the symptoms of hangover and hypoglycemia, which isn’t completely coincidental. Even in people without diabetes, low blood sugar is one of the multiple causes of hangovers.

But the fact that hangovers and hypoglycemia can have similar symptoms means you need to be especially careful about checking your blood sugar. It can be dangerous to let a hypo go untreated.

Truly excessive drinking can take a more serious toll on your health. More severe symptoms of a hangover include:

  • Shallow breathing
  • Low body temperature
  • Excessive vomiting (not able to hold down water)
  • Confusion
  • Seizures
  • Blue-tinged skin
  • Loss of consciousness

These severe symptoms could lead to big problems, including diabetic ketoacidosis (DKA), which is typically accelerated by dehydration, and can occur despite seemingly normal glucose levels. Check your blood sugar frequently or wear a continuous glucose monitor (CGM) to make sure you’re staying in range, as recommended by your doctor.

If someone you know is experiencing severe symptoms of a hangover, consider seeking emergency medical treatment, or call 911.

So You’re Hungover; What Should You Do?

First of all, pay very close attention to your blood sugar. You can expect sugar management challenges a day after drinking.

The hangover’s enemies are time and hydration. Most hangovers disappear within 24 hours, although some can last for days. It can be excruciating, but sometimes you simply must wait it out.

While you’re waiting, the next best thing you can do is hydrate. Consider consuming the types of foods and beverages that work for the flu.

Getting plenty of sleep also helps remedy a hangover; alcohol notoriously disturbs sleep patterns, so if you didn’t get a good night’s rest after drinking, taking a nap the next day can help you bounce back quicker.

It’s also a good idea to get plenty of electrolytes, which can help improve head and muscle pain. Good sources include sports drinks (although make sure to watch the carbohydrates!), coconut water, bone broth, as well as many minimally-processed foods. A big healthy breakfast is a great start, especially if it helps land your blood sugars in a safer range.

Other hangover cures have been difficult to verify scientifically. Whether it’s aspirin, coffee, or exercise, do what works for you.

How to Prevent a Hangover

The surest way to prevent a hangover is by abstaining from alcohol or only drinking in moderation. Some other tactics to help prevent hangovers include:

  • Drink alcohol only with food and never on an empty stomach
  • Drink slowly
  • Make sure you stay hydrated with water while drinking (a good rule of thumb is drinking one glass of water for every alcoholic beverage)
  • Keep a close watch on your blood sugar (sugary alcoholic beverages can make your blood sugars spike, while the alcohol itself can make you crash. Be wary of both consequences and check your blood sugar often).
  • Avoid sugary mixed drinks and sweet wines, which not only make blood sugar control even more difficult but may also make hangovers worse. Instead, mix liquor with water, seltzer water, or diet drinks.
  • Know your limits, and stick to them
  • Stick with friends or family who will watch (and potentially limit) your alcohol intake
  • Eat something to keep your blood sugar up overnight and drink plenty of water before going to bed after a night of drinking.

If you think you have a problem with drinking or develop signs of alcohol addiction, please get help immediately.

3 debates about addiction medicine to watch in 2023

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The U.S. is experiencing its deadliest drug crisis ever, and there’s no end in sight. And even as nearly 108,000 Americans die of drug overdose every 12 months, the federal government hasn’t changed much about its approach to drug use and addiction. 

With Republicans and Democrats each set to control one chamber of Congress, most advocates aren’t expecting Capitol Hill to suddenly step in. 

But some drug policy groups and major medical associations haven’t given up. Instead, they’ve continued to call for major overhauls — including several that the Biden administration, and potentially individual states, could pursue without help from Congress. 

Almost any change to U.S. drug policy is prone to controversy, however, and these are no exception. 

Below, STAT lays out the three debates likely to dominate the drug policy and addiction medicine landscape in 2023. 

Methadone 

In the fight against drug deaths, there’s no tool more effective than methadone. Patients taking the medication are 59% less likely to die of an opioid overdose. 

