Wil Dubois

Happy Saturday! Welcome to Ask D'Mine, our weekly advice column hosted by veteran type 1 and diabetes author and former clinical diabetes specialist Wil Dubois in New Mexico. 

This week, Wil is corresponding with a worried mom whose daughter is dating a young man in college who happens to have type 1, but isn't exactly taking great care of himself. It's a tricky situation, but Wil has some thoughts to share (of course!).

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Caroline, concerned mom from California, writes: I’m a nurse practitioner. My daughter met her current boyfriend in Greek life at university 18 months ago. I met him and learned he was newly diagnosed type 1 DM. Every time we went out he drinks pretty heavily. It troubled me but I thought OK, only on special occasions. Last New Year’s Eve he attended a party with us. He had 8 cocktails and then they went out drinking. I went home and cried. On New Years Day he was drinking again. They are living together in Seattle now a year later. I just visited them and he looks like a skeleton, so skinny, completely pale, ghostly white skin, and still drinking. My daughter is completely oblivious and says his diabetes is his issue. She has not one iota of a caregiver personality. I just keep saying to myself “not my patient, not my son” and I’ve said nothing. I don’t think it would help. Your articles, however, have helped me. He eats plates full of desserts (plural) when he drinks so... I guess no DKA yet. Honestly, it’s breaking my heart. Appreciate your candid articles and have used them with patients, I do end up helping with managing T1D until we can find endocrinology. Any thoughts?   

 

[email protected] D’Mine answers: Wow. Yipes. Whoever said that parenthood was easy didn’t have any children!

Thank you for your kind words. I was delighted to learn that you found my articles helpful with your patients. Speaking of patients, you said “not my patient, not my son.” I’d argue that’s only 50% correct. You’re right that he’s not your patient. But hey, this kid is cohabitating with your daughter. That makes him very much your son, regardless of what pieces of paper may be missing. As such, you have a mother-in-law’s butt-in license, just as if they were married, because even though he’s not directly your responsibility, his actions have a heavy impact on the person who is your absolute and sacred responsibility.

But that still leaves us with the very real issue of how to butt in effectively, without alienating your daughter. OK… Where to start? So he’s a heavy drinking frat boy, and that can bring some stereotypical worries along with real-life stories of situations gone bad. He’s not only a young male, but he’s a “young” type 1 as well, just recently dx’d. In addition to a taste for alcohol that shames even my merchant marine friends, he also has a sweet tooth.

In the biz we used to call this a "tuff nut to crack."

His health is declining but he doesn’t seem to care. Your daughter, even though she doesn’t have “one iota of caregiver personality” still must recognize that something is amiss with her beau, or she wouldn’t have to rationalize that his diabetes is the only issue.

Hmmmm… actually… she may be right.

OK, here’s my thinking. Let’s face it: Even extraordinarily heavy drinking like this kid is doing wouldn’t have that rapid of a health impact on a normal “healthy” young man. Sure, it will kill him in the long run, but we are still in the short-run here.

I’m not going to pull any punches -- there’s only one label for consuming 8 cocktails and then going out on the town for more: Binge drinking. And while the Centers for Disease Control (CDC) tells us that binge drinking is the most deadly pattern of excessive alcohol use in the U.S., the killing fields have more to do with vehicle crashes, falls, and violent encounters than a wasting illnesses. While theoretically he could die of alcohol poisoning, I suspect he’s successfully adapted to his current levels of consumption. So what gives with his declining health? I think your daughter is right. It’s his diabetes.

More precisely, it’s his diabetes combined with his frequent chronic binge drinking. If he were the normal Greek life party boy, he’d be OK for a few more years and hopefully grow the eff up before he met an untimely end. If he were just a newbie type 1 struggling with diabetes at the same time he was struggling with onset adulthood, he’d also be OK. But the combination of the two seems toxic.

To bolster my case here, you mentioned that he’s become so skinny he looks like a skeleton. Most alcohol abusers actually gain weight. Of course, we all know that high glucose—especially crazy high glucose—can lead to profound “runaway” weight loss.

OK. So now what? 

I’m thinking…

Oh, one thing I wanted to point out, as to not confuse other readers, was the eating deserts and DKA comment you made. While you are correct that heavy alcohol consumption can trigger ketoacidosis, even in non-D folk, I’m more worried about the opposite problem. His risk with binge drinking is actually greater on the low end of the blood sugar spectrum. Heavy alcohol consumption can cause profoundly low blood sugars, often many hours downstream. While the liver is busy trying to clear out the alcohol it isn’t clearing out excess insulin and it can’t release glucose. To make matters worse, alcohol—even in moderate amounts—causes hypoglycemia unawareness. His sweet tooth is likely the only thing that’s kept him hypo-seizure free.

So where does all of this leave us?

I’m still thinking…

OK. I’m a great believer in slow and steady change. And I’m thinking that controlling diabetes and dealing with problem drinking at the same time is too high a hurdle for a spoiled juvenile frat boy who’s a recent inductee into the diabetes hall of fame. My suggestion is that you run with the ball your daughter tossed you. Fix the diabetes control first. I think it’s more doable, and it’s probably the greater health threat in the short-term. Although in the long-term there’s not only the corrosive effects of alcohol abuse to worry about but there’s evidence that long-term heavy drinking can serve as a diabetes complication accelerator, leading to earlier and more aggressive onset of the whole range of diabetic complications.

Still. One hurdle at a time. Better to get to our goal slowly than not at all.

So how do you get his diabetes controlled? Easy. Well, easier than reversing binge drinking, anyway. When your daughter says his whole problem is his diabetes, agree with her. Tell her, you know what? I think you are absolutely right. It is his problem, but we can all work together to figure out how to fix it. Then work your contacts to find the best endo out there in Seattle. Find an open-minded CDE who has experience with young males (that will be harder than finding the endo). Find a support group. Get him good gear, including a CGM at a minimum. Get both daughter and frat boy to understand that type 1 is a team sport.

Once his diabetes starts getting in better control you’ll need to first work on safe drinking with diabetes, and hopefully, in the long run, a switch to more moderate levels of drinking. Like my merchant marine friends.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.