Alcohol, Exercise & Delayed Hypos

Slurred speech, an unsteady walk, drowsiness, confusion or sudden combativeness all look like being drunk, and all look exactly like a hypo. The core rule is simple: if in doubt, treat as a hypo. Sugar will not harm someone who is merely drunk, but a missed hypo can kill. Never let someone with diabetes be put to bed to sleep it off, a low overnight after drinking is one of the most dangerous situations there is.

The liver clears alcohol before anything else, so it stops releasing its stored glucose. That means a hypo after drinking can come hours later, be deeper and last longer. It also means emergency glucagon may not work, or works far less well, because glucagon asks the liver to release glucose it isn't willing to release. If someone has been drinking and is unresponsive, fitting or can't swallow, call 000 straight away, don't wait to see if glucagon works.

Aerobic activity, running, swimming, football, a long walk, usually drops glucose fast during the session. Anaerobic effort, heavy weights, sprints, a hard competitive game, often pushes glucose up at first from adrenaline, which is reassuring but misleading: muscles refill their fuel stores for hours afterwards, so a hypo commonly arrives 6 to 12 hours later, often overnight. During activity, treat any suspected low with the Rule of 15: stop play, 15g fast-acting carbs, wait 15 minutes, re-test before returning.

After a big night out or a hard session, a snack with slower carbohydrate plus protein before bed, toast and peanut butter, cheese and crackers, milk and cereal, a yoghurt, gives a buffer through the night. Extra glucose checks before bed and, if anyone is worried, during the night are sensible. Make sure fast-acting carbs are within arm's reach of the bed, not in the kitchen.