But methadone itself is a powerful opioid sometimes used to treat pain, and current regulations can make the medication extremely difficult to access. Currently, it’s only available at certified opioid treatment programs, or OTPs, that require patients to participate in frequent counseling and drug testing, and in some cases to show up in person every day to receive a single dose. 

Many addiction doctors want to dramatically deregulate the drug, allowing physicians to prescribe it directly to patients who can pick it up at a pharmacy. 

Sen. Ed Markey (D-Mass.) has taken up the cause, and the American Society of Addiction Medicine has also called for doctors to be allowed to prescribe methadone directly. 

The American Association for the Treatment of Opioid Dependence, which lobbies on behalf of methadone clinics, has called the proposal wrongheaded. Despite low rates of methadone overdose, they warn that increasing access to methadone could exacerbate the opioid crisis, and cite statistics showing that patients taking methadone are more likely to stay in treatment when they receive the medication through an OTP. 

While Congress seems unlikely to change methadone regulations, one recent report from George Washington University argues that the Biden administration could act of its own accord. It’s not clear whether the White House shares that opinion — but with over 80,000 opioid overdose deaths occurring each year, it’s a sure bet that methadone will be among the most contentious addiction debates of 2023.

Supervised injection

There’s perhaps no drug policy proposal more controversial than supervised injection — the practice of allowing people who use drugs to do so under medical supervision. While some studies show that the sites are helpful in reducing drug overdose deaths, only a handful are currently operating in foreign countries.

There are only two supervised injection sites currently operating in the U.S., both operated in New York by the same nonprofit. But a separate organization seeking to open a site in Philadelphia is embroiled in a years-long legal battle with the federal government that has sweeping implications.

Currently, supervised injection sites are considered illegal, thanks to the so-called “crack house statute” of 1986, which outlaws any space maintained for the express purpose of facilitating drug use. The Trump administration used that law in the 2019 suit that has kept Safehouse, the nonprofit, from opening its proposed site in Philadelphia. (One of the bill’s co-sponsors, incidentally, was Joe Biden, then a third-term senator representing Delaware.) 

It’s not clear, however, whether the current White House shares the view of the Trump-era Department of Justice. The current administration faces a deadline of Jan. 9 to respond to Safehouse and, in effect, decide whether to continue enforcing the ban on supervised injection sites. 

It’s also unclear whether other states will attempt to open supervised injection sites, and whether the federal government would turn a blind eye, as it has in New York. California’s legislature, for instance, passed a bill in 2022 that would have allowed several pilot sites to open. Gov. Gavin Newsom, a Democrat, vetoed the proposal, citing potential “unintended consequences.” 

Regardless of what happens in Philadelphia, the debate is far from over. Harm-reduction advocates, lawmakers, and even a small group of public health officials will certainly push to make 2023 the year supervised injection becomes a widely used overdose-prevention tactic. 

Telehealth

In a way, addiction doctors’ lives became easier during the Covid-19 pandemic. As part of the broader public health emergency, the federal government extended unprecedented flexibilities for prescribers and patients — in particular with respect to telehealth. 

For the first time, doctors could prescribe buprenorphine, a common medication for opioid addiction, without an in-person visit. It also became easier to give patients weeks’ worth of take-home methadone doses. 

The changes have been broadly popular among doctors, advocacy groups, and patients. The federal government recently moved to make them permanent. 

But some concerns, like quality of care or patient privacy, still remain. In all likelihood, the regulations are only half the battle — whether the health care system will continue to embrace them is another question altogether. 

As the country’s post-Covid recovery continues, it’s unclear whether doctors will keep using the telehealth flexibilities; whether insurers will keep reimbursing for telehealth services; and whether pharmacies will keep filling prescriptions written in the absence of an in-person visit.

