Can a diabetic have sweets during Diwali? Is dry wine safe to drink?

“Most patients of mine look for a cheat sheet during Diwali. They postpone their routine consultations for about three months, between the festive season and the new year, simply because they indulge knowingly and do not want to get caught. And inevitably in the new year, they seek advice and medication to roll back their sugar counts. The fact of the matter is this, there is no scope to err among diabetics. If you want to give in to your mithai cravings, then that has got to be done within the diet discipline that keeps your blood sugar levels in check,” says Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare.
HOW MUCH IS TOO MUCH? HOW SHOULD I SPACE OUT MY CONSUMPTION PATTERN?
Even the most compliant of patients have asked the doctor how much of mithai is good for them during Diwali in social situations. “Let me be very clear at the outset that the advisory applies to only those whose diabetes is well-controlled. There’s no room for indulgence among those who are poorly controlled. And no matter what kind of mithai you take, it is an additional sugar load and there will be a spike in sugar levels post-consumption. That’s a given. The idea is to be aware of that additional calorie load and manage other elements of your diet in such a manner that the total sugar load remains within limits,” he advises.
First, there has to be portion control. “All mithais are not of the same size. In fact, those made for festive occasions are bigger. I just had a jumbo-sized gulaab jamun delivered to my home as a gift. You have to discipline yourself to have just a small piece and not the whole sweet. Also, you must space out the consumption of your mithais, you cannot have them at will and arbitrarily, definitely not on the same day. Otherwise you can have sharp spikes,” says Dr Mithal.
The portion size depends on your overall carbohydrate intake. “What most people do not realise is that ghee is a double whammy. And most sweets are sinful not just because they have sugar, but because they are cooked in ghee. And once the mithai box has landed, you cannot be sure of the amount of ghee that has gone into the preparation of its contents. So if you are having a portion of sweets, please balance it out with your calorie intake from other food sources. For example, never team up sweets with poori/kachori for example. And certainly do not have them with high calorie meals but space out the timing,” he advises.
SOME MITHAIS ARE PROCESSED
Dr Mithal also has a word of caution for low-calorie or sugar-free sweets, prepared with substitutes. “The problem with low-sugar sweets from the shop is that one is never sure of a standardised food code. So you never know how they lower the calorie count. In fact, in such cases, the calorie count may be quite high because they are processed. Now processing involves layering food with additives and fats. Then they are prone to toxicity as they are wrapped in plastic cling films and one is not sure of how long ago they were packed in them,” says Dr Mithal.
HOW MUCH ALCOHOL CAN I TAKE?
Of course, with card parties and socialising, there is a fair bit of social drinking. In general, it is advisable for people with diabetes to avoid alcohol. This is particularly true for those whose diabetes is not well-controlled. Alcohol is a strict no-no for those with co-morbidities.
“An alcohol binge causes changes in behaviour and makes it harder to think clearly, leading to random, uncontrolled eating and unsafe activities. For people with diabetes, alcohol consumption does not usually raise blood sugar levels. However, alcohol has been shown to be associated with a short-term risk of developing low blood sugar (hypoglycemia) and long-term risk of damage to organs. The effect of alcohol on blood glucose levels differs depending on whether it is consumed with or without food. In the fasting state, the liver pours out stored glucose into the bloodstream and prevents blood glucose from plummeting to dangerous levels. When our liver is exposed to alcohol, it prefers to metabolise alcohol first and the release of glucose is hampered. If drinking alcohol is combined with the medications often used to treat diabetes—particularly insulin and sulfonylureas — it can lead to low blood glucose levels (<70mg/dl). This risk can last up to 24 hours after drinking alcohol. If you have had alcohol with dinner, it is advisable to check blood sugar before you sleep. If blood sugar is lower than 100 mg/dl, taking a small snack is advisable — a fruit, milk, or half a sandwich are good choices. Symptoms of low blood sugar can be confused with those of being in a drunken state, which can result in a low blood sugar reaction being missed with dangerous consequences.”
Like sweets, it is the amount of alcohol that matters. One alcohol unit is measured as 10 gm. This equals about 275 ml beer, 100 ml wine and 30 ml spirits (hard liquor). To find out how many units are there in a drink, check for the Alcohol Volume (ABV) on the label, which is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink. If the ABV is 12 per cent, it means 12 per cent of the volume of that drink is pure alcohol. “You can find out how many units there are in any drink multiplying the total volume of a drink (in ml) its ABV (measured as a percentage) and dividing the result 1,000. For example, if you have 500 ml of 5 per cent beer, you are taking 2.5 units of alcohol. Now, 30 ml of 40 per cent whisky will comprise 1.2 units of alcohol. Choose dry wines, light or low carb beers are preferable.”
But the problem lies in cocktails which are taken with juice or sugary cocktail mixes. “They will provide excessive calories. So watch what you are adding to the alcohol. Besides, Indians like to consume fried snacks with alcohol, which adds a huge burden of calories with unhealthy fats thrown in for good measure. Replace fried snacks with salads and roasted snacks like makhana, chana or egg white.”
The speed of drinking also matters. “It is best to restrict yourself to one drink per hour to allow the body to metabolise the alcohol. And no binge drinking please,” says Dr Mithal. And be it sweets or alcohol, one should always keep tabs on post-consumption sugar levels to avoid emergencies.
Perhaps, with diabetes assuming epidemic proportions in our country, it is time to revise our gifting culture that relies on a box of sweets as the minimum social grace. “In India, we should replace the idea of gifting sweets with a basket of fruits and nuts. These have their own calorie quotient but at least are still a lesser evil,” he adds.