Alcohol: the one that gets people at 3 a.m.

Alcohol is, statistically, the substance most people with type 1 will meet first — so it deserves the same weight as anything illegal. This page explains why the risk from drinking shows up hours after the last drink, why it's so easy to miss, and what to do if you drink.

Your liver can only do one job at a time

Your liver has two jobs here: clearing alcohol out, and releasing glucose when you're running low. It will not do the second one while it's busy with the first.

So the hypo doesn't usually arrive while you're drinking. It arrives hours later — in bed, asleep.

Drunk and hypo look the same

Being drunk and being hypo look identical from the outside: slurring, stumbling, confusion, drowsiness. That's the whole danger. The people around you may put you to bed to "sleep it off" when what you actually need is sugar. And with alcohol on board, you may not notice the signs yourself either.

If you drink

• Eat carbs while you drink — not instead of dinner.
• Never skip your long-acting insulin. Skipping it to "avoid a low" swaps one risk for another, and pushes you toward ketones.
• Eat something before bed.
• Set an alarm and actually check overnight. The time you most need to check is the time you're least likely to wake up for it on your own.
• Tell whoever you're staying with that you have type 1, and what a hypo looks like.

How much to adjust your insulin around drinking is a conversation to have with your diabetes team. They have heard it all before, and their job is to keep you safe around whatever you're actually doing.

Alcohol with other things

Alcohol often isn't alone. Two drugs together, or any drug with alcohol, interact in ways nobody can predict for you — see Staying safer for why mixing multiplies rather than adds, and the seven things to do if you're going to anyway.

And because being drunk and being hypo look the same, the people you're out with are part of your safety plan. Share What your friends should know with them.