15 New Year’s Resolutions for Greater Peace and Serenity

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15 New Year’s Resolutions for Greater Peace and Serenity

“New Year’s Resolutions are a great way to start life all over; a great way to leave the past behind and embark on a wonderful new adventure called: your life.” ~ Luminita D. Saviuc

This is a different kind of New Year’s Resolutions List; a list that’s meant to help you do the things you want to do, while at the same time learning to remain calm, flexible, open and receptive to whatever life sends your way. Because you and I know that life doesn’t always go as planned, and that’s okay.

15 New Year’s Resolutions for Greater Peace and Serenity

1. Be open and receptive.

Be open and receptive to whatever life sends your way.

2. Allow.

Allow life to shape you and to mold you in a majestic and graceful way.

3. Surrender.

On Surrender15 New Year’s Resolutions for Greater Peace and Serenity

Surrender to what is.

4. Let go.

Let go of fixed plans and concepts and allow events to follow their natural course.

5. Accept.

Accept life unconditionally and trust that it’s all happening for your highest good.

How to Create Your Ideal Life in 2023

6. Embrace.

Embrace with grace all that you face.

7. Be soft.

Be soft, fluid and yielding – just like water is, and let your softness overcome all that is rigid and hard.

8. Trust.

Trust your inner wisdom more than the wisdom of the world.

9. Treasure the moment.

Treasure the moment. Don’t let it pass by you unnoticed.

10. Be of good cheer.

Be of good cheer, there is always another way.

11. Where there is no love, pour love.

Follow the advice of St. John of the Cross, and

“Where there is no love, put love — and you will find love.”

12. Give thanks for all things.

Give thanks for every experience and every interaction life sends your way, no matter if good or bad because, and allow the passing of time to make you Better, not Bitter.

13. Speak from the heart.

Speak with love. Speak from the heart. Speak in such a way that people love to listen to you.

14. Work with love.

15 New Year’s Resolutions for Greater Peace and Serenity Happiness: Letters from Your Soul On Happiness 7 Ways to Make Every Day the Best Day of Your Life and Change Your Life 7 Precious Gifts Every Parent Should Offer Their Child The Importance of Self Love and How to Cultivate it

Whatever you do in life, work at it with all your heart. Work at it with love, passion, and dedication, “… as working for the Lord, not for human masters.” ~ (NIV) Colossians 3:23

15. Seek to become all that life created you to become.

Seek to become all that life created you to be.

“Be who God meant you to be and you will set the world on fire.” ~ St. Catherine of Siena

And these are the 15 New Year’s Resolutions every person should have on their list. Enjoy and Happy New Year! May 2023 and the new decade bring you all your heart and soul desire. And may you receive it all with grace and gratitude.

Getting More Daylight Could Mean Better Sleep at Night

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Falling asleep later and waking up later this time of year? It could be you need to reset your sleep/wake clock. Going outside to get more daylight exposure – especially during the morning – might help, new evidence suggests. 

Yes, the use of electric lights and screens in the evening can mess with your sleep, but that’s not the whole picture, says Horacio de la Iglesia, PhD, a professor of biology at the University of Washington in Seattle. In fact, daylight is considerably brighter, even on an overcast day, compared to indoor lighting. So they’re not the same. 

In a study of 507 college students at the University of Washington, shorter daylight hours pushed sleep time about a half-hour later in the wintertime, compared to the other times of year. 

“It is important for a couple of reasons,” de la Iglesia says. 

First of all, teenagers and young adults tend to have very late sleep timing, “or a late chronotype as we call it, that is predictive of physical and mental health. Also, if you have a late chronotype, it probably means you struggle to get out of bed, you end up sleeping less, and you also increase what we call ‘social jet lag.’”

Social jet lag is the difference in sleep timing between the weekend and weekdays, “and that also is predictive of poor health,” de la Iglesia says. 

‘An Easy Fix’

Poor sleep can be costly in more than one way. Researchers in 2021 estimated that sleep disorders cost nearly $95 billion each year to diagnose and treat in the United States. 

“People are investing a lot of money in trying to develop drugs that improve your sleep, that lengthen your sleep, that advance your clock,” de la Iglesia says.  But a simple action like taking a brisk walk in the morning, for example, can help adjust your sleep clock, “and it will make you feel better. That’s what we like about it – that it’s an easy fix,” he says. “Even if you can get out for short amounts of time, that should help you advance your clock … and help you cope with the winter blues.” 

The study was in college students, but the findings could apply to people of other ages, de la Iglesia says. For example, younger teenagers also could gain from getting more daylight. 

“And older adults struggle with the winter here, with trying to get out of bed, and I think this should definitely translate to all ages.”

The students wore automatic data loggers around their wrists to measure activity and light exposure. Outdoor light was defined as at least 50 lux in intensity. The researchers compared findings from all four seasons, including the summer session at the university. 

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The study was published online in November in the Journal of Pineal Research. 

If it seems to make more sense that a later sunset in summertime would mean a later bedtime, you’re not alone.

“Although we had a good reason to think that sleep would change seasonally, we didn’t have any clear prediction on which direction it will change,” de la Iglesia says. “And in fact, the prediction that we had was completely wrong.”

Students fell asleep 35 minutes later and woke up 27 minutes later than students during the summer school days. 

The researchers did not find any significant differences in sleep duration by season. But students used an alarm to wake up about 10% more often in the fall and winter, compared to the spring and summer. 

Multiple Health Effects Possible

“My take is that sunlight exposure seems to have more effect than artificial light exposure – which goes along with what we know,” says Karin Johnson, MD, the medical director of the Baystate Regional Sleep Medicine Program in Springfield, MA, who was not involved with the study. 

“In addition to sleep loss, the misalignment of the social schedule with the body’s schedule on its own, even if average sleep duration is the same, affects health,” she says. “This effect helps explain why making daylight savings time permanent in the winter would likely be exponentially worse than how much it affects us in the summer.”

A later midpoint of sleep – defined as the halfway point in clock time between falling asleep and waking up – evening chronotype, and more social jet lag are “strongly associated with many health problems,” Johnson says. Metabolic syndrome and obesity, cardiovascular issues, depression, anxiety, and poorer performance and thinking skills are examples.

Latitude Adjustment

Going forward, de la Iglesia and colleagues would like to expand the study to other locations. 

They plan to work with collaborators in San Diego, which is at a lower latitude and does not have the same shifts in daylight. That could help answer the question of what happens on other school campuses where the shift in seasons is not as strong.

“Maybe this is an issue of northern latitudes,” de la Iglesia says.

Insomnia: The Latest Research

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If you have trouble falling asleep or staying asleep, you may have insomnia, the most common sleep disorder. Between 10% and 30% of adults have chronic insomnia, and many more deal with it from time to time. Here’s a look at some of the latest research on this condition, its causes, and treatments that may help.

Insomnia Medications

A new type of drug is giving doctors another option when it comes to prescription medication to treat insomnia.

Orexin receptor antagonists. Some of the latest sleep medications are known as orexin inhibitors. They block the action of a brain chemical that keeps you alert, called orexin. Two of these drugs include:

  • Lemborexant (Dayvigo)
  • Suvorexant (Belsomra)

Scientists are studying two other similar drugs in clinical trials.

All sleeping pills come with risks and side effects. With some, you can develop a tolerance, which means it stops working effectively at the recommended dosage, or even feel like you can’t fall asleep without them. Some can cause you to walk, eat, or even drive in your sleep. Most can leave you feeling groggy the next day. Doctors usually only prescribe them for the short-term, and you have to stop using them gradually.

Melatonin. Your body makes this hormone as the sun goes down, telling you it’s time to get sleepy. A prescription form of melatonin helps you fall asleep by acting like melatonin in your brain.

Melatonin supplements are often sold as a treatment for insomnia. But both the American Academy of Sleep Medicine (AASM) and the American Academy of Physicians don’t recommend it, saying there isn’t enough evidence it actually works.

It’s also hard to know what you’re getting when you buy supplements. A 2017 analysis of dozens of supplements found that more than 70% of the time, the amount of melatonin in the product didn’t match what was on the label.

Nondrug Insomnia Therapies

Your doctor probably won’t prescribe a sleeping pill until you’ve tried other treatments. Scientists are studying nondrug therapies that can help insomnia, but cognitive behavioral therapy is one option sleep experts often recommend first.

CBT-I. The AASM put out new guidelines in early 2021 strongly recommending cognitive behavioral therapy for insomnia (CBT-I). When you do CBT-I, you meet with a therapist to learn how to change thoughts and behaviors that may be keeping you from getting a good night’s sleep. It involves several techniques that you may try one at a time or in combination.

  • Cognitive restructuring. The therapist will help you identify and change unhelpful thoughts and feelings that may be affecting your sleep, like anxiety about insomnia or unrealistic expectations.
  • Stimulus control. This means setting up a sleep environment with no distractions, going to bed and getting up at the same time every day, and leaving the bedroom, rather than tossing and turning, when you can’t get to sleep.
  • Sleep restriction. You’ll record the amount of time you spend sleeping with a sleep diary, then start staying in bed for only that amount of time plus 30 minutes. You’ll probably get less sleep at first. But the idea is to make yourself tired enough to get solid sleep, then gradually increase your time in bed.
  • Relaxation training. Your therapist can teach you relaxation techniques like breathing exercises and meditation that may help calm your mind.
  • Sleep hygiene. This includes a range of habits that promote good sleep, like getting exercise, cutting out late-night eating, alcohol and caffeine, and keeping your bedroom cool, dark, and quiet.

Therapists have traditionally provided CBT-I face-to-face. But throughout the COVID-19 pandemic, doctors have been working on alternatives to in-person sessions that appear to get good results.

Two recent studies showed that CBT-I conducted over the phone or through a video link is just as effective as face-to-face therapy. In 2020, the FDA approved an app that delivers CBT-I by prescription. Research into the app and web-based therapy programs has found that so-called digital CBT-I does help relieve insomnia.

Light therapy. Sunlight helps control your body’s sleep/wake cycle by regulating the sleep hormone melatonin. When that cycle is thrown off, artificial light that mimics sunlight can help, a practice called light therapy. You sit in front of a special box that puts out an intense light at the specific time of day and for the length of time your doctor prescribes. Research has found it’s particularly helpful with resetting your body clock if you work odd hours, like a night shift, or have jet lag. But it can also relieve insomnia.

Acupuncture. A large number of studies have looked at whether acupuncture may be an effective treatment for insomnia. Two reviews of the research published in 2021 found that acupuncture does help people sleep longer and wake up less often.

Causes of Insomnia

Other research is examining why people have insomnia and what can make it worse. Among the factors under review:

  • Genetics. Scientists are looking at whether the likelihood of having insomnia is something you’re born with. They’ve identified specific areas in our genes that appear to play a role in insomnia symptoms.
  • Light pollution. Korean researchers may have found a link between city lights and insomnia. A 2018 study showed that the more artificial outdoor light people were exposed to at night, the more likely they were to use sleeping medication.
  • COVID-19 pandemic. An AASM survey from March of 2021 found that more than half of American adults reported sleep problems, including insomnia, since the pandemic began.

And there’s evidence the virus itself can cause you to lose sleep. A 2020 British study found 5% of people treated for COVID-19 had insomnia in the 6 months after their diagnosis.

Insomnia and Dementia

Other recent studies have looked at a possible link between insomnia and thinking and memory problems. Poor sleep could mean cognitive impairment later in life.

One 2021 study looked at people who reported having insomnia when they were younger, and then had issues with cognition years later. The people most likely to end up with thinking and memory problems were those who had sleep-onset insomnia, meaning their main symptom was trouble falling asleep. Other research published in 2020 found that people who have insomnia and sleep less than 6 hours a night had double the risk of cognitive impairment.